Intrinsic capacity and its dimensions in relation to functional ability in older adults: A systematic review and meta-analysis

OBJECTIVES

This study aims to explore the association between declines in intrinsic capacity and its individual domains with functional impairment in older adults and to compare the predictive ability of overall intrinsic capacity and its specific domains for functional disability.

METHODS

We systematically searched PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, Wanfang, and VIP databases from inception to December 26, 2024. Meta-analysis was conducted using RevMan 5.4. Study quality was assessed with the Newcastle-Ottawa Scale, and evidence quality was evaluated using GRADE guidelines. The study protocol was registered in PROSPERO (CRD42025634431).

RESULTS

This meta-analysis included 15 longitudinal studies with 53,648 participants. Declines in locomotion, cognition, psychological well-being, and vitality were significantly associated with increased Activities of Daily Living (ADL) disability risk. Vision impairment also elevated ADL disability risk but hearing loss did not. Overall intrinsic capacity decline was linked to higher ADL disability risk (OR = 1.22, 95 % CI [1.16, 1.28]), with locomotion demonstrating stronger predictive power than overall intrinsic capacity. For instrumental activities of daily living (IADL) disability, declines in locomotion, cognition, psychological well-being, and vitality were significant risk factors. Sensory functions showed no significant association. Overall intrinsic capacity decline was strongly associated with IADL disability risk (OR = 1.41, 95 % CI [1.29, 1.54]), with no individual dimension showing significantly greater predictive power than overall intrinsic capacity. The GRADE evidence quality was rated as moderate.

CONCLUSIONS

This study confirms the role of overall intrinsic capacity and its individual domains in predicting functional impairment in older adults. It also compares the predictive value of overall intrinsic capacity with that of its specific domains, identifying locomotion decline as a key driver of functional impairment. Future research should further explore the longitudinal interactions among multiple intrinsic capacity domains using standardized intrinsic capacity assessment methods to refine the theoretical framework of healthy aging.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Periprocedural care for frail older patients with aortic stenosis undergoing transcatheter aortic valve replacement

Degenerative aortic stenosis (AS) is an aging-associated disease with alarmingly high mortality that has risen in prevalence in tandem with the global population aging. Treatment options for AS are currently limited to surgical or percutaneous valve intervention, which are associated with significant morbidity. It is increasingly recognized that the care of AS patients is frequently constrained by concomitant frailty, an under-recognized syndrome among older individuals. Many AS patients have concurrent aging-associated diseases, including atherosclerotic diseases, organ impairment, physical frailty, and nutritional deficiencies which limit functional improvement after valve intervention. It has become increasingly crucial for clinicians to address these concurrent issues in frail, older individuals with AS to achieve the best possible outcomes. We aim to review the well-studied relationship between frailty and AS, as well as possible strategies for periprocedural optimization and risk management.

Association Between Intrinsic Capacity and Hospital Admission Among Older Adults in the Emergency Department

This prospective cohort study assessed the impact of intrinsic capacity on hospital admissions among older adults after an Emergency Department (ED) visit. Assessing 1132 patients according to WHO's Integrated Care for Older People guidelines between March 1 and August 30, 2022, we found that 784 (69.26%) were admitted. The admission group demonstrated significantly lower intrinsic capacity scores (mean ± SD, 2.92 ± 1.29) compared to the discharge group (3.44 ± 1.23; p < .001). Multivariable logistic regression showed that higher intrinsic capacity scores were associated with lower odds of admission (adjusted odds ratio [aOR] = 0.81; 95% CI: 0.71-0.92; p < .001). Notably, patients with malnutrition had significantly higher odds of admission (OR = 3.12; 95% CI: 2.16-4.50; p < .001). These findings underscore the importance of integrating the intrinsic capacity assessment with traditional clinical indicators in the emergency care of older adults.

Conceptualisation and measurement of healthy ageing: Insights from a systematic literature review

This paper enhances the understanding and measurement of Healthy Ageing (HA) through a systematic review of its multidimensional operationalisation. Despite progress in HA research, no consensus exists on its constitutive elements, and current frameworks often do not capture its full complexity. Building on the World Health Organization (WHO) HA definition, we organise empirical evidence under three dimensions: intrinsic capacity (IC), functional ability (FA) and the environment (ENV). To identify conceptual, empirical and methodological gaps, we provide a structured synthesis of concepts, measures and instruments used in HA research, evaluating methodological advancement and standardisation in HA measurement. Following PRISMA guidelines, we extract data from 55 quantitative, qualitative and mixed-methods studies with a multidimensional HA focus. We arrange evidence into three primary domains (IC, FA and ENV; first order), 15 sub-domains (second order) and 84 themes (third order). We identify operational categories via thematic analysis and inductively determine the final categorisation, moving from third to first order based on conceptual and measurement considerations. Given the lack of systematic knowledge on ENV, we generate a more nuanced categorisation capturing different levels of analysis and contexts. We compute a mean usage ratio to assess differences in the application of validated tools across HA aspects. The review revealed substantial variability in HA conceptualisation and measurement. IC and FA are the most extensively studied domains, with well-established measurement approaches and widespread use. Common themes include locomotion, cognitive capacities and functional status. ENV remains significantly underexplored and lacks standardised measurement, as mainstream assessments still prioritise deficit-based approaches over enabling environments. This analysis calls for a standardised, multidimensional HA model integrating individual and contextual factors, recognising the role of structural environmental supports in shaping ageing trajectories. Future research should prioritise comprehensive HA measurement and pursue an interdisciplinary approach bridging conceptual and methodological gaps to inform HA policies effectively.

Risk factors for sarcopenia in community setting across the life course: A systematic review and a meta-analysis of longitudinal studies

BACKGROUND

Sarcopenia is generally an age-related condition in older people that impacts adverse health consequences in terms of quality of life, morbidity and mortality. With the increasing interest of clinical and research interest in sarcopenia internationally, the epidemiological evidence reveals sarcopenia risk begins in early adulthood, influenced by gene, lifestyle and a range of chronic conditions across life course.

OBJECTIVES

The purpose of this study was to systematically summarize the risk factors for sarcopenia across the life course, and to identity the high-risk population.

METHODS

Searches were performed in PubMed, Web of Science, Scopus, Embase, MEDLINE, and SPORTDiscus databases from inception to July 2024. Longitudinal studies assessing the risk factors for sarcopenia in community setting were included in the analysis. Fixed- and random-effect models were used to pool effect size. Based on the results of meta-analysis, we developed a risk predictive model for sarcopenia.

RESULTS

Fifty-three studies were included in our systematic review. Risk factors associating with sarcopenia were grouped into eight domains: sociodemographic, anthropometric, health behaviors, health condition, biomarkers, early life factors, psychosocial and living environment factors. Fifteen risk factors derived from the twenty-three included studies were eligible for meta-analysis, and ten variables were identified as statistically significant. A risk predictive model was developed for secondary sarcopenia in community setting.

CONCLUSIONS

This study provides a fully understanding of sarcopenia across the life-course. Our risk predictive model could facilitate the early identification and prevention of secondary sarcopenia in community setting.

REGISTRATION

The systematic review and meta-analysis have been registered in PROSPERO(CRD42024536346).

Cross-sectional associations of epigenetic clocks with intrinsic capacity and functional ability in older adults with frailty and cognitive impairment: the COGFRAIL study

Functional ability and intrinsic capacity (IC) have been proposed as determinants of healthy aging, but the extent to which these indicators are affected by biological aging remains unknown. We explored the association of biological age acceleration (BAA) with functional ability and IC in older adults with physical and cognitive impairments. This cross-sectional study used data from 163 individuals (84.0 ± 5.2 years [range 72-99], 61.8% women) of the COGFRAIL cohort. Functional ability on basic (BADL-Katz Index) and instrumental activities of daily living (IADL-Lawton Index) was assessed. IC was measured as a composite score (0-100, higher is better) including the locomotion, cognition, psychology, sensory, and vitality domains. BAA was assessed by Horvath's, Hannum's, PhenoAge, and GrimAge epigenetic clocks. In the fully adjusted model, higher BAAPhenoAGe was associated to lower functional ability in BADLs (β = - 0.021, 95% confidence interval = - 0.038 to - 0.003, p = 0.022), with no significant results observed for the remaining clocks. No significant association was found between BAA and IC, but some associations were found with specific IC domains. Particularly, BAAGrimAge was associated with lower locomotion scores (β = - 1.179, 2.286 to - 0.072, p = 0.037), while BAAPhenoAge tended to be associated with lower scores in vitality (β = - 0.257, - 0.539 to 0.025, p = 0.073). Higher BAAPhenoage was associated with lower functional ability in very old adults with frailty and cognitive impairment. Although no biological clock was associated with a composite IC score, some associations were found between second-generation epigenetic clocks and specific IC domains.

Longitudinal transitions in intrinsic capacity profiles and their associations with subsequent adverse outcomes among Chinese older adults: A nationwide prospective cohort study

AIMS

To characterize longitudinal transitions in intrinsic capacity (IC) profiles and investigate their associations with adverse outcomes.

METHODS

Data from three waves of the Chinese Longitudinal Healthy Longevity Survey were utilized. Latent profile and transition analyses identified IC profiles and their changes between the 2011 and 2014 waves. Cox proportional hazards and logistic regression models explored the associations of profile transitions with mortality, activities of daily living disability, instrumental activities of daily living disability, and recurrent severe diseases in the 2018 wave.

RESULTS

Two IC profiles were identified: high IC without physio-cognitive decline (HPCD) and low IC with mainly physio-cognitive decline (LPCD). Approximately 85.89% of participants' profiles remained stable, 12.53% transitioned to LPCD, and 1.58% transitioned to HPCD. Groups remaining in or transitioning to LPCD had increased risks of adverse outcomes compared to those with consistent HPCD profiles. Groups with transitions to HPCD profiles reported similar outcomes to that of consistent HPCD profiles.

CONCLUSIONS

Consistent monitoring and targeted preventative strategies are crucial to optimize IC profiles and reduce economic and public health burdens.

The Longitudinal Aging Study Amsterdam: design and cohort update 2025

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study of older adults in the Netherlands, with data on multiple domains of functioning available over a period of more than 30 years of follow-up. The study started in 1992 with a nationally representative sample of older adults aged 55-84 years. Over the years, three refresher cohorts (two cohorts aged 55-64 years in 2002 and in 2012, and one cohort aged 60-86 years in 2024) were added. The main aim of LASA was to describe determinants, trajectories and consequences of (changes in) physical, cognitive, emotional and social functioning. LASA has multiple strengths, including its multidisciplinary character, the very long period of follow-up, and the cohort-sequential design which enables the study of longitudinal changes as well as historical time trends in functioning. So far, findings based on data from LASA have been reported in more than 800 scientific publications (see www.lasa-vu.nl ). In this article, we provide an update of the design and methods of LASA, including a description of several ancillary studies such as the Loneliness study and the COVID-19 study.

Effects of Resilience, Self-Perceived Hearing Difficulty, and Demographic Factors on Psychological Distress in Adults With Hearing Loss

PURPOSE

Although hearing loss can have a substantial impact on mental health, relatively little research has focused on factors that predict mental health outcomes among adults with hearing loss. In this study, we examined the effects of self-perceived hearing difficulty and resilience on psychological distress in adults.

METHOD

Adult patients with hearing loss (N = 118) completed several questionnaires, including a demographic questionnaire, the Abbreviated Profile of Hearing Aid Benefit, the Brief Resilience Scale, and Kessler 6 Psychological Distress Scale. The relationships between demographic characteristics, self-perceived hearing difficulty, resilience, and psychological distress were assessed using bivariate analyses and multiple regressions.

RESULTS

Self-perceived hearing difficulty and resilience both predict psychological distress in adults with hearing loss, while controlling for age and income.

CONCLUSIONS

Findings suggest that both audiologic and mental health interventions support positive mental health outcomes in adults with hearing loss. Improving patients' resilience may be a particularly important goal for audiologists and mental health professionals who are working with adults with hearing loss.

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.

Association between physical activity and sedentary behaviour and changes in intrinsic capacity in Spanish older adults (Seniors-ENRICA-2): a prospective population-based study

BACKGROUND

Intrinsic capacity-the composite of all the physical and mental capacities of an individual-has been proposed by WHO as a marker of healthy ageing. However, the association of movement behaviours (physical activity and sedentary behaviour) with intrinsic capacity remains largely unexplored. We aimed to prospectively analyse the association of movement behaviours with intrinsic capacity in older adults.

METHODS

The Seniors-ENRICA-2 prospective, population-based study included a cohort of male and female community-dwelling older adults aged 65-94 years living in Spain. Accelerometer-based levels of sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed at baseline. An intrinsic capacity composite score (with higher scores indicating higher intrinsic capacity) was calculated at baseline and at two follow-up assessments across six domains: vitality (handgrip strength, appetite, and weight loss), cognition (Mini-Mental State Examination), psychological (Geriatric Depression Scale), locomotion (Short Physical Performance Battery), vision, and hearing.

FINDINGS

Between Dec 2, 2015, and Nov 23, 2017, 3273 participants were recruited to the Seniors-ENRICA-2 study. 2477 (75·7%) of 3273 participants had complete data for movement behaviours and intrinsic capacity at baseline and were therefore included in the analyses. 1314 (53·0%) of 2477 participants were female and 1163 (47·0%) were male. 1463 (59·1%) of 2477 participants provided follow-up data over a median of 2·3 years (IQR 2·1 to 2·5) and 940 over 5·5 years (5·2 to 5·8). When analysed as a continuous variable, higher levels of MVPA (mean percentage change [MPC] per 15 min 0·63%, 95% CI 0·06 to 1·21), but not LPA (-0·39%,-0·85 to 0·07), were associated with improvements in intrinsic capacity during follow-up, whereas higher levels of sedentary behaviour were associated with declines in intrinsic capacity (-0·29%, -0·57 to -0·01). Analyses by tertiles of physical activity confirmed that the highest (MPC 4·83%, 95% CI 1·98 to 7·75) and intermediate (5·44%, 2·52 to 8·45) tertiles of MVPA were associated with improvements in intrinsic capacity compared with the lowest tertile. By contrast, compared with the highest tertile, the lowest (MPC 5·48%, 95% CI 2·88 to 8·02) and intermediate (5·73%, 3·16 to 8·22) tertiles of sedentary behaviour were associated with improvements in intrinsic capacity.

INTERPRETATION

Sedentary behaviour was associated with a reduction of intrinsic capacity, and MVPA (but not LPA) was associated with an improvement in intrinsic capacity in older adults. Our findings support the importance of promoting physical activity and reducing sedentary behaviour for healthy ageing.

FUNDING

Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, French Agence Nationale de la Recherche, European Regional Development Fund/European Social Fund, Fondo de Investigaciones Sanitarias, the EU NextGenerationEU/Plan de Recuperación, and Transformación y Resiliencia.

Exploring the relationship between intrinsic capacity and social participation in healthy ageing: Evidence from Singapore

OBJECTIVE

The World Health Organization has identified intrinsic capacity and functional ability as key constructs in enabling healthy ageing. However, functional ability is distinct from actual levels of social and physical participation, which research has shown to be associated with health and wellbeing. This study distinguishes between functional ability and actual levels of social and physical participation, and utilizes the International Classification of Functioning, Disability and Health framework to examine the relationship between IC and the two constructs.

METHODS

This study utilizes cross-sectional self-reported data from a nationally representative panel of Singapore residents aged 56-75 (N = 6,434). We performed structural equation modelling to compare the direct and indirect effects (mediated by IADLs) of intrinsic capacity on social participation. Intrinsic capacity is modelled as a second-order model, and its 5 domains are assessed using self-reported indicators. IADLs was based on participants' self-reported difficulty in completing 7 instrumental daily activities. Social participation was measured using participants' frequency of engagement in various activities.

RESULTS

Intrinsic capacity is positively associated with higher levels of social participation among middle-aged and older adults aged 56-75 (β = 0.287, 95% CI [0.156, 0.414]) even after controlling for IADLs. The direct effect of intrinsic capacity on social participation accounts for 77.4 % of the total effect, while the indirect effect through IADLs accounts for 22.6% of the total effect.

CONCLUSION

Intrinsic capacity is associated with social and physical participation directly and indirectly through IADLs. This study emphasizes the need for healthcare interventions aimed towards the promotion of healthy ageing to adopt a holistic approach that enhance IC across its five domains, ensuring both social and physical participation and functional independence of older adults.

Intrinsic Capacity Across 15 Countries in the Survey of Health, Aging, and Retirement in Europe

Importance

Intrinsic capacity (IC) is a core component of the World Health Organization's healthy aging framework. Yet, despite multiple validations of IC across various settings, there is still a lack of longitudinal cross-national analysis.

Objective

To validate the IC construct, describe variance between key demographic groups, and create population centile curves across 15 countries using data from the Survey of Health, Aging, and Retirement in Europe (SHARE).

Design, Setting, and Participants

In this population-based multicenter cohort study, data from SHARE wave 5 (January to November 30, 2013) were analyzed, and subsequent care dependence in wave 6 (January to November 30, 2015) was determined. Adults 50 years and older from SHARE wave 5 with at least 1 available measure and follow-up data in SHARE wave 6 were included. Data analyses were conducted between December 11, 2022, and June 7, 2024.

Exposure

SHARE waves 5 and 6.

Main Outcomes and Measures

Changes in activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods included structural equation modeling, bifactor analysis, and path analysis. Construct validity was tested through multiple linear regression and validity of estimates through mediation analysis. Centile curves were established using the generalized additive models for location, scale, and shape.

Results

The sample included 64 872 eligible participants aged 50 to 104 years, with a mean (SD) age of 67.24 (10.01) years, of whom 35 976 (55.46%) were women. The bifactor confirmatory factor analysis model achieved good fit (comparative fit index, 0.986; Tucker-Lewis index, 0.981), suggesting an IC structure consisting of 1 general factor and 5 subdomains. Mediation analysis indicated that IC was associated with subsequent declining performance in ADL (standard coefficient [SD], -0.213 [0.002]; P < .001) and IADL (standard coefficient [SD], -0.209 [0.002]; P < .001) after adjusting for age, gender, educational attainment, socioeconomic status, and country. Socioeconomic status was associated with IC both within and between countries. Centile curves for IC by gender and country (5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles) were constructed.

Conclusions and Relevance

Results of this cohort study of older adults suggest that IC was a valid and reliable measure that effectively captured individual-level aspects of functional ability. The centile curves developed during the study suggest that IC has the potential to serve as a benchmark for health status in older populations.

Reference values for handgrip strength, five times sit-to-stand and gait speed in patients on hemodialysis

BACKGROUND

Low levels of muscle strength and physical performance predict adverse clinical outcomes in patients on hemodialysis; however, reference values remain lacking. We described reference values for handgrip strength, five times sit-to-stand (STS-5) and 4-m gait speed in a large-scale sample of patients on hemodialysis.

METHODS

Baseline data from the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis (SARC-HD) study were analyzed. Muscle strength was evaluated using handgrip strength and the STS-5, whereas physical performance was evaluated using usual 4-m gait speed before a midweek dialysis session. Sex- and age-specific smoothed reference curves for each test at the 3rd, 15th, 50th, 85th and 97th percentiles were constructed using generalized additive models for location shape and scale. Comparisons between sex and age were also performed.

RESULTS

Data from 1004 patients (39% female; 19-96 years; 49% ≥60 years) were analyzed. Declines in muscle strength and physical performance were observed with advancing age in both sexes. However, among males, muscle strength and performance were similar between 18 and 49 years of age. Males exhibited substantially greater performance in handgrip strength [10.3 kg, 95% confidence interval (CI) 9.1 to 11.4] and 4-m gait speed (0.10 s, 95% CI 0.05 to 0.14) compared with females. Older patients, independent of sex, exhibited poorer performance on most tests. Lower handgrip strength in the arm with arteriovenous fistula was observed in both sexes (males -2.3 kg, 95% CI -2.8 to -1.7; and females -2.1 kg, 95% CI -2.6 to -1.6).

CONCLUSION

Reference values obtained in this study may be used in clinical and research settings to identify patients on hemodialysis with low physical function according to sex and age. Future studies should test these reference values as potential predictors of adverse clinical outcomes.

Longitudinal Analysis of Intrinsic Capacity and Other Risk Factors in Aging: FREVO Study Protocol

Background/Objectives: Population aging presents important global and socio-economic challenges, especially in developing countries such as Brazil, where aging is projected to accelerate in the next years. This manuscript presents the protocol of the FREVO (risk factors in aging) study, a six-year longitudinal study that aims to assess intrinsic capacity and its interaction with other risk factors. Moreover, this study aims to evaluate the combination of these factors and their correlation with major adverse health outcomes among community-dwelling older adults in Petrolina, Brazil. Methods: This six-year prospective cohort study will recruit 496 participants aged 60 or older. Annual in-person assessments using validated tools will measure intrinsic capacity, personal information, lifestyle, and chronic conditions. Negative outcomes (falls, hospitalizations, dementia, and death) will be recorded biannually by phone. Statistical analyses will employ latent profile analysis to identify risk phenotypes and Cox regression models for time-to-event analyses. Results: This study will attempt to identify phenotypes and modifiable risk factors by using the WHO's intrinsic capacity framework in a low-resource Brazilian context for the assessment and promotion of healthy aging. Conclusions: Our findings will address important gaps that can contribute to a localized understanding of aging, aligning global frameworks with regional realities to promote independence, functionality, and quality of life for older adults.

Effects of S-ketamine on recovery quality in elderly patients with impaired intrinsic capacity after total knee arthroplasty: a single-centre, randomised, double-blind, placebo-controlled study protocol

INTRODUCTION

Elderly patients with impaired intrinsic capacity are at increased risk for delayed or suboptimal recovery from surgery. S-ketamine has been proven to improve postoperative recovery quality. However, limited trials are studying the postoperative recovery quality in elderly patients with impaired intrinsic capacity. Therefore, the objective of this study was to evaluate the impact of S-ketamine on the quality of recovery in elderly patients with impaired intrinsic capacity following total knee arthroplasty.

METHODS AND ANALYSIS

This is a single-centre, randomised, double-blind, placebo-controlled trial. Participants undergoing total knee arthroplasty will be randomly assigned in a 1:1 ratio to either the S-ketamine group (n=80) or the placebo group (n=80). The S-ketamine group will undergo an intravenous infusion of S-ketamine administered at a dosage rate of 0.2 mg·kg⁻1·h⁻1 for 1 hour. The placebo group will receive an intravenous saline infusion at an identical rate and duration. Postoperatively, the S-ketamine group will continuously infuse S-ketamine for 48 hours using a patient-controlled intravenous device, with a fixed rate of 0.01 mg·kg⁻¹·h⁻¹, a bolus dose of 0.02 mg·kg⁻¹, a lockout period of 10 min and a maximum infusion rate of 0.13 mg·kg⁻¹·h⁻¹. In contrast, the patient-controlled intravenous device for the placebo group will not contain S-ketamine. The primary outcome is the quality of recovery scores at 24 hours following total knee arthroplasty. Secondary outcomes encompass quality of recovery scores at 48 and 72 hours postoperatively, pain scores at rest and during movement, oral morphine equivalents, sleep quality assessments, depression scores, the Barthel Index and the time to meet discharge criteria.

ETHICS AND DISSEMINATION

Approval for the trial was granted by the Medical Ethics Committee of The Affiliated Hospital of Qingdao University (QYFYEC2024-74). Written informed consent will be obtained from each patient before enrolment. The results of this trial will be presented at scientific conferences and in peer--reviewed scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR2400087028.

Social robot PIO intervention for improving cognitive function and depression in older adults with mild to moderate dementia in day care centers: A randomized controlled trial

The increases in the older population, the prevalence of dementia, and the resulting social costs are burdensome to individuals, families, and the nation. This study examines whether the social robot PIO program intervention is effective for cognitive function and depression for older adults with mild to moderate dementia using two daycare centers in Daegu, Korea. Older adults with mild to moderate dementia and using a daycare center were included in the experimental (n = 33) and control (n = 33) groups. The experimental group participated in the social robot PIO program twice a week, 12 sessions, 50 minutes day for 6 weeks, and the control group received the usual care. From October 2022 through December 2022, a total 66 participants were included. Results showed that the cognitive function of the experimental group increased by 3.9±3.66, from 18.1±4.54 before intervention to 21.9±5.17 after intervention; the control group increased by 0.1±4.13, from 18.2±4.91 before intervention to 18.2± 4.77 after intervention. The difference between the two groups was statistically significant (t = 3.94, p<.001). Depression decreased -0.7±3.48 in the experimental group, from 5.9±4.74 before intervention to 5.2±4.65 after intervention, and decreased by -0.2±3.42, from 6.5±4.69 before intervention to 6.4±4.08 after intervention, in the control group, but the difference between the two groups was not statistically significant (z = -0.59, p =.557). It was confirmed that the social robot PIO program is effective in improving cognitive function in older people with mild to moderate dementia who use daycare centers. Therefore, it is recommended to periodically implement this program for the older adults who use daycare centers to improve cognitive function. The experimental group had lower depression than did those in the control group, but the effect is not statistically significant, so additional research is required. Trial Registration: CRIS (KCT0007936).

From geroscience to precision geromedicine: Understanding and managing aging

Major progress has been made in elucidating the molecular, cellular, and supracellular mechanisms underlying aging. This has spurred the birth of geroscience, which aims to identify actionable hallmarks of aging. Aging can be viewed as a process that is promoted by overactivation of gerogenes, i.e., genes and molecular pathways that favor biological aging, and alternatively slowed down by gerosuppressors, much as cancers are caused by the activation of oncogenes and prevented by tumor suppressors. Such gerogenes and gerosuppressors are often associated with age-related diseases in human population studies but also offer targets for modeling age-related diseases in animal models and treating or preventing such diseases in humans. Gerogenes and gerosuppressors interact with environmental, behavioral, and psychological risk factors to determine the heterogeneous trajectory of biological aging and disease manifestation. New molecular profiling technologies enable the characterization of gerogenic and gerosuppressive pathways, which serve as biomarkers of aging, hence inaugurating the era of precision geromedicine. It is anticipated that, pending results from randomized clinical trials and regulatory approval, gerotherapeutics will be tailored to each person based on their genetic profile, high-dimensional omics-based biomarkers of aging, clinical and digital biomarkers of aging, psychosocial profile, and past or present exposures.

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.

Effectiveness and cost-effectiveness of a home-based functional exercise programme for community-dwelling frail older adults, ACTIVE-AGE@home, provided by professionals and volunteers: protocol of a pragmatic randomised controlled trial

Between 2020 and 2050, the world's population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters' degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 TRIAL REGISTRATION NUMBER: NCT05946109.

Implications of intrinsic capacity subtypes for post-PCI patients older than 45

We aim to explore the contributing factors to intrinsic capacity (IC) in middle-aged and older patients after percutaneous coronary intervention (PCI). Intrinsic capacity comprises six core domains: cognition, locomotion, vitality, psychology, vision, and hearing. Each domain was assessed in detail using different scales, based on which the composite IC score was calculated. The study employed latent class analysis (LCA) to identify the various IC subtypes. Logistic regression analyses were used to determine the effect variables of IC subtypes. 318 middle-aged and older post-PCI patients filled out the assessments. Three distinct IC subtypes were found: 47.8% poor audition-vision group (class 1), 38% high cognition-psychology group (class 2), and 14.2% low locomotion-vitality group (class 3). The IC subtype classification may be impacted by factors such as cTnI, NT proBNP, cardiac function, exercise frequency, and comorbidities. Examining IC subtypes may be helpful for focused intervention, and further empirical research is still needed to determine their drivers.

Nutritional intake as a determinant of high-speed resistance and multicomponent training efficacy on strength in older women at risk of sarcopenia. A randomized clinical trial

BACKGROUND AND AIM

Despite advances in research on training and nutritional supplementation, it is largely unknown how micronutrient intake modulates the response to training in older adults. This study investigates the relationship between nutrient intake and response to training in older women at risk of sarcopenia.

METHODS

A randomized clinical trial with two parallel groups (high-speed resistance training (H-RT) and multicomponent training (MT)) was conducted over a 32-week intervention involving 80 older women at risk of sarcopenia (mean age: 77.36 ± 6.71 years). A food frequency questionnaire was administered to assess whether nutrient intake influenced strength outcomes measured by the Five Times Sit-to-Stand Test (5STS) and other functional variables.

RESULTS

Significant improvements in the five times sit to stand test (5STS) were observed in both groups post-intervention (p < 0.001), with no significant differences between them (p = 0.127), suggesting comparable effectiveness. In both groups, lower levels of vitamin B12 (H-RT: rp = -0.52; MT: rp = -0.50) and vitamin D (H-RT: rp = -0.55; MT: rp = -0.69) were associated with worse 5STS performance. Additionally, in the H-RT group, lower levels of vitamin E (rp = -0.36), magnesium (rp = -0.48), iron (rp = -0.43), and potassium (rp = -0.47) were also correlated with poorer performance.

CONCLUSIONS

The results indicate that improvements in strength are related to micronutrient sufficiency rather than macronutrient sufficiency. Deficiencies in vitamin D and B12 negatively impacted muscle strength gains in both H-RT and MT, while vitamin E, potassium, magnesium, and iron influenced H-RT outcomes. The lesser effect of micronutrient deficiencies on MT suggests it may be more suitable for individuals with mild deficiencies, as it requires fewer specific nutrients for muscle strength.

REGISTRATION

The study is registered at ClinicalTrials.gov under the identifier NCT05870046.

Exercise effects on intrinsic capacity in acutely hospitalised older adults: a pooled analysis of two randomised controlled trials

BACKGROUND

Hospitalisation often results in adverse effects in older adults, particularly an increased risk of functional and cognitive decline. Although in-hospital exercise interventions have shown benefits, their impact on intrinsic capacity (IC) remains unknown.

OBJECTIVE

To assess the effects of multicomponent exercise training on IC in acutely hospitalised older adults.

DESIGN

Pooled analysis of two randomised clinical trials.

SETTING

Three Acute Care for Elders units.

SUBJECTS

Hospitalised older adults (≥75 years).

METHODS

The control group received standard care, whereas the exercise group participated in an in-hospital multicomponent exercise program. The primary outcome was IC assessed using a composite score (0-100) across five domains: vitality (handgrip strength), cognition (Mini-Mental State Examination), psychological health (Yesavage Geriatric Depression Scale), locomotion (Short Physical Performance Battery) and sensory function (self-reported vision and hearing). Adverse outcomes were evaluated 1 year after discharge, including emergency visits, hospital re-admission and mortality.

RESULTS

A total of 570 patients (age 87.3 ± 4.8 years) were enrolled during acute hospitalisation [median duration 8 (interquartile range = 3) days] and randomised to the exercise (n = 288) or control group (n = 282). The exercise intervention significantly improved IC compared to the control group [7.74 points, 95% confidence interval (CI) 6.45-9.03, P < .001], with benefits observed in all IC domains. IC score at discharge was inversely associated with mortality risk during follow-up (OR = 0.98 per each increase in IC score at discharge, 95% CI = 0.96, 0.99, P = .010), although no association was found with emergency visits (P = .866) or re-admissions (P = .567).

CONCLUSIONS

In-hospital exercise is an effective strategy to enhance IC in hospitalised older adults. Additionally, the IC score at discharge was inversely related to the mortality risk within 1 year of discharge.

From biology of ageing to geroscience: where will knowledge take us?

Healthy life expectancy is a major challenge in many countries and one of the World Health Organisation's main concerns for the current decade. With different animal models, from invertebrates to mammals, research into the biology of ageing has identified various biological and physiological processes that alter the quality of ageing. Twelve characteristics of ageing have been defined, and the aim of a growing number of studies is to find how to slow down or halt their onset. Unfortunately, the direct transposition of animal models to humans is too often disappointing, and the race to bring anti-ageing products to market is a source of misleading promises. The development of geroscience will enable the identification and validation, with more relevant clinical evidence, of pro-ageing targets to develop anti-ageing therapies and aim for healthy ageing.

Frailty and Intrinsic Capacity as Predictors of Recovery in Older Patients Surgically Treated for Cancer: A Longitudinal Study

BACKGROUND

Advanced age, cancer, and surgery contribute to functional decline, with concurrent cancer and surgery exacerbating this decline due to slower recovery and adverse outcomes.

OBJECTIVE

To investigate the association between preoperative frailty and intrinsic capacity and postoperative functional recovery and quality of life in older patients surgically treated for cancer.

METHODS

This longitudinal study at a tertiary care medical center included 74 patients 75 years and older undergoing elective surgery for malignancies, excluding those with terminal-stage cancer. Data on demographic variables, Cumulative Illness Rating Scale for Geriatrics, Clinical Frailty Scale, and intrinsic capacity were collected at admission. The Minimum Data Set Activities of Daily Living (MDS-ADL) and EuroQoL 5-dimension 3-level questionnaire (EQ5D) were assessed at admission, after operation, and 1 month, 3 months, 6 months, and 1 year after the operation for cancer.

RESULTS

The mean age of the 74 participants was 80.3 ± 4.6 years, and 56.8% were female. The generalized estimating equation showed that an increased preoperative Clinical Frailty Scale score was significantly associated with worsened MDS-ADL (adjusted β = 1.25; 95% confidence interval = 0.39-2.11; P = .004) and decreased EQ5D score after surgery for cancer (adjusted β = -0.04; 95% confidence interval = -0.07 to -0.01; P = .004). No significant associations were observed between intrinsic capacity and postoperative MDS-ADL or EQ5D scores.

CONCLUSION

This study demonstrated that frailty is a better predictor of postoperative functional recovery and quality of life than intrinsic capacity in older cancer patients.

IMPLICATIONS FOR PRACTICE

Identifying frailty preoperatively can help healthcare providers better anticipate recovery challenges and tailor postsurgical care to improve outcomes.

Development of evaluation index system for functional ability of older patients with stroke based on healthy aging: a modified Delphi study

Background

The prevalence of stroke in the older population is high and it is critical to promote and maintain the functional status of older patients post stroke. Health measures centered on functional ability can scientifically reflect the health status of older individuals. The aim of this study was to develop an evaluation index system for assessing the functional ability of older patients with stroke based on the World Health Organization Healthy Aging Model.

Methods

Key indicators were identified through literature analysis and semi-structured interviews with 10 older patients with stroke. A two-round expert consultation process was conducted to evaluate and revise the indicators. Subsequently, a hierarchical construction model was established using the analytic hierarchy process to determine the weight of each level indicator.

Results

The evaluation index system comprised three first-level, 13 s-level, and 53 third-level indicators. The weights ranged from 0.143-0.429 for first-level indicators, 0.052-0.349 for second-level indicators, and 0.040-0.667 for third-level indicators.

Conclusion

The developed evaluation index system demonstrates reliability for assessing the functional ability of older stroke patients and provides a standardized framework for nursing staff to conduct functional assessment of older stroke patients.

A functional approach to model intrinsic capacity in ageing trajectories

The ageing process is a multifaceted phenomenon that affects individuals' physical, cognitive, and psychological well-being over time. To promote healthy ageing, in the mid-2010s, the World Health Organisation introduced the concept of intrinsic capacity (IC) as the set of physical and mental capacities of an individual. These capacities, categorised into five domains, namely cognition, vitality, locomotion, psychological well-being, and sensory, are assessed by healthcare practitioners using the ICOPE guidelines, a laborious and time-consuming task. This study leverages existing data from longitudinal studies, such as the well-known Health and Retirement Study, to align their dimensions with the ICOPE framework and understand how existing ageing trajectories fit within the new IC paradigm. Moreover, a novel IC scoring system has been validated statistically using linear mixed models, and a simple yet comprehensive data visualisation strategy has been designed to illustrate IC trajectories. Results show the significant negative impact of time on all IC domains, except psychological well-being, showing a gradual IC decline over the years. Additionally, significant associations between lifestyle factors, such as physical activity, alcohol and tobacco consumption, and body mass index, with IC trajectories have been identified. This work suggests the feasibility of using existing longitudinal studies to quantitatively model IC ageing trajectories following the ICOPE framework.

The Biological Rationale for Integrating Intrinsic Capacity Into Frailty Models

The assessment and management of two function-centered clinical care models, frailty and intrinsic capacity decline have been proposed to achieve healthy aging. To implement these two care models, several different guidelines have been advocated by different health organizations, which has resulted in confusion and cost-ineffective results in healthcare practice. Although there are various operational definitions and screening tools of frailty, the most accepted operational definitions are based on the recognition of frailty phenotypes or deficit accumulation-based frailty indexes. Intrinsic capacity, referred to as the total physical and mental capacities for individual to undertake daily tasks in everyday life, is another care model, including five domains. Similar or identical instruments have been used to assess frailty and intrinsic capacity. In the present narrative review, we outlined the biological rationale for integrating intrinsic capacity into frailty models and highlighted the hierarchical and energy-dependent order of the intrinsic capacity domains. The vitality domain or energy metabolism-related capacity, is the highest order dimension and the basis of other intrinsic capacity domains. Vitality vulnerability manifests as a pre-frailty status in function-centered healthy aging. We provided a conceptual framework of frailty phenotypes and frailty indexes based on the hierarchical and energy-dependent order of the intrinsic capacity domains, particularly vitality capacity. To facilitate the clinical translation of the framework, some potential energy metabolism-related biomarkers have also been proposed as critical components for assessing and screening vitality capacity in older age. The integrating framework not only provides testable theoretical hypotheses, particularly about vitality as a foundational element in aging, but could serve as a starting point for further research to unravel the mechanisms of frailty. It also improves cost-effectiveness for optimizing aging interventions in clinical healthcare and public health policies of healthy aging.

Cross-sectional and longitudinal associations between physical activity and intrinsic capacity in healthy older adults from the MAPT study

BACKGROUND

The construct of intrinsic capacity (IC) has been recently developed with the aim of assessing and monitoring life-long individuals' functional trajectories. Physical activity (PA) is recognized for its benefits on health but its associations with IC remain less investigated. We explored the cross-sectional and longitudinal associations of PA with IC in non-demented older adults.

METHODS

Eight hundred and thirty-seven males and females aged 70 years and over, were included in the present work. IC and its domains (mobility, vitality, cognition, psychology and sensory) were assessed over 2 years and converted to a 0-100 scale. Participants were categorized into 5 PA groups (0-29; 30-499; 500-999; 1000-1999; and 2000+ MET-min/week) using questionnaires. The associations between PA and IC variables (all reflected and square-root-transformed) observed over 2 years were examined using mixed-effect linear regressions.

FINDINGS

Over the 2-year follow-up, ordinal PA was associated with higher scores in IC (B = -0.066, SE = 0.015, p < .001) In addition, compared to the inactive group, most of the active groups had a slower decline in IC (B30-499 MET-min/week = -0.196, SE = 0.078; B500-999 MET-min/week = -0.208, SE = 0.076; B1000-1999 MET-min/week = -0.165, SE = 0.073; B2000+MET-min/week = -0.187, SE = 0.074; all p < .05). Subdomain analyses revealed that these associations were driven by mobility, vitality and psychological domain.

INTERPRETATION

This study suggests that PA may help preventing IC decline, especially mobility, vitality, and psychology in older adults.

Intrinsic Capacity and Instrumental Activity of Daily Living Among Community Dwelling Elderly in China: The Mediating Effect of Two-Way Social Support and Sense of Coherence

OBJECTIVES

To explore the influence of intrinsic capacity (IC) on instrumental activities of daily living (IADL) among community-dwelling elderly and to analyze the chain-mediated effects of two-way social support, and sense of coherence (SOC).

DESIGN

This study was a cross-sectional research design. Participants were recruited from September 2023 to December 2023 from Hangzhou City, Zhejiang Province, China, using a multistage sampling method.

SAMPLE

Participants in this study were at least 60 years old and had been currently living in the community for at least 1 year (n = 458).

MEASUREMENTS

The Integrated Care for Older People screening tool, the Brief Two-Way Social Support Scale, the Sense of Coherence Scale-13, and the Functional Activities Questionnaire were used to collect relevant data, which were statistically tested using structural equation modeling and multiple mediation effects.

RESULTS

There were correlations between IC, two-way social support, SOC and IADL in community-dwelling elderly (all p < 0.01). IC predicted two-way social support (β = 0.570, p < 0.001), SOC (β = 0.544, p < 0.001) and IADL (β = -0.492, p < 0.001); two-way social support had a positive predictive effect on SOC (β = 0.363, p < 0.001) but a negative predictive effect on IADL (β = -0.193, p < 0.001); SOC negatively predicted IADL (β = -0.150, p < 0.05).

CONCLUSIONS

To mitigate the impact of declining IC on IADL among community-dwelling elderly, to sustain independent living, and to reduce the risk of progression to illness and disability, this study proposes two-way social support and SOC as potential effective intervention targets. This conclusion holds implications for the assessment and intervention of elderly health, as well as the formulation of public health policies.

The Implementation of Infant Anoesis and Adult Autonoesis in the Retrogenesis and Staging System of the Neurocognitive Disorders: A Proposal for a Multidimensional Person-Centered Model

Background: Retrogenesis is the process by which the degenerative and vascular mechanisms of dementia reverse the order of acquisition in the normal development. Objective: The development of memory/knowledge after birth may help to know the biopsychosocial and functional characteristics (biosphere) of the retrogenesis. Methods: A literature review was performed in the PubMed, Google Scholar, and Scopus databases using 43 keywords related to retrogenesis: 234 eligible records were selected. Results: The infantile amnesia, characterized from anoesis, was described along the infant/child's biosphere in which the limbic system progressively develops the acquisition of the body knowledge (Anoetic Body Consciousness, AnBC). Anoesis is the infant memory state characterized by the absence of long-term memories of the many stressful/painful experiences that accompany the acquisition under the long-life voluntary control of the long-term memories fundamental for the body growth and survival (mainly chewing/swallowing and walking). At the age of 3-4 years, usually, the AnBC evolves, as a continuum, into the adulthood autonoesis with the emergence, in the child/adolescent, of the consciousness of "self" trough the development of the Episodic Autobiographic Memory (EAM) and the Autonoetic Mind Consciousness (AuMC). The development of cognition and knowledge is due to the progressive maturation of the whole limbic system and not only of the hippocampus. In the biopsychosocial retrogenesis, the EAM/AuMC vanishes progressively along the mild, moderate, and severe stages of dementia when the infant AnBC resurfaces, losing progressively the basic activities of daily living in a retrogenetic order of acquisition where the last functions to disappear are chewing/swallowing. Conclusion: The transition from the adult EAM-AuMC to the infant AnBC, as a continuum in the individual biosphere, adds a contribution to the assessment of the retrogenesis in dementia from a multidimensional person-centered model.

Association of intrinsic capacity with incident type 2 diabetes mellitus in older Chinese: Guangzhou Biobank Cohort Study

BACKGROUND

The World Health Organization introduced intrinsic capacity (IC) as a metric for healthy aging. However, we found no report on the association between IC and type 2 diabetes mellitus (T2DM). We investigated the association between IC and incident T2DM in older Chinese from the Guangzhou Biobank Cohort Study.

METHODS

IC was assessed across five domains equally: locomotion, vitality, cognition, psychological and sensory. Composite IC scores (0-10) were classified into three groups: poor (0-5.9), fair (6.0-8.9), and high (9.0-10), with higher scores representing greater IC. Multivariable linear regression and cox regression was used to analyze the association between IC with glycemia and T2DM, respectively.

RESULTS

Of 3582 participants with a mean age of 59.1 years (standard deviation (SD)=7.13) without baseline diabetes, during an average follow-up of 3.3 years (SD=0.86), 497 (13.87%) developed T2DM. After adjustments for potential confounders, those with baseline poor IC, versus high, had higher fasting glucose, 2-hour post-load glucose and glycosylated hemoglobin A1c at follow-up, and a higher risk of incident T2DM (HR (95%CI): 1.80 (1.20, 2.72)). Among IC domains, only vitality impairment was associated with an increased risk of T2DM (P for trend < 0.001).

CONCLUSION

We first reported the prospective associations of poor IC and vitality with higher glycemia and incident T2DM risk. Enhancing muscle strength to improve functional ability may be a possible intervention for reducing future risk of T2DM in older populations.

Implications of comprehensive geriatric assessment and Traditional Chinese Medicine constitution types for integrative geriatric care

BACKGROUND

Complementary medicine may enhance conventional geriatric care, but clinical guidance for incorporating Traditional Chinese Medicine (TCM) therapies remains limited. This study aimed to investigate the link between TCM body constitutions and comprehensive geriatric assessment scores in older adults.

METHOD

This prospective observational study recruited 100 participants aged 65 and older between January 2020 and December 2021. Each participant underwent comprehensive geriatric assessments, including the Body Constitution Questionnaire, functional tests, and comprehensive geriatric assessment questionnaires evaluating depression, activities of daily living, nutrition, cognition, comorbidities, frailty, and sensory impairments.

RESULTS

Increasing age, polypharmacy, and impaired Timed Up and Go Test performance were associated with abnormal TCM body constitutions, while sarcopenia was not. Specific geriatric domains significantly linked to abnormal constitutions included impairments in activities of daily living (ADLs), instrumental ADLs (IADLs), cognitive function, hearing, sleep, and urinary continence (all p < 0.05). Individuals with more than five affected geriatric domains were more likely to exhibit an abnormal constitution. Logistic regression identified sleep disturbances and dependence in ADLs as potential risk factors for developing an abnormal constitution.

CONCLUSION

This study elucidates key geriatric syndrome components linked to abnormal TCM constitutions in older adults, including hearing, sleep, continence, functional and cognitive impairments. Multiple affected geriatric domains increased the likelihood of an abnormal constitution. These findings inform holistic TCM-integrated care by identifying areas for targeted interventions to address constitutional abnormalities and promote healthy aging.

The definition of vitality-the perspectives of Dutch older persons

BACKGROUND

Vitality is often mentioned in the context of successful ageing, however, there is still no consensus on the definition of vitality. Moreover, older persons themselves have yet to be involved in establishing a definition of vitality.

AIM

To explore and describe how older persons define vitality, how they experience vitality, and what influences their vitality.

METHOD

A qualitative study consisting of 33 semi-structured interviews with community-dwelling older persons (60 +) in the Netherlands. The interviews were analysed using the thematic content analysis.

RESULTS

The definition of vitality that emerged from the interviews was "vitality is having the physical, cognitive, and social capacities to do what you want to do". The important dimensions of vitality can be divided into their capacities and their drivers in life. The capacities consisted of physical, cognitive, and social capacities. Sustaining these three capacities was important for the preservation of vitality. Main drivers in life were autonomy, independence, and meaning in life. Their experience of vitality was mostly determined by the balance between their capacities on one side and their drivers in life on the other side. Furthermore, this balance, and therefore their vitality, could be impacted by their lifestyle, loss of social network, coping, and role models.

CONCLUSION

According to older persons, vitality is determined by the balance between their capacities to do what they want to do on one side, and their drivers in life on the other side.

Enhancing cognitive functions in aged dogs and cats: a systematic review of enriched diets and nutraceuticals

With advancements in veterinary care and the growing recognition of pets as integral member of the family, the lifespans of dogs and cats have significantly increased, leading to a higher prevalence of age-related conditions, including cognitive dysfunction syndrome (CDS). CDS adversely impacts pets' quality of life and presents emotional and practical challenges for owners. Given its similarities to Alzheimer's disease in humans, CDS has gained attention as a target for nutrition-based interventions aimed at preserving cognitive function. This systematic review evaluates the efficacy of enriched diets and nutraceuticals in improving cognition in aging companion animals. A literature search was conducted using PubMed, CAB Abstracts, Web of Science, and Dimensions to identify clinical trials published in English that investigated the effects of enriched diets or nutraceuticals on cognitive functions in aged cats or dogs. Study quality was assessed using a modified CAMARADES checklist. A total of 30 studies (27 canine and 2 feline trials) published between 2002 and 2023 were reviewed. Studies on enriched diets generally demonstrated higher methodological quality compared to those on supplements. Omega-3 fatty acids showed cognitive benefits in aging pets, especially at higher doses, while antioxidants from plant extracts and products and vitamins E and C alone were less effective but remain essential for stabilizing omega-3 fatty acids. Other supplements, including S-adenosyl methionine, medium-chain triglycerides, homotaurine, and apoaequorin, also showed promise. However, future studies must standardize protocols, include robust control groups, and utilize both objective tasks and subjective questionnaires to strengthen conclusions.

Intrinsic capacity and ageing well for Aboriginal people in remote Western Australia: a longitudinal cohort study

OBJECTIVE

To assess intrinsic capacity, an important component of ageing well, in older Aboriginal people living in remote Western Australia.

STUDY DESIGN

Longitudinal cohort study; secondary analysis of survey and clinical assessment data.

SETTING

Kimberley region of Western Australia (six remote communities, and the town of Derby).

PARTICIPANTS

Aboriginal people aged 45 years or older, initially recruited 15 July 2004 - 17 November 2006.

MAIN OUTCOME MEASURES

Intrinsic capacity (assessed in each participant by questionnaire and review by a consultant specialist), overall and by domain, and presence of core activity limitations, at baseline and follow-up (8 February 2011 - 6 June 2013); risk of death by follow-up; preservation of intrinsic capacity at follow-up.

RESULTS

The mean age of the 345 participants at baseline was 60.2 years (standard deviation [SD], 11.6 years; range, 45-96 years); 152 were men (44.1%) and 193 were women (55.9%). Intrinsic capacity was unimpaired in all five domains for 55 participants (15.9%; 95% confidence interval [CI], 12.4-20.2%). Capacity in the vitality domain was unimpaired in 325 respondents (94.2%), in the psychological/mood domain in 318 (92.2%), and in the cognition domain in 289 people (83.8%); the locomotion domain was unimpaired in 174 people (50.4%), and the sensory domain in 117 people (33.9%). The proportion of men with full capacity in all five domains (32 of 152, 21.1%) was larger than for women (23 of 193, 11.9%). Of the 274 people included in follow-up analyses, intrinsic capacity was lower than at baseline for 66 people (24.1%), it was unchanged or improved in 111 participants (40.5%; 95% CI, 34.8-46.5%), and 97 people had died (35.4%). Thirty-seven of the 177 surviving participants for whom complete data were available had full capacity in all domains (20.9%; 95% CI, 15.5-27.6%). After adjustment for age, the number of unimpaired intrinsic capacity domains at baseline was inversely associated with having a core activity limitation at baseline (per domain: adjusted prevalence ratio, 0.43; 95% CI, 0.34-0.55) and follow-up (adjusted risk ratio, 0.62; 95% CI, 0.44-0.88), and with risk of death by follow-up (adjusted risk ratio, 0.83; 95% CI, 0.71-0.96).

CONCLUSIONS

Impaired intrinsic capacity in older Aboriginal people living in the Kimberley was most frequent in the sensory and locomotion domains. Reduced capacity in these domains could be highly amenable to treatment that would ensure that Elders can continue to take part in activities important for quality of life.

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.

Association of handgrip strength asymmetry and weakness with intrinsic capacity impairment among older adults in China

BACKGROUND

Declining intrinsic capacity (IC) significantly impacts health outcomes in aging populations. While weak handgrip strength (HGS) is associated with IC impairment, the role of HGS asymmetry remains unclear, especially among older Chinese cohorts.

METHODS

We included participants aged ≥60 years from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). IC was evaluated across cognitive, locomotion, psychological, sensory, and vitality domains. Asymmetry and weakness were measured using the maximum value of HGS. Logistic regression models were employed to examine the association of the individual and combined groupings of HGS asymmetry and weakness with IC impairment (a total score ≥ 2 across five domains). The potential non-linear relationship was explored using a restricted cubic spline (RCS) model.

RESULTS

Of the 4798 participants included (median age 66.0 years, IQR 63.0-71.0 years; 56.9 % male), 35.2 % had IC impairment. HGS asymmetry (OR = 1.26, 95 % CI: 1.11-1.43) and weakness (OR = 2.09, 95 % CI: 1.78-2.45) were both independent risk factors for IC impairment. Notably, participants experiencing both HGS asymmetry and weakness were at even higher risk of IC impairment (OR = 2.47, 95 % CI: 1.99-3.08), suggesting compounded effects on IC. Further subgroup analysis showed significant associations between HGS status and impairments in specific IC domains, particularly in locomotion. In contrast to other domains, it was the Weakness only group, rather than the Both group, that had the highest risk of vitality impairment. There was a U-shaped relationship between HGS asymmetry and IC impairment.

CONCLUSIONS

HGS asymmetry and weakness were associated with an increased risk of composite and individual domain IC impairment. Assessing and maintaining HGS symmetry and strength may have implications for the early identification of individuals at risk for IC impairment and the prevention of related adverse health outcomes.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

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.

Cohort trends in intrinsic capacity in England and China

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study of Ageing and the China Health and Retirement Longitudinal Study. Applying multilevel growth curve models, we found that more recent cohorts entered older ages with higher levels of capacity, while subsequent age-related declines were somewhat compressed compared to earlier cohorts. Trends were most evident for the cognitive, locomotor and vitality capacities. Improvements were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old participant of the English Longitudinal Study of Ageing born in 1950 had higher capacity than a 62-year-old born 10 years earlier. Trends were similar for men and women and were generally consistent across English and Chinese cohorts. Possible causes include broad societal influences and improvements in medical care.

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.

Sensitivity and Specificity of Three Measures of Intrinsic Capacity in Older People Aged 80 and Over in Nursing Homes

Purpose

Intrinsic capacity (IC), a crucial indicator for the United Nations Decade of Healthy Ageing 2021-2030, is defined by WHO as the foundation of functional ability, representing the composite of all physical and mental capacities of an individual. IC spans five function domains: Locomotor, psychological, cognitive, vitality, and sensory (including vision and hearing). Accurate IC assessment is vital for effective interventions, yet comparative analyses of these tools are scarce. Consequently, we evaluated the diagnostic accuracy of three IC assessment tools in individuals aged 80 and above-Integrated care for older people (ICOPE) Step 1, ICOPE Step 2, and the Lopez-Ortiz's IC scoring system.

Patients and Methods

This cross-sectional analysis included a total of 475 participants aged ≥80 years between July 2023 and January 2024 in 11 nursing homes in Ningbo, Zhejiang Province, China. To assess that included sociodemographic and health-related information alongside the three IC tools. Diagnostic efficacy was gauged using sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, Youden index, and the area under the curve (AUC).

Results

The detection of IC decline exceeded 85% across all methods. Using ICOPE Step 2 as a benchmark, ICOPE Step 1 showed robust performance across four domains of locomotion, psychological, cognitive, and vitality, whereas the Lopez-Ortiz's IC scoring system was generally ineffective.

Conclusion

All three IC assessment methods have limitations. To save resources, ICOPE Step 1 can be considered for direct assessment in non-sensory domains. Conversely, the ICOPE Step 2 and Lopez-Ortiz's IC scoring systems exhibited overly stringent and lenient thresholds, respectively. At this stage, IC assessment tools cannot balance subjectivity and objectivity; thus, it is recommended that the appropriate tool be selected according to actual application scenarios. Continuous improvement of IC assessment tools remains a requirement for future studies.

Gripping insights: prevalence of hypertension and its association with relative muscle strength-a cross-sectional study in an adult Indian population

BACKGROUND

Hypertension and muscle strength are known to be associated; however, identifying simple clinical indicators of this relationship is challenging. Relative muscle strength (RMS), defined as strength per unit muscle mass, has been proposed as a potential indicator, but its association with hypertension is unclear. This study aimed to estimate the prevalence of hypertension and determine its association with RMS in an adult Indian population attending a tertiary care center in Gujarat.

METHODS

This hospital-based cross-sectional study included 430 adults aged 18 years and older who were admitted to outpatient medicine clinics between January and October 2023. Grip strength and appendicular lean muscle mass (ALM), estimated using a validated formula, were measured. The RMS was calculated as grip strength/ALM. Hypertension was defined using standard criteria. Logistic regression was used to analyze the association between RMS (analyzed continuously and categorically in tertiles) and hypertension, adjusting for confounders. A p value of < 0.05 was considered significant.

RESULTS

The prevalence of prehypertension and hypertension was 187 (43%) and 96 (23%), respectively. Compared to participants in the low RMS tertile (0.00-2.45 kg/kg ALM), those in the high tertile (3.79-6.12 kg/kg ALM) had 26% lower odds of hypertension (OR 0.74, 95% CI 0.59-0.89) and 33% lower odds of prehypertension (OR 0.67, 95% CI 0.49-0.91) after adjusting for confounders. The RMS also showed strong negative correlations with systolic and diastolic blood pressure (r = - 0.559 and - 0.418, respectively; p < 0.001).

CONCLUSION

Increased RMS was significantly protective against prehypertension and hypertension. These findings highlight the potential importance of muscle quality, beyond muscle mass, in blood pressure regulation.

Factors influencing the self-management ability among older adults experiencing intrinsic capacity decline: a cross-sectional study

Aims

This study investigated the current status of intrinsic capacity and self-management abilities and analyzed the factors influencing the self-management abilities of older adults experiencing intrinsic capacity decline.

Methods

We included a sample of 382 older adults, with an average age of 72.92 ± 6.81 years, exhibiting intrinsic capacity decline in 38 communities in China. Questionnaires were administered using the sociodemographic questionnaire, the intrinsic capacity questionnaire, the social support scale, the self-rated health item, the eHealth literacy scale, and the self-management ability scale. The data were analyzed using descriptive statistics, Pearson correlation coefficients, and linear regression analysis.

Results

In this study, 43.5% of older people had impairments in three of the five dimensions of intrinsic capacity, the most significant proportion. The self-management ability score of older adults experiencing intrinsic capacity decline was 67.05 ± 12.53 out of 100. There were significant associations between age, perceived social support, and intrinsic ability composite score with self-management abilities (Age: β = -0.263; p < 0.001; social support: β = 0.291; p < 0.001; intrinsic capacity composite score: β = 0.179; p < 0.001). Higher levels of self-management ability were associated with more effective maintenance of psychological capacity, regardless of the type of older adults experiencing IC decline (all p < 0.05). For example, among older adults experiencing cognitive decline, maintaining psychological function was positively associated with self-management abilities (β = 0.294; p < 0.01).

Conclusion

The highest prevalence of concurrent impairments across three dimensions of intrinsic capacity was observed among older adults experiencing diminished intrinsic capacity. Fostering self-management abilities through social support and mental health interventions may benefit people experiencing intrinsic capacity decline.

Validation of intrinsic capacity and healthy sleep pattern in middle-aged and older adults: a longitudinal Chinese study assessing healthy ageing

OBJECTIVES

Intrinsic capacity (IC), a multidimensional construct encompassing mental and physical capacities, has been established in the aging framework by the World Health Organization. However, the detailed relationship between IC and Chinese sleep patterns (nighttime sleep and post-lunch naps) remains inadequately elucidated.

METHODS

Participants in this study were individuals aged ≥45 years residing in China, included in the China Health and Retirement Longitudinal Study (CHARLS). We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the second wave (July 2015-January 2016). Data from these waves were utilized for longitudinal analysis. Self-reported data included nighttime sleep and nap duration, along with other baseline characteristics. The IC evaluation involved physical examinations and blood tests. Initially, linear regression was used to assess the relationship between total sleep duration, nighttime sleep duration, nap duration, and IC change between the two waves that were determined by marginal effects (ME) and their corresponding 95% confidence intervals (CIs). Regression splines were employed to explore potential nonlinear associations. Subgroup and sensitivity analyses were conducted to investigate the heterogeneity of IC change under specific conditions and the robustness of our results. Mediation analysis was performed to identify potential factors mediating the relationship between sleep patterns and IC change.

RESULTS

Both excessive (>10 h) (total, ME: -1.12; 95% CI: -1.61, -0.64; nighttime, ME: -1.44; 95% CI: -2.29, -0.59) and insufficient (<6 h) sleep duration (total, ME: -0.43; 95% CI: -0.68, -0.18; nighttime, ME: -0.50; 95% CI: -0.73, -0.27) negatively impacted IC change. Moderate naps (≤60 min) mitigated the decline in IC change (ME: 0.28; 95% CI: 0.07, 0.49). IC values decreased at the slowest rate when nap time constituted one-seventh of total sleep time. The onset of dyslipidemia partially mediated the association between naps (≤60 min) and IC change (P =  0.02).

CONCLUSIONS

These findings suggest that maintaining a healthy sleep pattern of 6-8 h of nighttime or total sleep, along with a post-lunch nap of ≤60 min, helps preserve optimal IC or delay its decline. This is particularly beneficial for cognitive, psychological, and locomotion performance among middle-aged and older adults.

Intrinsic capacity decline as a predictor of functional disability in the elderly: A systematic review and meta-analysis

OBJECTIVES

To examine the predictive value of intrinsic capacity decline on functional disability among the elderly.

DESIGN

Meta-analysis.

METHODS

PubMed, EMBASE, Web of Science, The Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception until June 1, 2024. Stata 17.0 software was used to perform the meta-analysis. The methodological quality was evaluated using the Newcastle Ottawa Scale. The overall quality of evidence used GRADE guidelines to assess. A study protocol was registered in PROSPERO (CRD42023475461).

RESULTS

The meta-analysis included 8 cohort studies including 9744 elderly people. Functional disability including ADL disability (n = 6) and IADL disability (n = 7). The results showed that intrinsic capacity decline could predict ADL disability (HR = 1.08, 95 %CI 1.04-1.12; I2 = 98.2 %, P < 0.001) and IADL disability (HR = 1.11, 95 %CI 1.05-1.17; I2 = 96.4 %, P < 0.001). The overall risk of bias was low. And the grade of evidence that assessed by GRADE guidelines was rated as moderate.

CONCLUSIONS

Intrinsic capacity decline is a predictor of functional disability in the elderly. Therefore, screening intrinsic capacity decline has important clinical implications for early identifying the risk of functional disability, which contributes to providing individualized interventions ahead of potential functional disability for the elderly, thereby preventing functional disability, improving the quality of life and promoting healthy aging.

Sleep disturbances and intrinsic capacity trajectories among Chinese older adults: The Rugao Longevity and Ageing Study

Age related decline of intrinsic capacity (IC) is the core of the functional ability and risk factor of adverse outcomes such as disability, hospitalization, and mortality. However, the relationship between sleep disturbance and IC decline are largely unknown. We conducted a longitudinal study and used data of 1514 community elders from the aging arm of the Rugao Longevity and Ageing Study. We found that poor sleep quality is cross-sectional associated with an increased risk of lower IC. In longitudinal analysis, sleep disturbances were inversely associated with composite IC score changes after adjusting for confounders (PSQI>5 vs. PSQI≤5: mean difference [-0.23], P = 0.0005), suggesting that poor sleep quality was associated with a decline in IC during the follow-up period. In conclusion, sleep disturbances were associated with worse IC changes. The results suggest that improving sleep health may help prevent IC decline and hence decreasing the burden of geriatric nursing practice.