Effects of multi-domain intervention on intrinsic capacity in older adults: A systematic review of randomized controlled trials (RCTs)

Impact of a multicomponent physical exercise program on intrinsic capacity in community-dwelling older adults

Introduction

In 2015, the World Health Organization introduced intrinsic capacity, a health indicator encompassing five domains aimed at promoting healthy aging. Multicomponent exercise programs are recommended to maintain and optimize intrinsic capacity; however, evidence on their effects in robust older adults is limited. This study aimed to evaluate the effects of a multicomponent exercise program on intrinsic capacity in older adults.

Methods

Older adults (≥60 years) enrolled in a multicomponent training program in Porto Alegre (RS) were evaluated for intrinsic capacity using specific tests for each domain. The total score, ranging from 0 to 10 points, was obtained by summing the scores of the five domains. Participants underwent a 12-week multicomponent exercise intervention and were reassessed.

Results

After the 12-week intervention, the composite intrinsic capacity score significantly increased. Significant improvements were found in the cognitive, vitality and locomotion domains. The practice of Chinese curative gymnastics contributed to a one-point increase in the composite intrinsic capacity score. No association was found between frequency, duration of training, or the number of exercise modalities and the composite intrinsic capacity score.

Conclusion

The multicomponent exercise program positively influenced composite intrinsic capacity, with notable improvements in vitality, cognition, and mobility. Personalization and individualization of training, combined with health education and social integration, were crucial in promoting healthy aging in the studied sample.

Adopting a complex systems approach to functional ageing: bridging the gap between gerontological theory and empirical research

Functional ageing, related to but distinct from biological and environmental systems, is defined as the changes in physical, psychological, cognitive, and social functioning, as well as behavioural factors of individuals as they age. In this Personal View, we propose that a complex systems perspective to functional ageing can show how outcomes such as quality of life and longevity, and success in prevention and treatment, emerge from dynamic interactions among these domains, rather than from single causes. We support this view in three ways. First, we explain how three key principles of complex systems science-namely, resilience, non-linearity, and heterogeneity-apply to functional ageing. Second, we show how established gerontological theories and geriatric models align with these principles. Third, we illustrate the use of novel methodological tools available from complex systems science for studying functional ageing. Finally, we offer a glossary of key concepts and recommendations for researchers to adopt this perspective in future studies on functional ageing.

Nurses' Perception of Their Role in Leading Nurse-Led Interventions in Intrinsic Capacity Assessment to Improve Nursing Care of Older Adults

AIM

To explore nurses' perceptions of their role in leading nursing interventions for each domain of intrinsic capacity, based on the Integrated Care for Older People (ICOPE) framework to enhance care for older adults in acute settings.

DESIGN

A qualitative descriptive design was adopted.

METHODS

Conducted in a Singapore acute hospital from August to November 2023, recruited 21 inpatient nurses with at least 2 years of experience through purposive sampling. Data were collected via semi-structured interviews with 20 participants and one pilot participant. Inductive thematic analysis identified themes from the responses.

RESULTS

Four key themes emerged regarding nurses' roles in implementing the ICOPE framework: (1) Creating Awareness: emphasises communication to enhance understanding of ICOPE; (2) Providing Education: highlights structured educational initiatives; (3) Executing ICOPE: recognises nurses' role in interventions amid autonomy and workload challenges; and (4) Gathering Feedback: ensuring continuous input to enhance care quality.

CONCLUSION

The findings emphasise nurses' roles within the ICOPE framework, advocating for empowerment and collaboration to enhance care quality for older adults in acute settings.

IMPLICATIONS

This study highlights the need for nurses to understand their roles and independently lead nurse-led interventions. Healthcare institutions should facilitate this empowerment by reviewing existing nursing assessments to avoid duplication and optimise nurses' integration into the framework.

IMPACT

This study demonstrates the feasibility of the ICOPE framework in Singapore, empowering nurses to initiate interventions that enhance older adults' care and intrinsic capacity.

REPORTING METHOD

Adheres to the COREQ guidelines for qualitative research.

PATIENT OR PUBLIC CONTRIBUTION

None.

Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales

OBJECTIVE

Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults.

DESIGN

Cohort study.

SETTING AND PARTICIPANTS

A total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study.

METHODS

We derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0-8; IC2-Liu 2021, range: 0-4; IC3-ICOPE, range: 0-4; IC4-modified ICOPE, range: 0-8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty.

RESULTS

Among 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55-11.96; OR, 5.00; 95% CI, 1.75-14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45-12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18-0.19, P < .05).

CONCLUSIONS AND IMPLICATIONS

Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.

Prevalence of intrinsic capacity decline among community-dwelling older adults: a systematic review and meta-analysis

BACKGROUND

The concept of intrinsic capacity (IC) was introduced to define healthy aging and active aging based on functional capacity, yet there is limited understanding of the risk of IC decline at a population level.

AIMS

To consolidate existing evidence for rates of IC decline and risk factors among community-dwelling adults 60 years or older.

METHODS

According to the PRISMA guidelines, the literature search was independently conducted by two researchers in 8 databases from inception to January 2024 without language restrictions using combinations of free words and subject words. Qualities of included studies were assessed using Joanna Briggs Institute's (JBI's) critical appraisal checklist for prevalence studies. To pool the data, a random-effect meta-analysis was performed, followed by subgroup analysis and sensitivity analysis. All analyses were performed by Stata14.0.

RESULTS

From 1594 records, 15 studies were extracted with 33,070 participants for meta-analysis. The pooled prevalence of IC decline in community settings was 67.8% (95% CI: 57.0-78.5%; P < 0.001). The prevalence of IC decline in China (66.0%; 95% CI: 53.2-78.9%) was found to be slightly lower than in other countries/regions (73.0%; 95% CI: 59.8-86.3%); however, this difference was not statistically significant. Other subgroup analyses revealed no statistically significant differences in prevalence. Age, hypertension, diabetes, gender, education level, living status, smoking, regular exercise, marital status, and osteoarthritis are associated with IC decline.

CONCLUSION

More than two-thirds of older adults in the community are affected by IC decline, and age, hypertension, diabetes, female sex, low education level, living alone, smoking, irregular exercise, unmarried, and osteoarthritis are all risk factors for IC decline.

The Global Research Trends on Intrinsic Capacity of Older Adults: A Bibliometric and Visual Analysis of Papers Published During 2015-2023

Objective

The concept of intrinsic capacity (IC) revolves around healthy aging and active aging. Since the Introduction of the concept by the World Health Organization in 2015, a series of studies have been conducted by scholars from multiple fields. However, no bibliometric analysis has systematically investigated this issue. We aim to identify the current landscape and frontier trends of scientific achievements on IC in older adults through bibliometric approaches.

Methods

Quantitative analysis of publications relating to IC in older adults from 2015 to 2023 was interpreted and graphed through the Web of Science Core Collection database on December 5, 2023. A variety of quantitative variables was analyzed, including publication and citation counts, H-index, and journal citation reports. Co-authorship, citation, co-citation, and co-occurrence analyses were performed for countries/regions, institutions, authors, and keywords using the VOSviewer and CiteSpace.

Results

A total of 952 original and review articles in English were identified. The European countries possessed an absolute advantage in this field. The most contributive institution was the University of São Paulo. The most productive author is Cesari Matteo from France, followed by Qaisar Rizwan from the United Arab Emirates. However, a relatively low level of research cooperation existed between institutions and authors. Important topics mainly include the connotations, theoretical framework models, evaluation, screening tools, and application scenarios of IC. Among the promising hotspots, "biological aging", "ICOPE", "Covid-19", "prevention", "inflammation", "caf22", "prevalence", and "randomized controlled trial" displayed relatively latest average appearing year.

Conclusion

Global trends indicate a growing scientific output on IC in older adults, and developed countries are leading the way. There is still room for improvement in research team collaboration. The focus gradually shifts from theoretical research to empirical research. It is recommended to pay attention to the latest hot spots, such as "biological aging", "ICOPE implementation", "post-COVID-19 syndrome", and "biomarkers".

Effect of Exercise Programs on Physical Performance in Community-Dwelling Older Adults with and without Frailty: Systematic Review and Meta-Analysis

BACKGROUND

The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty.

AIM

To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community.

METHOD

A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect.

RESULT

We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05].

CONCLUSION

Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.

Moving towards the ICOPE Approach: Evaluation of Community-Based Intervention Activities on Improving Intrinsic Capacity

OBJECTIVES

Different types of community-based intervention activities may have differential effects in improving the intrinsic capacity (IC) of older people. This study aims to (i) identify subgroups of older people based on their IC impairments, (ii) examine the differential associations between different types of activity participations and change in IC across subgroups, and (iii) assess whether the activity participation patterns of older people align with the way that would benefit them the most.

METHODS

Participants were community-dwelling older people aged 60 years or above. They were screened for IC impairments at baseline, and their participation records of different types (cognitive, physical, nutritional, mental, and social) of intervention activities were collected for one year. An aggregated IC score was created based on four IC domains including cognitive (self-rated memory), locomotor (self-rated difficulties in walking), vitality (self-rated weight loss), and psychological (subjective well-being). Cluster analysis was used to group homogenous participants. Mixed-effects regression was used to examine the associations between activity counts (i.e., number of sessions participated) and change in IC. Activity participation patterns were also compared across subgroups.

RESULTS

Data were obtained from 7,357 participants (mean age = 74.72 years). Four clusters were identified, including those who were relatively robust (cluster 1, N = 4,380, 59.5%), those who had cognitive decline (cluster 2, N = 2,134, 29.0%), those who had impaired mobility and vitality (cluster 3, N = 319, 4.3%), and those with poor psychological well-being (cluster 4, N = 524, 7.1%). Overall, activity count was associated with IC improvement (β = 0.073, 95% CI [0.037, 0.108]). However, as regards the cluster-specific results, different types of activities were associated with IC improvement for different specific clusters. For instance, cognitive activity count was associated with IC improvement only for cluster 2 (β = 0.491, 95% CI [0.258, 0.732]). Notably, none of the activity types were associated with IC improvement for cluster 1. Regarding the activity participation patterns, there were no significant differences across the four clusters (Wilk's Λ = 0.997, F = 1.400, p = .138).

CONCLUSIONS AND IMPLICATIONS

IC improvement depended on the activity types and IC status of older people. In view of this, a people-centred and targeted approach should be adopted to maximize the overall benefits of intervention activities.