Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study

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.

Prevalence of frailty and association with intrinsic capacity decline among community-dwelling older people in Cameroon: a cross sectional study

BACKGROUND

Frailty and impairment in intrinsic capacity (IC) have been shown to increase the risk of poor outcomes in older people. We aimed to determine the prevalence of frailty and its association with decline in IC among people aged 60 and over in Cameroon.

METHODS

This cross-sectional study included community-dwellers aged ≥ 60 years. Frailty was assessed using Fried's criteria and IC decline using step 1 of the Integrated Care for Older People (ICOPE). Any abnormality reported for one of the six IC domains was considered as a positive screening. The significance level was p < 0.05.

RESULTS

Among 108 participants included (64.8% women, median age 70 years (65-75)), all had a decline of at least one IC. The prevalence of frailty was 52.8%.The main domains involved were cognition (93.5%), vision (88%) and hearing (87%). Compared to participants without frailty, the frail group was older, achieved lower education, had fewer children, had a more frequent history of falls and a higher number of deficits in IC domains. In the multivariable model, after adjusting for age, sex and comorbidities, the participants with preserved mobility (OR 0.18, 95%CI 0.068-0.49) and vitality (OR 0.11 95%CI 0.04-0.28) were likely to have a lower risk of frailty.

CONCLUSION

Frailty and IC impairment were common in this group of older Cameroonians. Further research with the monitoring of trajectories of IC and frailty as a research outcome may allow better comparison to tailor interventions taking into account our local resources.

CLINICAL TRIAL NUMBER

Not applicable.

Reference centiles for intrinsic capacity to monitor clinical health outcomes in real-world primary care cohorts

Intrinsic capacity (IC) refers to physical and mental capacities that determine healthy aging. IC is the central element of the World Health Organization care pathway 'Integrated Care for Older People' (ICOPE). However, the operationalization of a composite IC measurement in clinical settings remains to be defined. We used screening data from ICOPE implementation in a real-life population of 27,706 adults 60 years or older that were users of primary care services to elaborate and cross-validate IC scores and centile values for men and women. Here, we show that IC centiles were cross-sectionally associated with comorbidity, frailty and limitations in both activities of daily living and instrumental activities of daily living. External validation using populations from high-income (French INSPIRE-T cohort) and upper-middle-income (ICOPE Brazil) countries validated the associations between IC centiles and clinical outcomes. The IC centiles developed using ICOPE screening data constitute a standardized parameter to monitor individual and population IC through a clinically friendly approach.

Assessment and Scoring of Intrinsic Capacity in Older Adults: An Integrative Literature Review

PURPOSE

Promotion and maintenance of healthy aging is of utmost importance given the growing number of older adults worldwide. Fluctuation in intrinsic capacity (IC), defined as mental and physical functions, can be assessed objectively with an assigned score to predict health outcomes. The goal of the current review was to identify common measurement tools for IC assessment and evaluate IC scoring approaches.

METHOD

Seventeen studies met inclusion criteria for assessing five domains: vitality, locomotion, cognitive, psychological, and sensory.

RESULTS

Reviewed studies used diverse instruments with inconsistent scoring approaches. Scoring ranged from simple additive scores to complex item response theory models.

CONCLUSION

Establishing consistency in assessment and scoring for IC will ensure usability of scores in clinical practice to promote healthy aging and identify older adults at risk for disability or care dependence. Additional research is needed to establish consensus in standardized scoring, assessment, and measurement of IC. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Interpretable machine learning models to predict decline in intrinsic capacity among older adults in China: a prospective cohort study

BACKGROUND

Monitoring intrinsic capacity and implementing appropriate interventions can support healthy aging. There are, though, few tools available for predicting decline in intrinsic capacity among older adults. This study aimed to develop and validate an interpretable machine learning model designed to identify populations at elevated risk of a decline in intrinsic capacity.

METHODS

Using data from the China Health and Retirement Longitudinal Study baseline (2011) and 4-year follow-up (2015), a total of 822 participants were randomly allocated to a training set and a testing set at a 7:3 ratio. Five machine learning methods were employed to train the model and assess its performance through various metrics. The SHapley Additive exPlanation method was subsequently used to interpret the optimal model.

RESULTS

The 4-year incidence of decline in intrinsic capacity among the older adults in the sample was 44.6 % (n = 367). Nine variables were screened for model construction, among which eXtreme gradient boosting demonstrated the best predictive performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.715 (95 % CI 0.651-0.780) in the testing set. The SHapley Additive exPlanation method identified educational level, smoking, handgrip strength, self-rated health, and residence as the top five significant predictors.

CONCLUSIONS

The developed model can serve as a highly effective tool for primary care teams to identify older adults with early signs of decline in intrinsic capacity, facilitating the provision of subsequent screening and tailored interventions for intrinsic capacity.

Cognition Assessment with ICOPE-Monitor: Identifying Candidates for Novel Therapies

OBJECTIVE

To describe the clinical performance of the cognition battery on Step 1 (CogStep1) as a screening tool to detect (1) individuals with objective cognitive impairment regardless of their Mini-Mental State Exam (MMSE) score, and specifically (2) to identify patients who could potentially benefit from anti-amyloid treatments. It was hypothesized that CogStep1 was sensitive enough to identify individuals with mild stages of cognitive deterioration compared with a comprehensive neuropsychological and clinical evaluation.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Patients aged 60 and older referred to the Toulouse Memory Clinic.

METHODS

Participants underwent a comprehensive neuropsychological and clinical evaluation and were also screened with the integrated care in older people (ICOPE)-monitor Step 1 by trained health professionals a maximum of 6 months before their memory consultation. Objective cognitive impairment was defined as mild cognitive impairment (MCI) or dementia, according to National Institute on Aging and the Alzheimer's Association criteria. A positive CogStep1 screening was considered if people had at least 1 mistake in the 3-word recall or the time orientation (weekday, month, year). Sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were estimated.

RESULTS

Among the 352 participants [54.8% women, mean age 76.5 (SD 6.7)], 78.1% had a positive screening for CogStep1, and 75.6% had objective cognitive impairment. The clinimetric properties of CogStep1 to detect objective cognitive impairment (vs those without) were sensitivity = 87.0 (95% CI, 82.3-90.8), specificity = 48.8 (95% CI, 37.9-59.9), AUROC = 0.68 (95% CI, 0.62-0.74), PPV = 83.8 (95% CI, 78.8-87.9), and NPV = 55.3 (95% CI, 43.4-66.7). We found similar values among individuals with MCI or mild dementia who could be potential users of new anti-amyloid drugs (MMSE score ≥ 20 or 22).

CONCLUSION AND IMPLICATIONS

CogStep1 demonstrated good sensitivity and PPV to identify objective cognitive impairment among older people referred to a memory clinic. Achieving excellent sensitivity and specificity values is challenging for a very short test. However, CogStep1 proved useful for risk-stratifying patients who can benefit from further cognitive assessment, biomarker measurements, and therapeutic management, especially in the context of new anti-amyloid therapies.

Development and evaluation of a Physiotherapy-led, WHO-ICOPE-Based, Person-Centered Integrated Care Program (PTICOPE) module to enhance intrinsic capacity in older adults: Protocol for a randomized controlled trial

BACKGROUND

Declining intrinsic capacity (IC), encompassing domains such as locomotion, cognitive function, vitality, vision, hearing, and psychological well-being, is prevalent among older adults, impacting independence and quality of life (QoL). This study aims to develop and evaluate the Physiotherapy-led Person-Centered Integrated Care for Older People (PTICOPE) based on the WHO-ICOPE framework to enhance IC among older adults in Malaysia.

METHODS

This is a 12-week, multicenter, randomized controlled trial involving 70 community-dwelling older adults aged 60-75, recruited from three Pusat Aktiviti Warga Emas (PAWE) (Activity Center for Older Adults) in the Northern region of Malaysia. Participants will be randomized to either the intervention group, receiving the PTICOPE module workbook and guided use, or the control group, receiving general IC information, healthcare education, and self-care management. The recruitment of participants for this study has not yet commenced. Recruitment is expected to start after completing the validation of the PTICOPE module, however, it is anticipated that the recruitment start date is in February 2025 and will end in August 2025. Primary outcomes, including locomotor, psychological, cognitive, vitality, visual, and hearing functions using validated scales, will be collected at baseline, 4th, 8th, and 12th week of the study period. Secondary outcomes will evaluate QoL, activities of daily living, urogenital health, and oral health at baseline and 12th week. The normality of data will be checked. The independent t-tests, Chi-square tests, paired t-tests, and Repeated measures ANOVA will be used for data analysis, with a significant level at p < 0.05.

DISCUSSION

This study will develop a PTICOPE based on the WHO-ICOPE framework and test its efficacy in the older population residing in the community. The findings of this study hold the potential to establish an evidence-based approach for enhancing IC among community-dwelling older adults.

TRIALS REGISTRATION

Thai Clinical Trials (Number: TCTR20241029007).

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

Introduction

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

Methods

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

Results

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

Conclusion

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

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSION

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

A Social Robot in Home Care: Acceptability and Utility Among Community-Dwelling Older Adults

Background and Objectives

Social robots show great potential for delivering home-based aged care and supporting aging-in-place. This study aims to assess the acceptability of social robots in delivering home care to older adults across 7 domains: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy.

Research Design and Methods

This is a mixed-methods study. Thirty community-dwelling older adults, aged 51-88, engaged with a social robot, equipped with artificial intelligence and designed to interact with humans in a socially acceptable manner. The robot was operated 24/7 in participants' homes for 6 weeks. Descriptive analysis, latent growth mixture modeling, and thematic analysis were conducted for data analysis.

Results

Home-based robotic care was very well received. The average frequency of the use of different features of the robot was 23.4 times/person/day. Three trajectory groups of engagement in human-robot interactions were identified: those who are living alone or with an older spouse, with fair health and financial status were the most interactive group. Participants perceived the robot as user-friendly, manageable, and seamlessly integrated into their daily routine, such as reminding meal intake. The robot also reduced the stress of caregivers. It served as a companion and "good listener," ameliorating the feelings of loneliness, calming depressive emotions, and keeping participants informed about the outside world. Interestingly, participants believed that interacting with the robot enabled them to engage with contemporary technologies, acquire new skills, and showcase their fashion sense in front of friends.

Discussion and Implications

Home-based robots are acceptable and manageable by older adults. Future studies should examine the effectiveness of home-based robotic care on enhancing the health-related outcomes of older adults. Clinical Trial Registration Number: NCT06487611.

Association between pain, sleep and intrinsic capacity in Chinese older adults: Evidence from CHARLS

OBJECTIVES

To examine the relationship between pain, sleep, and intrinsic capacity (IC).

DESIGN

A cohort study.

SETTING AND PARTICIPANTS

Data were obtained from participants in China Health and Retirement Longitudinal Study (CHARLS) 2011-2015. The study population consisted of older adults who completed assessments on pain, sleep duration, sleep quality and IC at baseline.

MEASUREMENTS

Pain, sleep duration, and sleep quality were assessed through self-reports from participants. The total IC score was derived from five domains: psychological, sensory, cognitive, locomotor, and vitality. The relationships between pain, sleep duration, sleep quality and IC were analyzed using linear mixed models. The relationship between sleep duration and IC was analyzed using quadratic analysis. Stratified analyses by gender and age were also performed.

RESULTS

A total of 3517 participants were included in the analysis. After adjusting for all covariates, single-site pain (β = -0.29, 95% confidence interval [CI] = -0.38 to -0.20) and multisite pain (β = -0.41, 95% CI = -0.48 to -0.34) were significantly associated with a decrease in IC compared with older adults without pain; long sleep duration (β = -0.15, 95% CI = -0.24 to -0.06) was significantly associated with a decrease in IC compared with older adults with moderate sleep duration; and poor sleep quality (β = -0.63, 95% CI = -0.71 to -0.55) and fair sleep quality (β = -0.33, 95% CI = -0.40 to -0.27) were significantly associated with a decrease in IC compared with older adults with good sleep quality.

CONCLUSION

To maintain IC, it is important to ensure approximately 7.5 h of sleep duration, improve sleep quality, and manage pain. Interventions should begin as early as possible.

Developmental Trajectories of Intrinsic Capacity Among Older Adults: Results from the China Longitudinal Study of Aging

Background: Previous studies have shown that intrinsic capacity changes over time and can independently predict adverse outcomes such as mortality and care dependence in older adults. However, explorations of the heterogeneity in the developmental trajectories of intrinsic capacity are limited. Aim: This study aimed to identify potential intrinsic capacity trajectory groups and the factors impacting different trajectory groups among older adults. Methods: We utilized data from 2454 older adults aged 60 and above, sourced from the Chinese Longitudinal Healthy Longevity Survey. Our analyses were conducted using growth mixture modeling, chi-square tests, and multinomial logistic regression analysis. Results: We identified four intrinsic capacity trajectory groups among older adults in China: low-level intrinsic capacity (3.2%), medium-level increasing intrinsic capacity (13.0%), medium-level decreasing intrinsic capacity (12.0%), and stable high intrinsic capacity (71.8%). Age was an influencing factor of the medium-level increasing intrinsic capacity, medium-level decreasing intrinsic capacity, and stable high intrinsic capacity trajectory groups. Compared to individuals in the low-level intrinsic capacity trajectory group, individuals in the medium-level decreasing intrinsic capacity group were more likely to regularly exercise and participate in social activity, and those in the stable high intrinsic capacity group were more likely to be male, drink, participate in social activity, and have good self-rated health. Conclusions: Understanding the developmental trajectories of the intrinsic capacity of the older adults can contribute to formulating personalized intervention planning. We identified four intrinsic capacity trajectories in a cohort of older adults in China, which highlights significant heterogeneity in intrinsic capacity development. Our findings suggest that age, gender, exercise, drinking, social activity, and self-rated health of older adults have important effects on different intrinsic capacity development trajectories.

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.

Intrinsic Capacity and Life Quality Among Taiwanese Older People: A Cross-Sectional Study

Intrinsic capacity (IC), an internal composite ability proposed by the World Health Organization, is fundamental to older people's health. The present study examined potential models explaining the association between IC and quality of life (QoL) among older people in Taiwan. Frailty, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) were hypothesized to be mediators in the association between IC and QoL. Older people aged 50 years or above from community or medical center (N = 1,235; Mage = 72.63 years [SD = 7.19]; 601 males [48.7%]) completed a series of self-report and functional measures assessing IC, frailty, ADLs, and QoL. Results showed that IC was significantly associated with frailty, BADL, IADL, and QoL in the mediation models. Frailty was found to be a significant mediator in the association between IC and QoL alone or together with IADL. The findings indicate that IC is an important factor for older people to maintain good health and live a fulfilling life.

Intrinsic capacity and its association with predictors among Chinese empty nest older adults in communities: a latent class analysis

OBJECTIVES

This study aimed to examine Intrinsic Capacity (IC) subgroups and the association of IC subgroups with IC predictors in Chinese urban empty nesters.

METHODS

A convenient sample of 385 older adults aged 60 and above in Community Health Service Center was recruited from Hei Longjiang Province, China, between June 2023 and December 2023. Latent class Analysis (LCA) was conducted to explore IC subgroups using the sensory, cognition, locomotion, psychological, and vitality domains of IC as input variables. Multinomial logistic regression was performed to explore the association between latent subgroups and the IC predictors.

RESULTS

We identified three IC subgroups: "Low IC level-Low locomotion domain"(33.5%), "Medium IC level-Low sensory domain" (16.9%) and "High IC level" (49.6%). Being young, married, without multimorbidity, receiving visits from children ≥ 1 time per week, a low score of self-neglect, a high score of social networking, and a low score of loneliness were closely correlated to the "High IC level" subgroup of empty-nest older adults in communities.

CONCLUSION

The potential subgroups of the IC of empty-nest older adults in communities can be identified through five IC domains. The older empty-nesters should pay extra attention to their critical IC predictors. Community medical staff and other workers should provide intervention measures for different subgroups of older adults to improve their IC in an effective and individualized manner.

Predictive value of a self-administered frailty screening questionnaire for the effectiveness of functional rehabilitation evaluated with the locomotor functional independence measure in a geriatric rehabilitation unit: a multicentre cohort study

BACKGROUND

Patient Reported Outcome Measures (PROMs) are questionnaires that collect health data directly from the patient, without any intervention from a third party. The aim of rehabilitation units is to restore function. Functional gain can be evaluated with classic scales, such as the locomotor subscale of the Functional Independence Measure. This study aimed to assess the accuracy of a new self-assessment questionnaire pertaining to physical, sensory and cognitive ability (abbreviated SEPCO) for the prediction of functional prognosis in older patients admitted to a rehabilitation unit.

METHODS

In this multicentre observational study including patients admitted to 12 rehabilitation centres in France, all included patients completed the SEPCO on admission. Poor response to rehabilitation was defined as relative effectiveness < 40% on the evolution of the locomotor FIM subscale. Components of the questionnaire potentially associated with the outcome of rehabilitation were confirmed for inclusion upon expert review and summed to form an overall score. The final score had five components: the depression score of the HADS, the SOFRESC vision score, the SOFRESC balance score, the stress urinary incontinence subscale of the USP, and the EPICES socio-economic deprivation score. A logistic regression model adjusted for baseline characteristics assessed the performance of the SEPCO score to predict change in functional status, defined by the relative functional gain for the locomotion subscale of the Functional Independence Measure (FIM).

RESULTS

A total of 153 patients (mean age 79.2 ± 8.1 years, 72.5% women) were included. By multivariate analysis, a 5-scale SEPCO score ≥ 1.1 predicted worse functional improvement with an odds ratio (OR) of 2.575, 95% Confidence Interval (CI) 1.081 to 6.133, p = 0.03. Sensitivity for this threshold was 67.4% (95% CI 52.0-80.5%), with a specificity of 58.8% (95% CI 46.2-70.6%). Having a SEPCO ≥ 1.1 almost doubled the probability of poor response to rehabilitation (from 27.3 to 52.5%).

CONCLUSION

The SEPCO score can predict poor functional gain from rehabilitation. Future studies should validate this score on an external cohort. The SEPCO could serve as a complement to the initial clinical evaluation performed by physicians, and assist physicians in setting each patient's rehabilitation goals.

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.

The status quo and influencing factors of intrinsic capacity among community-dwelling older adults from the perspective of Ecological Systems Theory: A cross-sectional study

BACKGROUND

As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network.

METHODS

A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6).

RESULTS

The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC.

CONCLUSIONS

Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults.

Feasibility and Psychometric Properties of Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) Cognitive Screening Test

BACKGROUND

Intrinsic capacity, a concept proposed by the World Health Organization, includes multidimensions to better understand older adults' health conditions for successful healthy aging. One of the key dimensions of intrinsic capacity is cognition. The present study aimed to examine if the cognitive test in Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) is a suitable instrument for screening cognition impairment.

METHODS

Older adults from community or medical center settings in Tainan were recruited (n = 553; mean ± SD age = 75.80 ± 8.32; 60.8% females). All participants were administered the ICOPES-TW cognitive test, the Mini-Mental State Examination (MMSE), Lawton Instrumental Activities of Daily Living (IADL), and Barthel Index (BI) in an in-person interview conducted by a well-trained research assistant.

RESULTS

The ICOPES-TW cognitive test was highly correlated with the MMSE total score (r = -0.752) and moderately correlated with IADL (r = -0.426) and BI scores (r = -0.390). When using a cutoff score of 1 for the ICOPES-TW cognitive test, its accuracy to identify cognitive impairment defined by the MMSE was 60% (sensitivity = 0.98, specificity = 0.41). When using cutoff score of 2, the accuracy was 83% (sensitivity = 0.69, specificity = 0.90). Moreover, the ICOPES-TW cognitive test had similar properties to the MMSE in terms of known-group validity (distinguishing different age and educational level groups).

CONCLUSIONS

Using ICOPES-TW cognitive test with appropriate cutoff point in different healthcare settings could help providers and researchers quickly identify if an older adult has a cognitive impairment. However, the screening ability of ICOPES-TW cognitive test was deemed fair but future studies are recommended to help improve it.

Analysis of body composition, functionality and muscle-specific strength of older women with obesity, sarcopenia and sarcopenic obesity: a cross-sectional study

During aging, changes in body composition can result in sarcopenic obesity, which is a condition in which obesity occurs accompanied by the loss of muscle mass and strength caused by sarcopenia. Although the effects of obesity and sarcopenia on body composition are known, the muscle-specific strength in older women with sarcopenic obesity remains under-researched. The objective of this study was to evaluate community-dwelling older women for the absence or presence of obesity, sarcopenia and sarcopenic obesity and compare them in terms of body composition, functional physical performance and muscle-specific strength. One hundred and fifty-six older women (± 74 years) were evaluated for body composition using Dual X-ray Absorptiometry, handgrip strength with a Jamar dynamometer and functional performance using gait speed and timed up and go tests. The presence of obesity, sarcopenia and sarcopenic obesity was found in 32.7%, 15.4% and 25% of the sample, respectively. Comparing groups, community-dwelling older women with sarcopenic obesity exhibited poorer functional physical performance (TUG ± 14 s), and lower muscle-specific strength (± 1.18). Sarcopenic obesity was associated with muscle-specific strength (95% IC 0.016-0.241), and TUG (95% CI 1.001-1.137). These findings indicate that the combination of obesity and sarcopenia has a negative impact on skeletal muscle, reducing muscle-specific strength and physical performance in older women with more declines than either disease alone. Therefore, this comprehensive assessment gives useful information for incorporating muscle-specific strength into the diagnosis of sarcopenic obesity in the older people.

Integrated Care Services for Dementia and Their Challenges from a Nursing Home Perspective: An Ethnographic Study

Background

The number of older adults living with dementia is increasing in China and worldwide. There is limited attention paid to dementia care in nursing homes, and this study aimed to explore the current situation and challenges of providing integrated care services in nursing home settings.

Methods

A 3-month focused ethnographic study, including semi-participatory observations and in-depth interviews, was conducted in a nursing home in Suzhou, China, from June to August 2022. Twelve residents and sixteen caregivers were observed, and sixteen observed caregivers were interviewed. The Rainbow Model guided data collection. Deductive analysis was used to examine the integrated care services, and a combination of deductive and inductive analysis was applied to explore the challenges.

Results

The Combination of Medical and Elderly care and Medical Consortia were two main integrated care services. Eighteen challenges that threatened integrated care were identified. The nursing homes mainly faced professional and clinical challenges, while Medical Consortia encountered challenges at all levels, especially the organizational level.

Conclusions

The integrated care services of residents living with dementia should be further strengthened. Policymakers, caregivers, and researchers should make more precise efforts to address the challenges that threaten integrated care services, thereby promoting better services for residents.

Development and validation of a functional ability index for older adults: a multicohort study

BACKGROUND

The aim of this study was to develop and validate a functional ability index (FAI) that incorporates aspects of intrinsic capacity and environmental factors of older individuals based on the World Health Organization framework of healthy ageing.

METHODS

Data of 7016 participants ≥60 years participating in the baseline survey of China Health and Retirement Longitudinal Study was used for the development and internal validation of the FAI. External validation was performed in a separate cohort of 1295 older individuals aged ≥60 years. Functional independency was considered the primary outcome and additional proxies of healthy ageing were considered as secondary outcomes. Cluster dendrogram was used to identify the distinct hierarchical clusters of all included variables for inclusion in the FAI. Backward elimination logistic regression model was implemented to identify the most significant variables associated with independency to be included in the FAI.

RESULTS

The FAI score ranged from 0 to 19 and individuals having FAI ≥ 12 were more likely to be independent and at lower risk of negative outcomes. For each unit increase in the FAI the risk of having independency increased by 30%-58% cross-sectionally in the two cohorts, whilst the 2-year risk of independency increased by 20%. The FAI demonstrated a C-statistic of 0.73 (95% confidence interval, 0.72 and 0.75) for the primary outcome.

CONCLUSIONS

The FAI we developed effectively measured the functional ability status of community dwelling older individuals. FAI could serve as a tool for evaluating older individual's functional ability in routine health assessment.

Real-life intrinsic capacity screening data from the ICOPE-Care program

The Integrated Care for Older People (ICOPE) program is a healthcare pathway that uses a screening test for intrinsic capacity (IC) as its entry point. However, real-life data informing on how IC domains cluster and change over time, as well as their clinical utility, are lacking. Using primary healthcare screening data from more than 20,000 French adults 60 years of age or older, this study identified four clusters of IC impairment: 'Low impairment' (most prevalent), 'Cognition+Locomotion+Hearing+Vision', 'All IC impaired' and 'Psychology+Vitality+Vision'. Compared to individuals with 'Low impairment', those in the other clusters had higher likelihood of having frailty and limitations in both activities of daily living (ADL) and instrumental activities of daily living (IADL), with the strongest associations being observed for 'All IC impaired'. This study found that ICOPE screening might be a useful tool for patient risk stratification in clinical practice, with a higher number of IC domains impaired at screening indicating a higher probability of functional decline.

A latent profile analysis of rest-activity behavior patterns among community-dwelling older adults and its relationship with intrinsic capacity

Rest-activity behavior clusters within individuals to form patterns are of significant importance to their intrinsic capacity (IC), yet they have rarely been studied. A total of 1253 community-dwelling older adults were recruited between July and December 2021 based on the baseline survey database of the Fujian Prospective Cohort Study on Aging. Latent profile analysis was used to identify profiles of participants based on rest-activity behaviors, whereas logistic regression analysis was carried out to investigate the relationship between profiles and IC. We identified three latent profiles including: (1) Profile 1-labeled "Gorillas": High physical activity (PA), moderate sedentary behaviors (SB), screen time (ST) and sleep (n = 154, 12%), (2) Profile 2-labeled as "Zebras": Moderate PA, low SB, ST and high sleep (n = 779, 62%), and (3) Profile 3-labeled as"Koalas": High SB, ST, low PA and sleep (n = 320, 26%). Logistic regression revealed a negative correlation between low IC and the "Gorillas" profile (β = - 0.945, P < 0.001) as well as the "Zebras" profile (β = - 0.693, P < 0.001) among community-dwelling older adults, with the "Koalas" profile showing the weakest IC compared to the other profiles. The demographic traits i.e., female, older age, living alone, and low educational level also correlated with low IC. Identifying trends of rest-activity behaviors may help in drawing focus on older adults at risk of decreasing IC, and develop personalized improvement plans for IC.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Development and validation of an intrinsic capacity score in the UK Biobank study

BACKGROUND

In 2015, the World Health Organization introduced the concept of intrinsic capacity (IC) to define the individual-level characteristics that enable an older person to be and do the things they value. This study developed an intrinsic capacity score for UK Biobank study participants and validated its use as a tool for health outcome prediction, understanding healthy aging trajectories, and genetic research.

METHODS

Our analysis included data from 45,208 UK biobank participants who had a complete record of the ten variables included in the analysis. Factor adequacy was tested using Kaiser-Meyer-Olkin, Barthelt's, and the determinant of matrix tests, and the number of factors was determined by the parallel analysis method. Exploratory and confirmatory factor analyses were employed to determine the structure and dimensionality of indicators. Finally, the intrinsic capacity score was generated, and its construct and predictive validities as well as reliability were assessed.

RESULTS

The factor analysis identified a multidimensional construct comprising one general factor (intrinsic capacity) and five specific factors (locomotor, vitality, cognitive, psychological, and sensory). The bifactor structure showed a better fit (comparative fit index = 0.995, Tucker Lewis index = 0.976, root mean square error of approximation = 0.025, root mean square residual = 0.009) than the conventional five-factor structure. The intrinsic capacity score generated using the bifactor confirmatory factor analysis has good construct validity, as demonstrated by an inverse association with age (lower intrinsic capacity in older age; (β) =-0.035 (95%CI: -0.036, -0.034)), frailty (lower intrinsic capacity score in prefrail participants, β = -0.104 (95%CI: (-0.114, -0.094)) and frail participants, β = -0.227 (95%CI: -0.267, -0.186) than robust participants), and comorbidity (a lower intrinsic capacity score associated with increased Charlson's comorbidity index, β =-0.019 (95%CI: -0.022, -0.015)). The intrinsic capacity score also predicted comorbidity (a one-unit increase in baseline intrinsic capacity score led to a lower Charlson's comorbidity index, β = 0.147 (95%CI: -0.173, -0.121)) and mortality (a one-unit increase in baseline intrinsic capacity score led to 25 % lower risk of death, odds ratio = 0.75(95%CI: 0.663, 0.848)).

CONCLUSION

The bifactor structure showed a better fit in all goodness of fit tests. The intrinsic capacity construct has strong structural, construct, and predictive validities and is a promising tool for monitoring aging trajectories.

Predictive Capacity of the Integrated Care for Older People Screening Tool for Intrinsic Capacity Impairments: Results From the INSPIRE-T Cohort

BACKGROUND

The Integrated Care for Older People (ICOPE) approach was developed by the World Health Organization (WHO) aiming to shift the traditional focus of care based on diseases to a function- and person-centered approach, focused on maintaining and monitoring intrinsic capacity (IC). This study aimed to investigate the ability of the ICOPE screening tool to identify older people with clinically meaningful impairments in IC domains.

METHODS

This cross-sectional analysis included 603 older adults, participants (mean age 74.7 [SD = 8.8] years, women 59.0%) of the INSPIRE Translational (INSPIRE-T) cohort. Responses at screening were compared to results of the subsequent in-depth assessment (ie, Mini-Mental State Examination, Mini Nutritional Assessment, Short Physical Performance Battery, Patient Health Questionnaire-9, and clinical investigation of vision problems) to determine its predictive capacity for impairments at the IC domains (ie, cognition, psychological, sensory (vision), vitality, and locomotion).

RESULTS

The ICOPE screening items provided very high sensitivity for identifying abnormality in vision (97.2%) and varied from 42.0% to 69.6% for the other domains. High specificity (>70%) was observed for all the IC domains, except for vision (2.7%).

CONCLUSIONS

The ICOPE screening tool can be a useful instrument enabling the identification of older people with impairments in IC domains, but studies with different populations are needed. It should be considered as a low-cost and simple screening tool in clinical care.

The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis

BACKGROUND

Assessing and monitoring intrinsic capacity (IC) is an effective strategy to promote healthy ageing by intervening early in high-risk populations. This review systematically analyzed the global detection rates of IC deficits and explored variations across diverse populations and data collection methods.

METHODS

This study was preregistered with PROSPERO, CRD42023477315. In this systematic review and meta-analysis, we systematically searched ten databases from January 2015 to October 2023, for peer-reviewed, observational studies or baseline survey of trials that assessed IC deficits among older adults aged 50 and above globally following the condition, context and population approach. The main outcome was intrinsic capacity deficits which could be assessed by any tools. Meta-analyses were performed by a random-effect model to pool the detection rates across studies and subgroup analyses were conducted by populations and data collection methods.

RESULTS

Fifty-six studies conducted in 13 countries were included in the review and 44 studies with detection rates of IC were included in the meta-analysis. The pooled detection rate of IC deficits was 72.0% (65.2%-78.8%) and deficits were most detected in sensory (49.3%), followed by locomotion (40.0%), cognition (33.1%), psychology (21.9%), and vitality (20.1%). Variations in detection rates of IC deficits were observed across studies, with higher rates observed in low- and middle-income countries (74.0%) and hyper-aged societies (85.0%). Study population and measurement tools also explained the high heterogeneity across studies.

CONCLUSION

IC deficits are common among older adults, while heterogeneity exists across populations and by measurement. Early monitoring with standardized tools and early intervention on specific subdomains of IC deficits are greatly needed for effective strategies to promote healthy ageing.

The effect of progressive exercise prescription for group exercise guidance for Taiwan seniors and Integrated Care for old People: Post-event movement observation

Purpose

This study is aimed at the seniors of the "2022 Taiwan Senior Citizens Fitness Club Subsidy Plan" with a sample.

Method

The doctor will diagnose and confirm whether the physical condition suits participation. Then, the professional sports instructor will design and arrange a progressive fitness enhancement group course suitable for the Senior person's physical fitness, conducted four times a week, every 2 h, for three months of group course training. Afterward, four group course instructors analyzed the motor ability of the three periods through a video, divided into 21 evaluation indicators. The data collection will be from January to May 2023. In addition, the Integrated Care for Old People (ICOPE) was used to assess the situation.

Result

The results showed that all indexes were significantly better than those in week one at week 6. All indexes at week 12 were significantly better than those in week one and week 6 (p < .001), and the benefit of all indicators was the largest (Cohen's d: 2.79-5.11), the reliability of the scores of each index ICC (0.73-0.94).

Conclusion

Progressive and multifaceted guidance on how to safely and effectively enhance the physical activity of senior citizens may be the most suitable method. Through progressive energy enhancement, the participants' physical activity and cognitive function can be improved, especially the overall rhythm of the music, which can be combined with high and low impact, dynamic and static balance control, agility, flexibility, and extensibility to achieve the benefits of health promotion.

Assessing intrinsic capacity in Taiwan: Initial psychometric properties of the Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW)

BACKGROUND

The World Health Organization (WHO) proposed the concept of intrinsic capacity (comprising composite physical and mental capacity) which aligns with their concepts of healthy aging and functional ability. Consequently, the WHO promotes the Integrated Care for Older People (ICOPE) framework as guidance for geriatric care. Consequently, each government should have a screening tool corresponding to ICOPE framework to promote geriatric care. The present study examined the initial psychometric properties of the Taiwan version of ICOPE (i.e., ICOPES-TW).

METHODS

Older people (n = 1235; mean age = 72.63 years; 634 females [51.3%]) were approached by well-trained interviewers for participation. A number of measures were administered including the ICOPES-TW, WHOQOL-AGE (assessing quality of life [QoL]), Clinical Frailty Scale (assessing frailty), Barthel Index (assessing basic activity of daily living [BADL]), and Lawton Instrumental Activities of Daily Living Scale (assessing instrumental activity of daily living [IADL]).

RESULTS

The ICOPES-TW had a two-factor structure (body functionality [eigenvalue = 1.932] and life adaptation [eigenvalue = 1.170]) as indicated by the results of exploratory factor analysis. Internal consistency of the ICOPES-TW was low (Cronbach's α = 0.55 [entire ICOPES-TW], 0.45 (body functionality factor), and 0.52 (life adaptation factor). ICOPES-TW scores were significantly (i) positively correlated with age (r = 0.321), IADL (r = 0.313), and frailty (r = 0.601), and (ii) negatively correlated with QoL (r=-0.447), and BADL (r=-0.447), with all p-values < 0.001.

CONCLUSION

The ICOPES-TW could be a useful screening tool for healthcare providers to quickly evaluate intrinsic capacity for Taiwanese older people given that it has moderate to strong associations with age, BADL, IADL, QoL, and frailty.

Linking Agricultural Activity Frequency to Loneliness in Rural Hospital Patients: A Cross-Sectional Study

Introduction Agriculture is deeply woven into the fabric of rural life, influencing the economy, and the social and health dynamics of rural communities. While it offers physical and mental health benefits through regular physical activity and interaction with nature, the solitary nature of farming activities may also lead to social isolation. This study explores the complex relationship between the frequency of agricultural engagement and feelings of loneliness among rural inhabitants with chronic diseases, addressing a gap in the literature concerning the impact of agricultural practices on social well-being. Method A cross-sectional analysis was conducted among patients over 40 who frequented the general medicine department in Unnan City, a rural area of Japan. The study utilized the Japanese version of the University of California, Los Angeles (UCLA) Loneliness Scale to assess loneliness and collected data on agricultural activity frequency through questionnaires. Multivariate logistic regression analyses examined the association between agricultural activities and loneliness, controlling for demographic and health-related variables. Results Among 647 participants, higher frequencies of agricultural activities were significantly associated with increased loneliness, especially for individuals engaging in agriculture four to five times weekly or daily. Engaging in agricultural activities four to five times weekly and daily significantly increased the likelihood of higher loneliness levels, with odds ratios (OR) of 1.80 (p = 0.039) and 2.47 (p < 0.01), respectively, when compared to engagement less than once a week. Age emerged as an influential factor, with individuals aged 75 and older showing increased odds of experiencing higher loneliness (OR 1.56, p = 0.025). Conclusion The study underscores the dual nature of agricultural engagement in rural communities, highlighting its role in both supporting physical health and contributing to social isolation. These findings advocate for developing targeted interventions that mitigate loneliness among rural populations, suggesting the need for a balanced approach that encompasses social and healthcare strategies to enhance the overall well-being of individuals engaged in agriculture.

Factors associated with the intrinsic capacity in older adults: A scoping review

INTRODUCTION

In 2015, the term 'intrinsic capacity' (IC) was proposed by the World Health Organisation to promote healthy aging. However, the factors associated with IC are still discrepant and uncertain.

AIM

We aim to synthesise the factors connected with IC.

METHODS

This scoping review followed the five-stage framework of Arksey and O'Malley and was reported using PRISMA-ScR guidelines.

RESULTS

In all, 29 articles were included. IC of older adults is associated with demographic characteristics, socioeconomic factors, disease conditions, behavioural factors, and biomarkers. Age, sex, marital status, occupation status, education, income/wealth, chronic diseases, hypertension, diabetes, disability, smoking status, alcohol consumption, and physical activity were emerged as important factors related to the IC of older adults.

CONCLUSIONS

This review shows that IC is related to multiple factors. Understanding these factors can provide the healthcare personnel with the theoretical basis for intervening and managing IC in older adults.

RELEVANCE TO CLINICAL PRACTICE

The influencing factors identified in the review help to guide older adults to maintain their own intrinsic capacity, thereby promoting their health and well-being. The modifiable factors also provide evidence for healthcare personnel to develop targeted intervention strategies to delay IC decline.

NO PATIENT OR PUBLIC CONTRIBUTION

As this is a scoping review, no patient or public contributions are required.

Intrinsic capacity assessment using World Health Organization Integrated Care for Older People Step 1, and the association with frailty in community dwelling older adults

AIM

This study aimed to investigate the association between intrinsic capacity (IC) and frailty in community-dwelling older adults. Specifically, we examined the utility of the World Health Organization's Integrated Care for Older People Step 1 screen for identifying frail older persons in the community.

METHODS

This is a cross-sectional analysis of a community frailty screening initiative. IC loss was ascertained using the World Health Organization's Integrated Care for Older People Step 1 questions. The Clinical Frailty Scale was used to categorize participants as robust (Clinical Frailty Scale S1-3) or frail (Clinical Frailty Scale ≥4). Logistic regression was used to analyze the association of individual and cumulative IC losses with frailty, adjusting for confounders. Additionally, the diagnostic performance of using cumulative IC losses to identify frailty was assessed.

RESULTS

This study included 1164 participants (28.2% frail). Loss in locomotion (adjusted odds ratio [AOR] 1.47, 95% CI 1.07-2.02), vitality (AOR 1.58, 95% CI 1.04-2.39), sensory (AOR 1.99, 95% CI 1.51-2.64) and psychological capacities (AOR 1.92, 95% CI 1.45-2.56) were significantly associated with frailty. Loss in more than three IC domains was associated with frailty. Using loss in at least three ICs identifies frailty, with sensitivity of 38.6%, specificity of 83.5% and positive predictive value of 47.4%. Using loss in at least four ICs improved specificity to 96.9%, and is associated with the highest positive predictive value of 57.6% and highest positive likelihood ratio of 3.55 for frailty among all cut-off values. The area under the receiver operating characteristic curve was 0.64 (95% CI 0.61-0.68).

CONCLUSIONS

IC loss as identified through World Health Organization's Integrated Care for Older People Step 1 is associated with frailty community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 457-463.

Cognitive function is associated with performance in time up and go test and with leptin blood levels in community-dwelling older women

Considering the challenge that cognitive dysfunction and dementia represent to health is imperative to prioritize early diagnosis strategies and explore the pathophysiological mechanisms. There is no consensus on specific markers and physical tests that indicate cognitive decline in older. The objective of this study was to evaluate a panel of inflammatory biomarkers and physical function and investigate their association with cognitive function in community-dwelling older women. Seventy-one participants were included in this study. Cognitive function was assessed by Mini Mental State Examination, muscle strength using dynamometer, body composition using Dual X-ray absorptiometry, respiratory muscle strength using manuvacuometer, and physical function using the Short Physical Performance Battery and Time Up and Go (TUG) tests. Blood samples were collected to analyze a panel of inflammatory biomarkers. The cognitive function was associated with TUG (β = - 0.48; 95%IC = - 0.54 to - 0.21; p < 0.001), inspiratory muscle strength (β = 0.30; 95%IC = 0.005-0.03; p = 0.009), and leptin concentrations (β = 0.32; 95% IC = 0.001-0.006; 0.007). Time spent on TUG test and leptin levels accounted for 27% of variability in cognitive function independent of age. Poorer physical function with leptin plasma levels is associated with decreased cognitive function in older women. These findings contribute to comprehension of pathophysiology underlying cognitive decline and informing the development of new approaches to prevent, diagnose, monitoring and treat cognitive decline in aging.

A simple scoring algorithm based on intrinsic capacity for functional ability in community-dwelling older adults in Taiwan

BACKGROUND

Intrinsic capacity (IC) is a comprehensive indicator of the overall well-being of older adults, and assessing of IC can help identify early stage of disability and tailor intervention to individual needs. However, there is a lack of effective and simple IC assessment tools. This study aimed to establish predictive scoring algorithms of IC to identify older adults at high risk of impaired functional ability.

METHODS

We conducted a cross-sectional study in Southern Taiwan, measuring IC using 7 subitems: cognition, locomotion, vitality, vision, hearing, psychological well-being, and medication usage were measured. Functional ability outcomes included frailty, basic activities of daily living, and instrumental activities of daily living (IADL). The capability of 7 domains of IC in predicting functional ability was assessed by multivariable logistic regression. The prediction of capability of scoring algorithms was indicated by receiver operating characteristic (AUC) curves and measures of sensitivity and specificity.

RESULTS

A total of 1,152 older adults were recruited and analyzed. Locomotion emerged as a significant predictor of IADL disability and worsening frailty. The IC-based weighted scoring algorism for predicting IADL demonstrated satisfactory capability (AUC: 0.80), as did the algorithm for predicting worsening frailty (AUC: 0.90). The optimal cutoff points for predicting IADL disability and frailty worse were estimated respectively at 13 and 16, with sensitivity/specificity values of 0.74/0.75 for the IADL prediction algorithm and 0.92/0.77 for the frailty prediction algorithm.

CONCLUSION

Our 7-domain IC screening tool proves to be sensitive and practical for early identification of functional disability and frailty among community-dwelling older adults in Taiwan.

The strong inverse association between plasma concentrations of soluble tumor necrosis factor receptors type 1 with adiponectin/leptin ratio in older women

Complex inflammatory crosstalk between muscular and adipose organs during ageing is controlled by adipokines and myokines. The Adiponectin/Leptin ratio (A/L ratio) has proven to be a promising biomarker for identifying insulin sensitivity, cardiovascular risk and adipose tissue inflammation. Although the A/L ratio has been related to inflammatory conditions, its ability to associate with or indicate the behavior of other inflammatory mediators remains unknown. The present study aimed to verify the association between the A/L ratio and a panel of inflammatory biomarkers in community-dwelling older women. The plasmatic concentrations of adiponectin, leptin, resistin, brain-derived neurotrophic factor (BDNF), interferon-gamma (IFN-γ), interleukins 2, 4, 5, 6, 8 and 10, tumour necrosis factor (TNF) and its soluble receptors (sTNF-r) 1 and 2 were evaluated in 71 community-dwelling older women with 75 (±7) years. The A/L ratio was negative and inverse correlated with BNDF (r = -0.29; p = 0.01), IL-8 (r = -0.37; p = 0.001) and sTNFr- 1 (r = -0.98; p < 0.001) levels. A strong and inverse association, with proportional effect, between A/L ratio and sTNFr-1 concentrations was found (Adjusted R2 = 0.22; β = -0.48; p > 0.001). It suggests that the presence of sTNFr-1 causes an inflammatory effect that affect cross-talk between muscle and adipose tissue, contributing to pro-inflammatory imbalance, which may have molecular and functional consequences. In addition, we provide insights into diagnostic biomarkers for inflammation, especially related to muscle wasting and intrinsic capacity in older people.

Social determinants of intrinsic capacity: A systematic review of observational studies

BACKGROUND

The World Health Organization defined healthy ageing as the maintenance of functional ability with ageing. Intrinsic capacity is a measurement of healthy ageing, and can be shaped by social determinants. However, an overall understanding of how multiple social determinants contribute to intrinsic capacity remains unclear. We aim to summarize observational studies investigating the relationships between social determinants and intrinsic capacity among community-dwelling adults.

METHODS

A systematic search was conducted through Medline, Embase, PsycInfo, Web of Science, and CINAHL until August 14, 2023.

RESULTS

After reviewing 813 articles, we included 21 studies from nine countries in Asia, Europe, and America. Seventeen studies used a cross-sectional design and the others were longitudinal studies. Social determinants related to intrinsic capacity can be classified into five domains, containing socioeconomic status (16, 76.2% of studies), lifestyles (14, 66.7%), psychosocial factors (9, 42.9%), material circumstances (4, 19.0%), and healthcare systems (1, 4.8%). Strong evidence supported that better intrinsic capacity was associated with higher education, higher wealth, more physical activities, no smoking, more social engagement, and being married or partnered. The relationships of intrinsic capacity with dietary patterns and alcohol drinking were contradictory across studies. Research on the associations of working status, housing environments, and healthcare accessibility with intrinsic capacity was insufficient to draw conclusions.

CONCLUSION

These findings highlight roles of socioeconomic status, lifestyles, and psychosocial factors in improving intrinsic capacity thus promoting healthy ageing. Future research is needed to investigate causal relationships between social determinants and intrinsic capacity, especially material circumstances and healthcare systems.

Intrinsic Capacity and Its Biological Basis: A Scoping Review

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review

BACKGROUND

The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity.

METHODS AND FINDINGS

Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain.

CONCLUSION

Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.

Detection rate of decreased intrinsic capacity of older adults: a systematic review and meta-analysis

OBJECTIVES

To systematically assess the prevalence of decreased intrinsic capacity in older adults, stratified by relevant factors such as country, sex, sample source, and region.

METHODS

We conducted a comprehensive search of PubMed, Web of Science, EMBASE, The Cochrane Library, PsychINFO, CINAHL, China Knowledge Resource Integrated Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database to collect studies published on the decline of intrinsic capacity in older adults before February 24, 2023. The results of the study were analyzed using the Stata 15.0 software package, using a random-effects model to estimate the pooled detection rate of decreased intrinsic capacity in older adults. The Joanna Briggs Institute Critical Appraisal Tool was used to assess the quality of all included studies.

RESULTS

A total of 16 studies (67,881 older adults in 4 countries) were included. The results showed that the pooled detection rate of decreased intrinsic capacity in older adults was 76.1% (95% CI: 68.0%-84.2%). The 16 studies had obvious heterogeneity, and further subgroup analysis showed that the detection rate of decreased intrinsic capacity in older adults was higher in developed countries, females, and hospitals. Thirteen studies found that the pooled detection rate was 73.7% (95%: CI 64.5%-82.8%) for decreased intrinsic capacity in Chinese older adults, with higher rates in mainland China and Hong Kong than in Taiwan.

CONCLUSIONS

Our study suggests that intrinsic capacity declines more rapidly in older adults. Understanding the degree of decline in the intrinsic capacity of older adults will help to provide an important basis for the formulation and development of care policies for older adults.

TRIAL REGISTRATION NUMBER

PROSPERO (CRD42023402680).

Diagnostic performance analysis of the Integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity

BACKGROUND

Intrinsic capacity (IC) is a comprehensive indicator of an individual's positive attributes. The World Health Organization (WHO) recommends a two-step approach to assess IC decline among older people. The first step involves the used of the integrated care for older people (ICOPE) screening tool to identify potential issues, and the second step involves using detailed assessments for confirmation. This study aimed to assess the diagnostic performance of the ICOPE screening tool as a simple preliminary screening to identify IC decline among community-dwelling older people, which has been rarely reported in China.

METHODS

This cross-sectional study included 228 community-dwelling older individuals aged ≥ 75 (mean age, 84.0 ± 4.4 years; 131 [57.5%] females) who completed the IC evaluation according to the WHO IC assessment pathway. The diagnostic performance of the ICOPE screening tool was calculated using a 2 × 2 table and a receiver operating characteristic curve.

RESULTS

The proportion of possible IC decline identified by the ICOPE screening tool was 79.4%, whereas the actual IC decline assessed by the detailed assessment was 73.2%, mainly in locomotion. The ICOPE screening tool showed sensitivity and specificity of 94.6% and 62.3%, respectively, with an overall diagnostic accuracy of 86.0%. The diagnostic effectiveness of the ICOPE screening tool was 0.91 (95% confidence interval: 0.87-0.95, p = 0.020). Except for the sensory dimension, the sensitivity of the ICOPE screening tool for diagnosing impairments in each dimension of the IC was the highest in the cognition domain (100%) and the lowest in the vitality domain (51.3%), whereas the specificity was the highest in vitality (94.7%) and the lowest in cognition (55.6%).

CONCLUSIONS

The ICOPE screening tool exhibits high sensitivity and can be used as an IC screening tool in community-dwelling older people. However, further improvements are needed in the vitality dimension of the ICOPE screening tool to enhance its sensitivity in identifying individuals at risk of malnutrition.

Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study

BACKGROUND

intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains.

OBJECTIVES

to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes.

METHODS

secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity.

RESULTS

amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)).

CONCLUSIONS

half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.

Associations between Vitality/Nutrition and the Other Domains of Intrinsic Capacity Based on Data from the INSPIRE ICOPE-Care Program

BACKGROUND

The vitality domain of intrinsic capacity (IC) represents the synthesis of biological interactions and metabolism. As part of the Integrated Care for Older People (ICOPE) program developed by the World Health Organization (WHO), vitality focuses on the nutritional status of older adults. The objective of this work was to describe the vitality domain of IC in community-dwelling older people and to examine the associations of the vitality components (appetite loss and weight loss) with the other IC domains assessed within the framework of ICOPE.

METHODS

Cross-sectional data were obtained between January 2020 and February 2022 through the INSPIRE-ICOPE-Care program, a real-life ICOPE implementation initiative developed in the Occitania region of France. Participants were men and women aged 60 and older, looking for primary care services within the French healthcare system.

RESULTS

Appetite loss was reported by 14.0% (2013) of the participants, and weight loss by 12.4% (1788). A total of 863 participants (6.01%) declaring weight loss also suffered from appetite loss. In total, 2910 participants (20.27%) screened positive for the domain of vitality. Appetite loss was significantly associated with positive screenings for the domains of cognition (OR = 2.14 [1.84;2.48]), vision (OR = 1.51 [1.28;1.79]), hearing (OR = 1.18 [1.01;1.37]), psychology (OR = 3.95 [3.46;4.52]), and locomotion 'OR = 2.19 [1.91;2.51]). We found significant associations of weight loss with the IC domains of cognition (OR = 1.65 [1.42;1.93]), psychology (OR = 1.80 [1.56;2.07]), locomotion (OR = 1.64 [1.41;1.91]), vision (OR = 1.24 [1.04;1.47]), and hearing (OR = 1.32 [1.12;1.55]). People reporting simultaneous appetite and weight loss showed higher odds of screening positive for psychological (OR = 5.33 [4.53;6.27]) and locomotion impairments (OR = 3.38 [2.88;3.98]).

CONCLUSIONS

Appetite and weight loss are common among older people and are related to other potential IC impairments, especially psychological and locomotion. Further studies are needed to explore the longitudinal associations of vitality with the incidence of clinically meaningful declines in the other IC domains.

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

OBJECTIVES

This review summarizes the measurements of intrinsic capacity in 5 domains across different studies and evaluates the quality of research papers.

DESIGN

Scoping review of papers written in English and Chinese published in peer-reviewed journals.

SETTING AND PARTICIPANTS

The intrinsic capacity of older adults was assessed using the multidomain structure (Cognition, Locomotion, Psychological, Sensory and Vitality) proposed by the World Health Organization.

METHODS

We searched PubMed, MEDLINE, and Web of Science for papers in English, and CNKI, CBM for papers written in Chinese published until September 13, 2022. Both cross-sectional and cohort studies of multidomain measurements of intrinsic capacity were included. Three independent reviewers appraised the quality of studies, and Cohen's kappa was calculated to determine interrater reliability. Data were listed by author, year, setting, country, age range and number of participants, measurement and calculation of intrinsic capacity, and data acquisition method.

RESULTS

We included 53 studies. Twenty-one studies were of high quality, 31 studies were of moderate quality, and 1 study was of low quality. Measurements of intrinsic capacity and derivation of the summative index score were heterogeneous. Intrinsic capacity was usually assessed in 4 or 5 domains. Sensory was the most frequently overlooked domain or subdivided into vision and hearing in some studies. Indicators of vitality were the most heterogeneous. We also found consistency in heterogeneous measurements. The most common measurements of cognition, locomotion, and psychological capacity were the Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale respectively. Self-reported questionnaires were commonly adopted in sensory domain. The Mini-Nutritional Assessment and grip strength were the most measured indicators of vitality.

CONCLUSIONS AND IMPLICATIONS

The focus on capacity and disease should be balanced to better promote healthy aging in older adults. Heterogeneity of intrinsic capacity measurements underscores the need for consensus about standardized measurements and calculation procedures.

Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study

BACKGROUND

The World Health Organization (WHO) has developed the Integrated Care for Older People (ICOPE) strategy to face the challenges of ageing societies. This strategy is focused on person centered care and the assessment intrinsic capacity (IC). Early identification of five domains of IC (cognition, locomotion, vitality, sensory (hearing and vision), and psychological) has been shown to be related with adverse outcomes and can guide actions towards primary prevention and healthy ageing. IC assessment proposed by the WHO ICOPE guidelines is composed by two steps: First, Screening for decreased IC by the ICOPE Screening tool; second, by the reference standard methods. The aim was to assess the performance of diagnostic measures (sensibility, specificity, diagnostic accuracy, and agreement of the ICOPE Screening tool) compared to the reference standard methods in European community-dwelling older adults.

METHODS

Cross-sectional analysis of the baseline of the ongoing VIMCI (Validity of an Instrument to Measure Intrinsic Capacity) cohort study, which was carried out in Primary Care centers and outpatient clinics from 5 rural and urban territories in Catalonia (Spain). Participants were 207community dwelling persons ≥ 70-year-old with Barthel ≥ 90, without dementia or advanced chronic conditions who provided their consent to participate. The 5 IC domains were assessed by the ICOPE Screening tool and the reference methods (SPPB, gait speed, MNA, Snellen chart, audiometry, MMSE, GDS5) during patients' visit. Agreement was assessed with the Gwet AC1 index.

RESULTS

ICOPE Screening tool sensitivity was higher for cognition (0.889) and ranged between 0.438 and 0.569 for most domains. Specificity ranged from 0.682 to 0.96, diagnostic accuracy from 0.627 to 0.879, Youden index from 0.12 to 0.619, and Gwet AC1 from 0.275 to 0.842.

CONCLUSION

The ICOPE screening tool showed fair performance of diagnostic measures; it was helpful to identify those participants with satisfactory IC and showed a modest ability to identify decreased IC in older people with high degree of autonomy. Since low sensitivities were found, a process of external validation would be recommended to reach better discrimination. Further studies about the ICOPE Screening tool and its performance of diagnostic measures in different populations are urgently required.

Comparison of the predictive value of intrinsic capacity and comorbidity on adverse health outcome in community-dwelling older adults

OBJECTIVES

To compare the predictive value of intrinsic capacity (IC) and comorbidity on all-cause mortality and falls.

METHODS

This prospective cohort study included 220 older adults (84.0±4.4 years) followed for 3 years in a community in Beijing. The methodology recommended by the World Health Organization was used to assess IC, and comorbidity was assessed by the Cumulative Illness Rating Scale for Geriatrics.

RESULTS

The areas under the characteristic curve of IC and comorbidity were 0.78 vs. 0.67 (p=0.033), respectively, in predicting all-cause mortality, and 0.69 vs. 0.61 in predicting falls (p=0.032). The vitality domain impairment (odds ratio [OR]=3.28, p=0.013), and cognition domain impairment (OR=3.97, p=0.004) were significantly associated with all-cause mortality. Locomotion domain impairment (OR=2.35, p=0.010) was associated with higher fall risk.

CONCLUSION

IC might be a better predictor than comorbidity in community-dwelling older adults, in which the vitality, locomotion and cognition domains should be given more attention.

Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus

BACKGROUND

Intrinsic capacity (IC) is a novel concept focusing on normal and healthy aging. The effect of IC on the risk of chronic kidney disease (CKD) according to KDIGO category in older type 2 diabetes mellitus (T2DM) patients has rarely been studied. We investigated whether a decline in IC is associated with the risk of CKD according to KDIGO 2012 categories.

METHODS

This is a cross-sectional study. The exposure variables (IC score and body mass index) and outcome variable (KDIGO categories of the risk of CKD) were collected at the same timepoint. A total of 2482 older subjects with T2DM managed through a disease care program were enrolled. The five domains of IC, namely locomotion, cognition, vitality, sensory, and psychological capacity were assessed. Based on these domains, the IC composite score was calculated. CKD risk was classified according to the KDIGO 2012 CKD definition. Univariate and multivariate analyses were used to assess the association between IC score and KDIGO categories of risk of CKD.

RESULTS

The KDIGO CKD risk category increased in parallel with IC score (p for trend < 0.0001). In multivariate analysis, compared to those with an IC score 0, the odds ratio of having a KDIGO moderately increased to very high risk category of CKD was 1.76 (1.31-2.37) times higher for those with an IC score of 2-5. Furthermore, an increased IC score was associated with a higher prevalence of moderate and severe obesity. Moreover, there was a synergistic interaction between IC score and obesity on the KDIGO moderately increased to very high risk category of CKD (synergy index = 1.683; 95% CI 0.630-3.628), and the proportion of the KDIGO moderately increased to very high risk category of CKD caused by this interaction was 25.6% (attributable proportion of interaction = 0.256).

CONCLUSIONS

Our findings indicate that IC score may be closely related to the KDIGO moderately increased to very high risk category of CKD. In addition, there may be a synergistic interaction between IC score and obesity, and this synergistic interaction may increase the KDIGO CKD risk stage.

Comparative Analysis of Intrinsic Capacity Impairments, Determinants, and Clinical Consequences in Older Community-Dwellers in Japan and Taiwan: Longitudinal Studies Showing Shared Traits and Distinct Presentations

OBJECTIVES

Despite the recognized impact of intrinsic capacity (IC) impairment on healthy aging, international comparisons in different sociocultural contexts are scarce. This study aimed to compare IC impairment among community-dwelling older adults in Japan and Taiwan to explore the context of healthy aging in different countries.

DESIGN

Comparative observational study.

SETTING

National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan and Longitudinal Aging Study of Taipei (LAST) in Taiwan.

PARTICIPANTS

794 individuals (age range, 60.0-86.5 years) from NILS-LSA and 1,358 (60.0-96.7 years) from LAST.

MEASUREMENTS

IC impairment was evaluated across the domains of locomotion, cognition, vitality, sensory capacity, and psychological well-being. Participants were categorized as having impaired IC or healthy. We investigated associations between IC impairment, falls, and all-cause mortality.

RESULTS

IC impairment was present in 54.9% and 37.3% of participants in the NILS-LSA and LAST cohorts, respectively. Male NILS-LSA participants with impaired IC (odds ratio [OR]:1.50, 95% confidence interval [CI]:1.03-2.20), with hearing loss (OR:1.98, 95% CI:1.00-3.90) were more likely to fall. In LAST, impaired locomotion (OR:2.14, 95% CI:1.46-3.14) increased the risk of falls. Men with impaired IC (hazard ratio [HR]; 2.14, 95% CI:1.10-4.15) and visual impairment (HR:2.21, 95% CI:1.15-4.25) and women with impaired psychological well-being (HR:4.94, 95% CI:1.28-18.97) in the NILS-LSA cohort had greater risk for all-cause mortality; however, this was not shown for LAST participants.

CONCLUSION

The prevalence and distribution of IC impairment and associated biomarkers differed significantly between participants in Japan and Taiwan. However, the associations with adverse outcomes remained similar, emphasizing the need for tailored interventions for healthy aging.

Exploring the Presence of Humanoid Social Robots at Home and Capturing Human-Robot Interactions with Older Adults: Experiences from Four Case Studies

BACKGROUND

Social robots have the potential to bring benefits to aged care. However, it is uncertain whether placing these robots in older people's home is acceptable and whether human-robot interactions would occur or not.

METHODS

Four case studies were conducted to understand the experiences of older adults and family caregivers when humanoid social robot Ka Ka was placed in homes for two weeks.

RESULTS

Four older adults and three family caregivers were involved. Older adults interacted with the social robot Ka Ka every day during the study period. 'Talking to Ka Ka', 'listening to music', 'using the calendar reminder', and 'listening to the weather report' were the most commonly used features. Qualitative data reported the strengths of Ka Ka, such as providing emotional support to older adults living alone, diversifying their daily activities, and enhancing family relationships. The voice from Ka Ka (female, soft, and pleasing to the ear) was considered as 'bringing a pleasant feeling' to older adults.

CONCLUSIONS

In order to support aging-in-place and fill the gaps of the intensified shortage of health and social manpower, it is of prime importance to develop reliable and age-friendly AI-based robotic services that meet the needs and preferences of older adults and caregivers.

Approaching person-centered clinical practice: A cluster analysis of older inpatients utilizing the measurements of intrinsic capacity

Background

Maintaining the intrinsic capacity (IC) of older inpatients is a novel view in providing person-centered treatments in clinical practice. Uncertainty remains regarding the primary nature of IC among older hospitalized patients.

Objectives

We aimed to understand the status of IC among older inpatients by a cluster analysis based on IC measurements.

Methods

This is a cross-sectional study conducted in the geriatric department of Beijing Hospital in China. Older inpatients who were older than 60 years and who underwent comprehensive geriatric assessments were included. The inpatients were classified into subgroups based on 13 measurements of IC according to unsupervised methods (K-means cluster analysis and t-SNE). Subgroup differences were investigated for domains of IC, age, sex, frailty, activities of daily living, and falls.

Results

A total of 909 inpatients with a mean age of 76.6 years were included. Almost 98% of the inpatients showed IC impairment. Locomotion impairment was the most prevalent problem (91.1%), followed by sensory impairment (61.4%), psychological impairment (57.3%), cognition decline (30.7%), and vitality problem (29.2%). A total of five clusters were obtained by classification: Cluster 1 (56.6% of the participants) showed high IC with fair impairment of locomotion and vision; clusters 2 and 3 (37.8 % of the participants) had additional impairment of sleep in the psychological domain; clusters 4 and 5 (5.6% of the participants) represented a severe loss of all the IC domains; and clusters 1-5 showed a gradual decline in the IC score and were significantly associated with increased age, frailty, decreased activities of daily living, and falls. Significant correlations among the domains were observed; the locomotion domain showed the strongest links to the others in network analysis.

Conclusions

Great declines in IC and disparities between IC domains were found in older inpatients. IC-based primary assessment and classification enabled us to identify the variation of functional abilities among the older inpatients, which is pivotal for designing integrated treatment or care models in clinical practice.