Measurements of Intrinsic Capacity in Older Adults: A Scoping Review and Quality Assessment

Trajectories of intrinsic capacity decline and related factors in old persons: A 15-year community-based cohort study in Beijing

BACKGROUND

Intrinsic capacity (IC) is vital to the World Health Organization's healthy ageing framework. This study aims to develop an IC assessment model, and identify its longitudinal trajectories and related factors in old persons.

METHODS

This was a 15-year three-wave prospective cohort study of the 10/66 dementia series researches in Beijing, China. Totally 2 156 community-dwelling old persons aged 65 years and over were included at baseline to develop an IC assessment model, with 474 completing follow-up surveys for IC trajectory identification. IC was assessed using 11 items of the five domains and bifactor-multidimensional item response theory model. The group-based trajectory model and multivariate logistic regression model were employed to identify longitudinal trajectories and related factors of IC.

RESULTS

Three IC trajectories were identified as low baseline IC with rapid descending trajectory (11.39%), medium baseline IC with moderate descending trajectory (75.53%), and high baseline IC with slight descending trajectory (13.08%). Compared to the "slight descending trajectory", aged 75 years and over (aOR: 9.48), female (aOR: 4.75), and unmarried/non-cohabiting (aOR: 4.73) were positively associated with the "rapid descending trajectory". Completed secondary school/higher education (aOR: 0.08; aOR: 0.27), more vegetables/fruits intake (aOR: 0.91; aOR: 0.94), and private restricted support network (aOR: 0.17; aOR: 0.37) were negatively associated with the "rapid descending trajectory" and "moderate descending trajectory".

CONCLUSIONS

Community-dwelling old persons in Beijing exhibit three IC trajectories, with the majority showing moderate descending trajectory. Interventions should address gender or education inequities and modifiable factors like diet and social support to mitigate IC decline.

Sarcopenia and intrinsic capacity in older adults: A systematic review

INTRODUCTION

Sarcopenia and intrinsic capacity are closely linked factors that impact the health and functional aging of older adults.

OBJECTIVE

This systematic review aims to investigate the associations between the domains of IC and sarcopenia in older adults.

MATERIAL AND METHODS

The study follows PRISMA guidelines and is registered on PROSPERO. The review included original studies (cohort, cross-sectional, or randomized controlled trials) with participants aged 60+ diagnosed with sarcopenia (based on EWGSOP or other recognized definitions). Intrinsic capacity (IC) was assessed based on the five domains defined within the IC framework-cognition, locomotion, sensory, psychological, and vitality. The Integrated Care for Older People (ICOPE) approach developed by the World Health Organization supports the optimization of IC and functional ability through person-centred and coordinated care. Exclusion criteria included studies with insufficient data on sarcopenia prevalence and IC scores, as well as reviews or studies unrelated to sarcopenia or IC.

RESULTS

A total of 397 articles were identified, with 5 meeting the inclusion criteria. These studies, involving 6651 participants aged 60 to 82 years (54.8 % male, 45.2 % female), examined the association between sarcopenia and intrinsic capacity in older adults, using the diagnostic criteria for sarcopenia proposed by the EWGSOP and assessing IC based on its key components. Despite the limited number of studies, the findings suggest a significant link between declining intrinsic capacity and sarcopenia.

FINAL CONSIDERATIONS

These results underscore the importance of a multifactorial approach in assessing and managing sarcopenia, which may improve early detection and support healthy aging.

Knowledge, attitudes, and practices regarding intrinsic capacity in the elderly population: A cross-sectional study in Shanghai, China

To investigate the knowledge, attitudes, and practices (KAP) of the elderly population regarding their intrinsic capacity, as defined by the World Health Organization as a marker of healthy aging. A cross-sectional study was conducted at the Shanghai Traditional Chinese Medicine Hospital from July to November 2023. Participants' socio-demographic information and KAP scores were collected through a self-designed questionnaire. A total of 507 elderly individuals participated, with 53.25% being male and a mean age of 70.76 ± 7.63 years. The mean knowledge, attitude, and practice scores were 19.58 ± 8.85, 30.07 ± 4.81, and 34.71 ± 7.77, respectively. Pearson's correlation analysis showed significant positive correlations among the KAP scores (all P < 0.001). Multivariate logistic regression indicated that knowledge scores (OR = 1.127, P < 0.001), attitude scores (OR = 1.189, P < 0.001), and current employment status (OR = 2.759, P = 0.009) were associated with proactive practices. Structural equation modeling demonstrated that knowledge had a direct influence on attitude (β = 0.572, P < 0.001) and practice (β = 0.776, P < 0.001), while attitude directly impacted practice (β = 0.412, P < 0.001). The study reveals that the elderly lack knowledge but have positive attitudes and proactive behaviors about intrinsic capacity. Enhancing education and attitudes is vital for healthy aging and well-being.

Intrinsic Capacity Trajectories: Implications for Subsequent Falls and Hospitalizations Among Older Adults

BACKGROUND

Intrinsic capacity (IC) is the composite of an individual's physical and mental capacities. However, the association between IC trajectories and falls and hospitalizations remains uncertain. This study aimed to determine the IC trajectories among older adults, investigating its association with subsequent risk of falls and hospitalizations.

METHODS

This study enrolled 3 902 older adults aged ≥65 from the National Health and Aging Trends Study (Wave 2015-2019). A bifactor model was used for repeated measurements of the 5 IC domains to generate IC scores for 4 time points (Wave 2015-2018). IC trajectories were identified using group-based trajectory modeling, and modified Poisson regression was used to analyze the associations between IC trajectories and subsequent fall and hospitalization risk.

RESULTS

The mean age of the participants was 76.70 years (standard deviation = 6.78), and the majority were female (57.3%). Three IC trajectories were identified, including persistently low (17.86%), persistently moderate (33.96%), and persistently high (48.18%). Compared with the persistently low class, the moderate and high classes have significantly lower fall and hospitalization risks. Multivariate-adjusted rate ratios fall occurrence were 0.87 (95% confidence interval [CI]: 0.78-0.98) and 0.74 (95% CI: 0.65-0.85), for multiple falls were 0.81 (95% CI: 0.68-0.96) and 0.52 (95% CI: 0.41-0.66), for hospitalization occurrence were 0.76 (95% CI: 0.66-0.87) and 0.48 (95% CI: 0.39-0.58), and for multiple hospitalizations were 0.65 (95% CI: 0.53-0.80) and 0.37 (95% CI: 0.28-0.48), respectively.

CONCLUSIONS

IC trajectories were associated with falls and hospitalizations. Strategies focusing on improving and maintaining IC at a higher level over time could help reduce the subsequent risk of falls and hospitalizations.

Intrinsic capacity and loneliness, according to sex, in an upper-middle income country: insights from the ELSI-Brazil cohort

OBJECTIVES

To investigate the association between loneliness and intrinsic capacity, a multidimensional indicator of healthy ageing, in Brazilians aged ≥50 years.

METHOD

This cross-sectional study used baseline data from 7,123 participants of the nationally representative Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-2016). Intrinsic capacity (IC) (sensory, mobility, psychological, cognitive, and vitality), was determined using a validated composite z-score (higher scores = better capacity). Loneliness comprised a single-item. Quantile regression models were stratified by sex after adjusting for sociodemographic, and health characteristics.

RESULTS

The median IC were lower in women than in men (-0.54 vs. 0.69, respectively). Loneliness was related to lower IC composite z-scores in both sexes, demonstrating stronger associations at lower quantiles. The IC composite z-score decreased in those experiencing severe loneliness, both in women (quantile 0.75: β = -0.39; 95% CI = -0.47 to -0.31) and men (β = -0.36; 95% CI = -0.54 to -0.17). However, mild loneliness was associated with worse IC among men only at quantile 0.25 (β = -0.12; 95% CI = -0.23 to -0.01), different from women.

CONCLUSION

Loneliness was associated with worse IC. Cross-sectional design limits causal inference, but supports that community engagement, social support, and accessible environments are crucial for promoting healthy ageing in both sexes.

Comparison of robustness, resilience and intrinsic capacity including prediction of long-term adverse health outcomes: The KORA-Age study

BACKGROUND

Frailty, resilience and intrinsic capacity (IC) are concepts to evaluate older person`s health status, but no comparison of their associations with adverse health outcomes exists. We therefore aimed to assess which concept is most useful for determining long-term health of older adults.

METHODS

Analyses were based on the KORA (Cooperative Health Research in the Region of Augsburg)-Age study (n = 940, 65-93 years). Frailty was evaluated using the physical frailty-phenotype by Fried et al. For comparability to resilience and IC, we chose the protective concept of robustness instead of frailty in the present analysis. Resilience was measured by the 11-item resilience-scale. The IC-score was based on 4 domains (locomotion, cognition, vitality and psychiatric capacities). Associations with falls, disability, and hospitalization at 3-year and 7-year follow-up and with mortality were evaluated by multivariable adjusted logistic and Cox regression. Concept overlaps were illustrated by a Venn-diagram.

RESULTS

In the fully adjusted models, robustness showed significant inverse associations with most outcomes (3-year follow-up: OR (95%CI): disability 0.448 (0.300-0.668), 7-year follow-up: falls 0.477 (0.298-0.764), hospitalization 0.547 (0.349-0.856), and all-cause mortality 0.649 (0.460-0.915)) while resilience and IC showed significant inverse associations with disability only (e.g., 7-year-follow-up: resilience: 0.467 (0.304-0.716), IC: 0.510 (0.329-0.793)). 23% of the participants met the criteria for both robustness and IC while 22% met those for robustness and resilience.

CONCLUSION

Robustness was the most useful concept, showing the strongest protective associations for most adverse health outcomes. IC and resilience showed their main strengths in capturing protective associations for disabilities. Robustness overlapped with resilience and IC, supporting the concept of mind-body-interaction.

Assessing intrinsic capacity for person-centred HIV care: a cross-sectional study in ageing populations in Malaysia and Hong Kong

INTRODUCTION

WHO's Integrated Care for Older People (ICOPE) proposes we measure the functional construct of intrinsic capacity (IC) to monitor and identify individuals with age-associated vulnerabilities. Assessments of IC may be useful to address the evolving, non-HV care needs of ageing people with HIV (PWH). However, to date, its utility within the context of HIV has not been assessed.

METHODS

Participants included 200 PWH attending out-patient care (2021-2023) in Universiti Malaya Medical Centre, Malaysia and 101 community controls aged 35 years and above. The ICOPE framework was adapted to derive aggregate IC scores (ranging 0-6) encompassing the five domains of cognition, sensory (hearing and vision), mobility, mood and vitality. Multivariable analyses were used to explore the association of IC scores in PWH with multiple health outcomes including frailty, difficulties performing instrumental activities of daily living (IADL) and inflammatory markers. Area under the receiver operator characteristic (AUC-ROC) was calculated to predict frailty and IADL deficits in the current cohort and an independent cohort of 275 PWH from Hong Kong (HK).

RESULTS

Median (interquartile range, IQR) age among PWH and controls were 50 (42-56) and 50 (39-59) years, respectively. There were more males among PWH (83% vs. 56%, p<0.001). All PWH received antiretroviral therapy (ART) for a median duration of 11 (8-14) years. Aggregate IC scores were lower in PWH but not significantly different compared to controls, (5.4 vs. 5.6, p = 0.093) and PWH performed significantly worse than controls only in the cognitive domain. Aggregate IC scores in PWH was independently associated with frailty (OR 0.17 95% CI 0.07-0.42, p<0.001), IADL deficits (OR 0.25 95% CI 0.14-0.46, p<0.001) and all other patient-reported outcomes assessed. Aggregate IC scores correlated with IL-6 but not sCD14 and sCD163 levels. IC scores performed well in identifying PWH with frailty (AUC-ROC ≥ 0.80) in the HK and Malaysian cohorts but more modestly (AUC-ROC ≥ 0.64) for IADL deficits.

CONCLUSIONS

IC is a good composite measure to monitor non-HIV, age-associated physical and social vulnerabilities in PWH on ART and should complement disease-based monitoring in routine HIV care. Assessments of IC should be validated in larger, longitudinal cohorts of PWH from diverse settings.

Understanding the well-being of residents in Chinese Continuing Care Retirement Communities-a case of Shanghai

Introduction

China is one of the world's fastest-aging countries. Continuing Care Retirement Communities (CCRCs) have emerged as a viable option for accommodating and serving older adults. However, Chinese CCRCs are still in the early stages, and comprehensive research on resident well-being is still deficient. The study aims to assess how well residents in CCRCs are faring in terms of their psychological and physical health, considering China's aging population and changing societal structures.

Methods

After a thorough literature review to pinpoint relevant well-being measures in psychological and physical health, the study implemented a survey to capture residents' experiences and perceptions, and subsequently analyzed how well-being correlates with demographic characteristics.

Results and discussion

The results show that while Chinese CCRCs can enhance residents' well-being through personalized care and social activities, challenges such as psychological distress and declining physical health remain. Demographic factors, including living situation and length of stay, also affect residents' well-being. The study emphasizes the importance of ongoing research and evaluation to guide evidence-based practices and improve CCRCs continuously. Overall, it offers a comprehensive analysis of the wellbeing of Chinese CCRCs residents, shedding light on both psychological and physical health aspects and providing valuable insights for enhancing CCRCs design, implementation, and evaluation in China and elsewhere.

Intrinsic capacity transitions predict overall and cause-specific mortality, incident disability, and healthcare utilization

OBJECTIVES

To develop an intrinsic capacity (IC) score and to investigate the association between IC transition with overall and cause-specific mortality, incident disability and healthcare utilization.

DESIGN

Retrospective cohort study SETTING AND PARTICIPANTS: Data from 1852 respondents aged ≥ 65 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed.

MEASUREMENTS

Transitions of IC score were categorized into three groups: (1) Improved IC (IC2003-1999 >0), (2) Stable IC (IC2003-1999 = 0), (3) Worsened IC (IC2003-1999 <0). Cox regression and subdistribution hazard models were used to investigate IC transitions and 4-year overall and cause-specific mortality, respectively. Logistic regression were employed to develop weighted IC score (wIC, 0-16) and assess its association with incident disability and healthcare utilization. Similar analysis were repeated using non-weighted IC (nIC, 0-8) to ensure robustness.

RESULTS

Comparing to decreased wIC group, stable or increased wIC participants had significantly lower 4-year all-cause mortality, and death from infection, cardiometabolic/cerebrovascular diseases, organ failure and other causes. (Hazard ratio (HR) ranged from 0.36 to 0.56, 95% CI ranged from 0.15 to 1.00, p ≤ 0.049 in the stable wIC group; HR ranged from 0.41 to 0.51, 95% CI ranged from 0.22 to 0.94, p ≤ 0.034 in the increased wIC group). Moreover, individuals with stable or increased wIC demonstrated lower risk of incident disability and hospitalization. (Odds ratio (OR) = ranged from 0.34 to 0.70, 95% CI ranged from 0.19 to 1.00, p ≤ 0.048). Participants with stable wIC also exhibited reduced risk of emergency department visits (OR = 0.58, 95% CI = 0.41 to 0.82, p = 0.002). These results were generally consistent in the nIC model.

CONCLUSION

Participants with stable or increased IC experienced significantly lower all-cause and most cause-specific mortality, incident disability, and healthcare utilization, which was independent of baseline IC and comorbidities. The findings remained consistent across weighted and non-weighted IC model.

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.

Association between intrinsic capacity and oral health in older patients in a frailty clinic

PURPOSE

This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline.

METHODS

This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were established within each domain, and the number of IC deficit domains was calculated for each patient. Oral function assessment included oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Patients who met three or more criteria were classified into the oral hypofunction (OHF) group. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between IC deficit and OHF.

RESULTS

Of 222 included patients (mean age 78.3 ± 6.3 years; 39.6% men), 105 (47.3%) met the criteria for OHF. This OHF group showed a significantly higher prevalence of locomotion, cognition, psychology, and sensory domain deficits than the normal oral function group. Multivariate analysis adjusted for age and sex revealed a significant association between IC deficits and OHF (odds ratio [OR], 1.33; 95% confidence interval [CI] 1.04-1.70). A significant association was also observed between the locomotion domain and OHF (OR, 2.06; 95% CI 1.13-3.76).

CONCLUSION

This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function.

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".

Longitudinal change of intrinsic capacity and associated factors in older Chinese adults: China Health and Retirement Longitudinal Study

BACKGROUND

Although intrinsic capacity (IC) has been constructed in older populations, whether IC retains the same structure over time has not been formally examined, nor have the factors associated with the changes in IC over time been thoroughly investigated. This study aimed to establish that the structure of IC remains unchanged over time by testing its longitudinal measurement invariance and to investigate factors that influence the longitudinal change of IC over time.

METHODS

Data came from 7,271 participants aged 60 and older from the China Health and Retirement Longitudinal Study in 2011 (Wave 1) and 2015 (Wave 3). Bifactor confirmatory factor analysis (CFA) was used to construct IC with its domains, and the longitudinal measurement invariance of IC between Waves was tested.

RESULTS

Bifactor CFA fitted the data well at both Waves and showed good construct validity. Partial scalar invariance was supported with non-invariant intercepts for delayed word recall, math, and close vision. Decreases in IC were associated with increasing age, being female (-0.030, 95% CI: -0.045, -0.016), living in rural areas (-0.019, 95% CI: -0.030, -0.009), BMI < 18.5 (-0.019, 95% CI: -0.035, -0.003), and hypertension (-0.012, 95% CI: -0.022, -0.001). Increases in IC were associated with higher education (primary school: 0.012, 95% CI: 0.001, 0.024; lower secondary school: 0.023, 95% CI: 0.005, 0.041) and drinking ≥4/week (0.019, 95% CI: 0.003, 0.034). Stratifying the sample by gender, the protective effect of education was observed only in women.

CONCLUSIONS

The bifactor structure of the IC construct was valid and retained its meaning over time. Longitudinal changes in IC were associated with various sociodemographic factors, lifestyle, and health conditions, confirming the need to monitor IC for timely intervention, particularly in those with risk factors for IC decline.

Intrinsic Capacity and Its Biological Basis: A Scoping Review

BACKGROUND

In 2015, the World Health Organization (WHO) introduced the concept of intrinsic capacity (IC) to define healthy aging based on functional capacity. In this scoping review, we summarized available evidence on the development and validation of IC index scores, the association of IC with health-related factors, and its biological basis. The review specifically focused on identifying current research gaps, proposed strategies to leverage biobank datasets, and opportunities to study the genetic mechanisms and gene-environment interactions underlying IC.

METHODS

The literature search was conducted across six databases, including PubMed, CINAHL, Web of Science, Scopus, AgeLine, and PsycINFO, using keywords related to IC.

RESULTS

This review included 84 articles, and most of them (n=38) adopted the 5-domains approach to operationalize IC, utilizing correlated five factors or bifactor structures. Intrinsic capacity has consistently shown significant associations with socio-demographic and health-related outcomes, including age, sex, wealth index, nutrition, exercise, smoking, alcohol use, ADL, IADL, frailty, multimorbidity, and mortality. While studies on the biological basis of the composite IC are limited, with only one study finding a significant association with the ApoE gene variants, studies on specific IC domains - locomotor, vitality, cognitive, psychological, and sensory suggest a heritability of 20-85% of IC and several genetic variants associated with these subdomains have been identified. However, evidence on how genetic and environmental factors influence IC is still lacking, with no available study to date.

CONCLUSION

Our review found that there was inconsistency in the use of standardized IC measurement tools and indicators, but the IC indices had shown good construct and predictive validity. Research into the genetic and gene-to-environment interactions underlying IC is still lacking, which calls for the use of resources from large biobank datasets in the future.

From biological aging to functional decline: Insights into chronic inflammation and intrinsic capacity

Intrinsic capacity is the sum of an individual's physical and mental capacities, which helps determine functional ability. Intrinsic capacity decline is an important predictor of adverse health outcomes and can identify individuals at higher risk of functional decline. Aging is characterized by a decrease in physiological reserves and functional abilities. Chronic inflammation, a mechanism of aging, is associated with decreased intrinsic capacity, which may mirror the broader relationship between aging and functional ability. Therefore, it is crucial for maintaining functional ability and promoting healthy aging to study the mechanisms of intrinsic capacity decline, identify easily available markers, and make targets for intervention from the perspective of chronic inflammation. We reviewed the current research on chronic inflammation, inflammation-related markers, and intrinsic capacity. To date, there is still no inflammatory markers with high specificity and sensitivity to monitor intrinsic capacity decline. Interleukin-6, C-reactive protein, and tumor necrosis factor-alpha may potentially indicate changes in intrinsic capacity, but their results with intrinsic capacity or each intrinsic capacity domain are inconsistent. Considering the variations in individual responses to changes in inflammatory markers, it may be beneficial to explore the use of multiple analytes instead of relying on a single marker. This approach could be valuable in monitoring the decline of intrinsic capacity in the future.

In-Hospital Fall Risk Prediction by Objective Measurement of Lower Extremity Function in a High-Risk Population

OBJECTIVES

Limited data exist regarding association between physical performance and in-hospital falls. This study was performed to investigate the association between physical performance and in-hospital falls in a high-risk population.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

The study population consisted of 1200 consecutive patients with a median age of 74 years (50.8% men) admitted to a ward with high incidence rates of falls, primarily in the departments of geriatrics and neurology, in a university hospital between January 2019 and December 2021.

METHODS

Short Physical Performance Battery (SPPB) was measured after treatment in the acute phase. As the primary end point of the study, the incidence of in-hospital falls was examined prospectively based on data from mandatory standardized incident report forms and electronic patient records.

RESULTS

SPPB assessment was performed at a median of 3 days after admission, and the study population had a median SPPB score of 3 points. Falls occurred in 101 patients (8.4%) over a median hospital stay of 15 days. SPPB score showed a significant inverse association with the incidence of in-hospital falls after adjusting for possible confounders (adjusted odds ratio for each 1-point decrease in SPPB: 1.19, 95% CI 1.10-1.28; P < .001), and an SPPB score ≤6 was significantly associated with increased risk of in-hospital falls. Inclusion of SPPB with previously identified risk factors significantly increased the area under the curve for in-hospital falls (0.683 vs. 0.740, P = .003).

CONCLUSION AND IMPLICATIONS

This study demonstrated an inverse association of SPPB score with risk of in-hospital falls in a high-risk population and showed that SPPB assessment is useful for accurate risk stratification in a hospital setting.