Intrinsic Capacity in Older Adults: Recent Advances

Multidomain intervention for delaying aging in community-dwelling older adults (MIDA): study design and protocol

BACKGROUND

The exploration of interventions to delay aging is an emerging topic that promotes healthy aging. The multidomain intervention has the potential to be applied in the field of aging because it concentrates on the functional ability of older adults. There is currently no literature reporting on a multidomain intervention involving cognition, exercise and nutrition for delaying aging.

METHODS

The Multidomain Intervention for Delaying Aging in Community-dwelling Older Adults (MIDA) is a Zelen-design randomized controlled trial with a 6-month intervention duration. The multidomain intervention comprises cognitive training, exercise training, and nutritional guidance, delivered through both group sessions and individual family interventions. A total of 248 participants aged 60 to 85 years will be randomized to the intervention group or control group and followed up for 12 months. The primary outcome is the change in epigenetic age acceleration and pace of aging following the multidomain intervention. The secondary outcomes are the changes in frailty score and intrinsic capacity Z-score. Other outcomes include physical functions, body composition, aging biomarkers, inflammatory markers, haematology and biochemistry parameters, and lifestyle factors.

CONCLUSIONS

This study will explore the effects of the multidomain intervention on delaying aging in community-dwelling older adults. We aim to introduce a new approach to delaying aging and offer a practical multidomain intervention strategy for healthcare institutions.

New insights on the use of mini nutritional assessment: Impact of alternative calf circumference cutoffs

BACKGROUND & AIMS

The Mini Nutritional Assessment - Short Form (MNASF) is an easy, quick, and validated tool for screening and diagnosing malnutrition among older individuals. Despite its clinical relevance, using body mass index (BMI) and a universal calf circumference (CC) cutoff might pose limitations. Therefore, our study aimed to investigate the potential of using sex-specific and BMI-adjusted CC cutoff values within the MNA-SF to classify nutritional status and assess its prognostic significance.

METHODS

Older patients hospitalized with varied diagnoses were included. BMI and CC measurements were conducted by registered dietitians. MNA-SF, which considers either BMI or CC, was utilized to classify nutritional status. Patients scoring 0-7 points were classified as malnourished. Four different approaches for MNA-SF were considered: Traditional: i) using BMI, ii) the alternative/surrogate using a non-sex specific CC < 31 cm; Newly adapted approaches: iii) using sex-specific CC cutoff values ≤ 34 cm for men and ≤33 cm for women, without BMI adjustment factors; iv) using sex-specific BMI-adjusted CC cutoff values ≤ 34 cm for men and ≤33 cm for women. BMI adjustment factors were: -3 cm of CC for BMI 25-29.9 kg/m2, -7 cm for BMI 30-39.9 kg/m2, and -12cm for BMI ≥40 kg/m2. The prevalence of nutritional categories across different MNA-SF approaches was estimated. Cox regression analysis and Receiver Operating Characteristic (ROC) curve analysis were performed to evaluate and compare their predictive significance for overall survival.

RESULTS

This study included 242 patients (58.8 % men, median age of 68 years, interquartile range: 64 to 74). Cancer was the most frequent reason for hospitalization (36.6 %). Scores in MNA-SF were significantly lower when using sex-specific unadjusted & BMI-adjusted CC. The frequency of malnutrition ranged from 21.9 % (MNA-SF using BMI) to 41.7 % (MNA-SFadj.CC≤34/33). The incidence of mortality was significantly higher among malnourished patients classified using the sex-specific unadjusted (58.2 %) and BMI-adjusted CC approaches (63.3 %), compared to 38.2 % and 40 % when using BMI and the non-sex-specific CC < 31 cm, respectively. All approaches had similar survival prediction (area under the ROC curves 65-67 %), and were independently associated with mortality. Using BMI-adjusted CC with sex-specific cutoff values (≤33/34) within the MNA-SF significantly improved survival prediction sensitivity (63.6 % versus 38.2 % with BMI and 40 % with CC < 31). Malnourished patients classified by MNA-SF using sex-specific and BMI-adjusted CC cutoff values ≤ 33/34 exhibited the highest risk of mortality based on hazard ratios, compared to those classified by MNA-SF using BMI or CC < 31.

CONCLUSION

Our study demonstrates that using sex-specific, unadjusted, and BMI-adjusted CC cutoffs values within MNA-SF classified a greater number of patients at risk of or already experiencing malnutrition, as well as a higher incidence of mortality among malnourished individuals. These methods showed greater sensitivity and achieved a more balanced trade-off between sensitivity and specificity compared to traditional approaches (using BMI or CC < 31). Pending future validation, these approaches have potential to offer a more reliable alternative for assessing nutritional status and improving prognostication in this population.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

TRIAL REGISTRATION NUMBER

ChiCTR2400087028.

Intrinsic capacity trajectories and cardiovascular disease incidence among Chinese older adults: a population-based prospective cohort study

BACKGROUND

Intrinsic capacity (IC), a composite of physical and mental capacities, is a marker of healthy aging. However, the association between changes in IC and trajectories in older adults and the onset of cardiovascular diseases (CVD) remains unclear.

OBJECTIVE

To identify IC trajectories over time and assess the associations between IC trajectories and the incidence of CVD among older adults.

METHODS

The prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. To determine IC trajectory during 2011-2015, we included adults aged 60 years or older without CVD at baseline, who completed the follow-up visits in 2013 and 2015. We assessed IC through five domains (locomotion, sensory, vitality, cognition, and psychology) using the WHO framework. We determined the onset of CVD by self-reported diagnoses of heart disease or stroke. We performed a group-based trajectory model to identify IC trajectory, and cox proportional hazard models to estimate the adjusted hazard ratio (HR) for CVD incident across different IC trajectory groups, adjusting for sociodemographic factors, lifestyle health behaviors, and cardiovascular metabolic factors.

RESULTS

The study included 3 336 adults without CVD at baseline, with the mean age of 66.64 (SD:5.53) years, and 49.4% were male. The baseline mean IC score was 5.40 (SD:1.70). We identified three IC trajectory: (1) moderate IC with subsequent increase (61.3%), (2) low IC with slow decline (27.61%), and (3) high IC with subsequent decline (11.09%). During the average follow-up of 6.78 years, we identified 1,351 cases of incident CVD. After adjusting for covariates, adults who in the low IC with slow decline group were 1.68 (95% CI: 1.38-2.04) times more likely to develop CVD, compared to adults in the high IC with subsequent decline group.

CONCLUSION

IC trajectory among Chinese older adults is heterogeneous. Low IC with slow declining is associated with an increased risk of CVD incidence.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR PRACTICE

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

Development 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.

A functional approach to model intrinsic capacity in ageing trajectories

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

Identification of Facilitators and Barriers to Functional Ability in Elderly Stroke Patients: A Descriptive Qualitative Study

Purpose

Stroke can cause long-term disability in elderly individuals, and improving the functional ability of patients is vital. This study sought to determine the facilitators and barriers to functional ability in elderly stroke patients from the perspective of healthy aging and to provide a theoretical basis for precise interventions.

Patients and Methods

This study was conducted between December 2023 and January 2024. Eleven patients and eight medical staff from a tertiary hospital were selected for semi-structured interviews using purposive sampling. The interview data were analyzed using thematic analysis.

Results

A total of 19 interviewees participated, including 11 patients and eight medical staff members. Among the patients, four had hemorrhagic stroke and seven had ischemic stroke; ages ranged from 60 to 77 years. Among the medical staff, five had bachelor's degrees and three had master's degrees; ages ranged from 30 to 47 years. Five major themes were identified, including 16 sub-themes. Key themes included: medical service factors, health belief factors, patient factors, family factors, and social/environmental factors.

Conclusion

The core elements for improving the functional ability of patients are establishing a service model of multidisciplinary teamwork; guaranteeing the continuity of in-hospital and home rehabilitation; enriching the form and content of health education to improve patient knowledge of the disease; providing psychological support to alleviate patients' negative emotions; and establishing of effective social safeguards and support systems.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

The relationship between intrinsic capacity and functional ability in older adults

INTRODUCTION

Intrinsic Capacity in integrated geriatric care emphasizes the importance of a thorough functional assessment. Monitoring the intrinsic capacity of older individuals provides standardized and reliable information to prevent early disability. This study assessed the relationship between intrinsic capacity and functional ability in older adults.

METHOD

This cross-sectional study involved 210 older individuals aged 60 and above referred to Rasoul Akram Hospital. Data collection included ADL and IADL scales, the Snellen chart, the Hearing Handicap Inventory, the hand dynamometer, the TUG test, the AMT test, and the GDS. Data analysis was conducted using SPSS software v.26 via independent t-tests, ANOVA, Pearson correlation coefficient, and multiple regression analysis.

RESULTS

The participants were 70.13 ± 7.04 years. 57.6% were older females and 42.4% were older males. Age showed a significant and inverse correlation with both ADL (P < 0.001, r = -0.23) and IADL (P < 0.001, r = -0.39). The adjusted coefficient of determination (R²) for the five domains of intrinsic capacity (sensory, cognitive, locomotion, psychological, vitality) as well as age and BMI was 0.16 for ADL and 0.32 for IADL.

CONCLUSION

Age and TUG could only weakly explain ADL changes, while vision, hand grip strength, cognition, and age had moderate predictive ability of IADL. Therefore, by assessing these predictors, we can predict disability before it occurs and make necessary interventions.

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

AIM

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

DESIGN

A qualitative descriptive design was adopted.

METHODS

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS

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

IMPACT

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

REPORTING METHOD

Adheres to the COREQ guidelines for qualitative research.

PATIENT OR PUBLIC CONTRIBUTION

None.

The role of socioeconomic factors in sex differences in intrinsic capacity among older adults: A cross-sectional study in Taiwan

Objectives

The World Health Organization's Integrated Care for Older People (ICOPE) framework launched in 2019 is used to assess the intrinsic capacity of older individuals. Older women may face greater socioeconomic disadvantages, which can impact their physical and mental well-being. Therefore, we examined sex differences in intrinsic capacity and the influence of socioeconomic status.

Methods

We conducted a cross-sectional study in Tainan, Taiwan, recruiting 1,268 adults aged 60 or older in 2022. The ICOPE screening assessed cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Intrinsic capacity scores ranged from 0 to 6 and were categorized as impairment (1 or higher) or no impairment (0). Binary logistic regression models were used to analyze sex differences in intrinsic capacity, adjusting sequentially for demographics, lifestyle, and socioeconomic factors.

Results

The prevalence of intrinsic capacity impairment was 34 %. Women had significantly higher odds of intrinsic capacity impairment (women vs. men, odds ratio [OR] = 1.39, 95 % CI = 1.10-1.75). After sequentially adjusting for demographic characteristics, lifestyle, and socioeconomic factors, the ORs were 1.46 (95 % CI = 1.12-1.90), 1.69 (95 % CI = 1.23-2.31), and 1.24 (95 % CI = 0.88-1.73), respectively. Stratified analyses showed that higher odds of impairment in women than in men was evident only in the financially dependent group (P for interaction = 0.059).

Conclusions

Older women in Taiwan have poorer intrinsic capacity than men, a disparity largely attributable to women's lower socioeconomic status. Strategies to promote healthy aging among women from disadvantaged socioeconomic backgrounds may help mitigate this sex difference in intrinsic capacity.

The ability of decline in intrinsic capacity to indicate the risk of mortality in older adults: A meta-analysis

OBJECTIVE

To evaluate the ability of decline in intrinsic capacity to indicate the risk of mortality in older adults.

DESIGN

Meta-analysis.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, CNKI, VIP, and CBM were searched for relevant studies published from inception to October 31, 2023. Stata17.0 software was used to perform the meta-analysis. A random effects model was used to pool the results of the risk of mortality (as hazard ratios, HRs) in older adults and decline in intrinsic capacity. The Newcastle Ottawa Scale was used to evaluate the quality of studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to determine the confidence in the estimated effect of pooled outcomes.

RESULTS

Twelve studies, with a total of 38,531 participants, were included in this meta-analysis. The findings show that older adults with intrinsic capacity decline have a higher risk of mortality (HR = 1.11, 95 % CI 1.08-1.14, I2 = 95.9 %, P<0.001) than older adults with normal intrinsic capacity. The pooled HR estimates for the locomotion, vitality, and cognitive dimensions of intrinsic capacity in the prediction of mortality were 0.89 (HR = 0.89, 95%CI 0.83-0.96, I2 = 41.3 %, P = 0.146), 0.76 (HR = 0.98, 95 % CI 0.59-0.97, I2 = 60.8 %, P = 0.078), and 0.99 (HR = 0.99, 95 % CI 0.98-1.00, I2 = 0.0 %, P = 0.664), respectively. The pooled HR estimates of the psychological dimension to predict mortality were not statistically significant (P > 0.05). GRADE evaluations of outcome indicators were of moderate confidence.

CONCLUSIONS

Decline in intrinsic capacity is a significant predictor of mortality. Locomotion, vitality, and cognition dimensions can all predict mortality. Clinical personnel should early assess the intrinsic capacity of older adults, focusing on changes in the dimensions of locomotion and vitality, to identify the risk of mortality, avoid adverse health outcomes, and improve the quality of life of older adults. Review protocol registered in PROSPERO: CRD42023481246.

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.

Intrinsic capacity and survival among older adults with gastrointestinal malignancies: The Cancer and Aging Resilience Evaluation registry

BACKGROUND

Intrinsic capacity (IC) was introduced by the World Health Organization (WHO) as a marker of healthy aging, and is defined as the combination of an individual's physical, mental, and psychological capacities. This study aimed to assess IC via a patient-reported geriatric assessment (GA) and evaluate its association with survival among older adults with gastrointestinal (GI) malignancies.

METHODS

Data were used from a single-institution prospective registry of older adults undergoing GA before cancer therapy. Key domains of IC (vitality, locomotion, and sensory [hearing and visual], psychological, and cognitive capacities) were captured via GA, and each was given a score of 0 or 1 (0, impaired) to compute the total IC score (range, 0-6, where 6 indicates no impairment and ≤5 indicates impairment in ≥1 domains). A frailty index (FI) was measured via the deficit accumulation method. Cox regression models and Kaplan-Meier curves were used to examine the impact of IC impairment on survival.

RESULTS

The study included 665 patients; the median age was 68 years, 57.4% were men, and 72.9% were White. The median IC score was 4, and 79.3% of participants showed impairment in ≥1 domains of IC. Most commonly impaired domains were locomotion (48.7%) and vitality (43.9%). IC was inversely associated with FI (Spearman coefficient, -0.75; p < .001). IC impairment was associated with inferior overall survival (score, 4-5: adjusted hazard ratio [aHR], 1.7; 95% CI, 1.11-2.48; score, 2-3: aHR, 1.9; 95% CI, 1.30-2.85; score, 0-1: aHR, 1.9; 95% CI, 1.11-2.48).

CONCLUSIONS

IC impairment is associated with frailty and reduced overall survival in older patients with GI malignancies. GA can be used to screen for IC impairment as recommended by the WHO.

PLAIN LANGUAGE SUMMARY

The World Health Organization introduced intrinsic capacity as a marker of healthy aging. Intrinsic capacity is the combination of an individual's physical, mental, and psychological capacities. It contains six key domains: vitality, locomotion, and sensory (hearing and visual), psychological, and cognitive capacities. Older adults with cancer are susceptible to a decrease in intrinsic capacity as a result of cancer and the aging process. In this study, we aimed to assess the intrinsic capacity for patients with gastrointestinal cancer and also identify whether there exists any association of intrinsic capacity with overall survival. We identified that approximately 80% of this population had one or more impaired domains, and more intrinsic capacity impairment was associated with reduced overall survival.

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.

Frailty: a global health challenge in need of local action

Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.

Oral frailty: A concept analysis

AIM

To clarify the concept of oral frailty to provide a clear and standardized conceptual basis for further research in older people.

DESIGN

Rodgers and Knafl's evolutionary concept analysis approach.

METHODS

The narrative analysis detailedly extracted and synthesized the attributes of oral frailty, as well as its antecedents, consequences and related terms under the guidance of Rodgers' evolutionary method.

DATA SOURCES

Multiple databases including Pubmed, CINAHL and Cochrane were searched using selected search terms 'oral frail*', 'oral health' and 'aged' respectively. Articles written between 2013 and 2023 were included, and grey literature was excluded.

RESULTS

A total of 32 articles were included for further analysis and synthesis. The attributes of oral frailty were hypofunction, predisposing in nature, non-specific and multidimensional. Antecedents of prefrailty were classified into four categories, namely, sociodemographic characteristics, comorbidity, physical function and psychosocial factors. Consequences of oral frailty include three themes: increased risk of adverse outcomes, poor nutritional status and possibility of social withdrawal. Related terms that had shared attributes with oral frailty were oral health, functional dentition, oral hypofunction and deterioration of oral function.

CONCLUSIONS

Oral frailty is an age-related phenomenon reflected in decreased oral function. The findings of this concept analysis are conducive to understanding and clarifying the oral frailty, which can help clinicians or other healthcare providers to consider how to distinguish oral frailty in older adults and further promote the development of this field.

IMPACT

Oral frailty is increasingly recognized as an age-related phenomenon reflected in decreased oral function. As it is newly proposed, no consensus has been reached regarding the theoretical and operational concept of it. Through clarifying the concept, this paper will guide future healthcare research on oral frailty regarding the influencing factors, mechanisms and interventions, thus raising the awareness with regard to oral health among older adults. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: In the context of older adults, oral frailty is a concept that requires further research to guide future theoretical development, and the influencing factors, mechanisms and interventions need to be further studied. Raise awareness with regard to oral health among older people and more attention will be paid to the early identification and intervention of oral frailty, so as to further improve the quality of life of older adults.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Visit-to-visit blood pressure variability is associated with intrinsic capacity decline: Results from the MAPT Study

BACKGROUND

The effectiveness of the body physiological regulatory mechanisms declines in late life, and increased Blood Pressure Variability (BPV) may represent an alteration in cardiovascular homeostatic patterns. Intrinsic Capacity (IC) has been proposed by the World Health Organization as a marker of healthy aging, based on individual's functional abilities and intended at preserving successful aging. We aimed to investigate the association of visit-to-visit BPV with IC decline in a population of community-dwelling older adults.

METHODS

The study population consisted of 1407 community-dwelling participants aged ≥70 years from the MAPT study evaluated during the 5-year follow-up. Systolic BPV (SBPV) and diastolic BPV (DBPV) were determined through six indicators. Cognition, psychology, locomotion and vitality constituted the four IC domains assessed. Total IC Z-score resulted from the sum of the four domains Z-scores divided by 4. The incidence of domain impairment over time was also assessed.

RESULTS

Higher SBPV was significantly associated with poorer IC Z-scores in all linear mixed models [1-SD increase of CV%: β(SE)=-0.010(0.001), p < 0.01]. Similar results were observed for DBPV [1-SD increase of CV%: β(SE)=-0.003(0.001), p = 0.02]. Incident IC impairment was significantly higher in participants with greater SBPV, [HR=1.16 (95 % CI, 1.01-1.33), p = 0.03], while greater DBPV did not show a higher risk of incident IC impairment.

CONCLUSIONS

Greater BPV is associated with IC decline over time. Our findings support BP instability as a presumable index of altered cardiovascular homeostatic mechanism, suggesting that BPV might be a clinical marker of aging and addressable risk factor for promoting healthy aging.

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.

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.

A State-of-the-Art of Exoskeletons in Line with the WHO's Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle-foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.

Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity

BACKGROUND

Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity.

METHODS

Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities.

RESULTS

We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory.

CONCLUSIONS

These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Evaluating the impact of aerobic and resistance green exercises on the fitness, aerobic and intrinsic capacity of older individuals

OBJECTIVE

Our study determined the impact of 12-week aerobic exercise (AE) and aerobic + resistance exercises (AE + RE) within the green exercise concept, on senior fitness, aerobic capacity, and intrinsic capacity (IC).

METHODS

The study was a multicenter, randomized controlled study conducted at two senior living facilities with individuals aged 65 and above whose cardiorespiratory and musculoskeletal conditions are suitable for moderate exercise and who have normal cognition levels. Block randomization was applied to 96 participants in a ratio of 1:1:1 to be assigned to AE, AE + RE, and control (C) groups. Intervention groups received exercise sessions led by physiotherapists within the senior living facilitiy gardens, with a frequency of once a week for 50 min, for 12 weeks. Also, they were prescribed additional exercise sessions on two additional days of the week. At the commencement of the study and 12th week, shuttle walking test, senior fitness test (SFT), intrinsic capacity assessment (with Timed Up and Go test, Mini Mental State Examination, Geriatric Depression Scale-15, Mini Nutritional Assessment, handgrip strength test) was conducted of all participants. The primary outcome was the Z score of IC, secondary outcomes were VO2max and SFT subparameters. The study was registered in the Protocol Registry and Results System (Clinicaltrials.gov PRS) with the registration number NCT05958745.

RESULTS

90 participants successfully completed the study, with 30 individuals in each of the AE, AE + RE, and C groups. By the end of the 12th week, the arm curl score was significantly higher in the AE + RE compared to the C (mean difference: 3.96, 95 % CI= 2.47 to 5.46, p = 0.01). There were significant differences in chair stand, two-minute step, 8-foot up-and-go, chair sit and reach, and back scratch tests in both AE and AE + RE compared to C. AE and AE + RE exhibited significantly higher shuttle test distances and VO2max values compared to the C (p < 0.0001). AE + RE achieved a significantly higher total IC score than the C (mean difference: 0.59, %95 CI= -0.07 to 1.26, p = 0.025).

CONCLUSION

In this study within the green exercise concept, both AE and AE + RE led to similar improvements in strength, flexibility, mobility, endurance, and aerobic capacity. Notably, AE + RE demonstrated an additional benefit by increasing the total IC, while AE alone did not exhibit the same effect.

Cerebellum and Aging: Update and Challenges

The cerebellum plays a vital role in the aging process. With the aging of the cerebellum, there is a decline in balance and motor function, particularly fine motor skills, and an increased risk of falling. However, in recent years, numerous studies have revealed that the cerebellum has several roles besides balance and fine motor skills, such as cognitive function and memory. It also plays a role in many neurodegenerative diseases. Interestingly, the cerebellum ages more rapidly than other brain regions, including the hippocampus. With increasing studies reporting that the cerebellum has a more prominent and interconnected role in the brain, it is essential to understand why aging affects it more, leading to solutions to help curb the accelerated decline. Here, we summarize the cerebellum's function and look at how it ages at the cellular, molecular, and functional levels. Additionally, we explore the the effects of alcoholism on the aging cerebellum as well as the role of the cerebellum in diseases such as Alzheimer's, Parkinson's, and Multiple Sclerosis.

Intrinsic capacity trajectories, predictors and associations with care dependence in community-dwelling older adults: A social determinant of health perspective

AIMS

To identify intrinsic capacity trajectories, predictors of intrinsic capacity trajectories and associations between intrinsic capacity trajectories and care dependence in community-dwelling older adults in China.

METHODS

A retrospective longitudinal study was conducted, and the data were obtained from a five-year national longitudinal cohort study of older adults in China between 2011 and 2015. The social determinants of health framework informed the data analysis and interpretation.

RESULTS

A total of 3893 older adults met the selection criteria and were included in the study. Three intrinsic capacity trajectories were identified: high trajectory (15.7 %), stable trajectory (52.7 %) and declining trajectory (31.6 %). Social determinants contribute to intrinsic capacity decline in older adults. Decreased cognitive function, psychological status, and locomotion at baseline were associated with care dependence.

CONCLUSION

Approximately thirty percent of the older adults in this cohort study experienced a decline in intrinsic capacity within a 5-year period. Social determinants contributed to this decline in older adults.

Household polluting cooking fuels and intrinsic capacity among older population: A harmonized nationwide analysis in India and China

BACKGROUNDS

Household polluting cooking fuels, as an important changeable behavior, are related to various detrimental health effects among the elderly. There is limited research on the association between polluting cooking fuel use and intrinsic capacity (IC) as an indicator of healthy aging. This study aimed to evaluate the above-mentioned association in India and China, where polluting cooking fuel use is common.

METHODS

We enrolled 33,803 participants aged ≥60 years from two nationally representative studies: the Longitudinal Aging Study in India and the China Health and Retirement Longitudinal Study. Polluting cooking fuel use was defined as a self-report of using wood, coal, kerosene, crop residue, or dung. IC was measured by five aspects, including locomotion, cognition, vitality, sensory, and psychological capacity. The random-effects mixed linear regression and logistic regression with population weighting were performed. Multivariable-adjusted model and propensity score were used to adjust for potential confounders.

RESULTS

A total of 47.54 % and 59.32 % of elderly adults reported primary cooking using polluting fuels in India and China, respectively. Using polluting cooking fuels was consistently associated with IC decline; particularly, cognitive capacity was the most susceptible domain. In India, participants using polluting fuels had a 1.062 (95 % confidence interval [CI]: 1.047-1.078) times risk for IC deficits, whereas more prominent results were observed in China (odds ratio [OR]: 2.040, 95 % CI: 1.642-2.533). Such harmful effects might be alleviated by transferring from polluting to clean fuels. Additionally, the duration of polluting fuel use was also positively associated with IC deficits.

CONCLUSION

This study provided substantial public implications on healthy aging for the elderly population at a global scale, strengthening the importance of health education and policy efforts to accelerate the transition from polluting to clean fuels.

Use of behavior change techniques in physical activity programs and services for older adults: findings from a rapid review

BACKGROUND

Understanding behavior change techniques (BCTs) used in randomized controlled trials (RCTs) of physical activity programs/services for older adults can help us to guide their implementation in real-world settings.

PURPOSE

This study aims to: (a) identify the number and type of BCTs used in physical activity programs/services for older adults evaluated in large, good quality RCTs and (b) explore the impact of different BCTs on different outcome domains.

METHODS

This is a secondary data analysis of a WHO-commissioned rapid review of physical activity programs/services for older adults. Fifty-six trials testing 70 interventions were coded for the type and number of BCTs present using a published BCT taxonomy. The proportion of positive effects found from physical activity interventions using the most common BCTs was calculated for the outcomes of physical activity, intrinsic capacity, functional ability, social domain, cognitive and emotional functioning, and well-being and quality of life.

RESULTS

Thirty-nine of the 93 possible BCTs were identified in the included trials and 529 BCTs in total (mean 7.6, range 2-17). The most common BCTs were "action planning" (68/70 interventions), "instructions on how to perform a behavior" (60/70), "graded tasks" (53/70), "demonstration of behavior" (44/70), and "behavioral practice/rehearsal" (43/70). Interventions that used any of the most common BCTs showed overwhelmingly positive impacts on physical activity and social domain outcomes.

CONCLUSION

Consideration of which BCTs are included in interventions and their impact on outcomes can improve the effectiveness and implementation of future interventions. To enable this, providers can design, implement, and evaluate interventions using a BCT taxonomy.

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

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

The Association between Kidney Function Biomarkers and Delayed Memory Impairments among Older Adults in the European North of Russia

The prevention of memory decline requires better knowledge of biological markers. We studied the associations between kidney function biomarkers and memory decline (assessed with the Mini-Mental State Examination-MMSE) in elderly individuals without dementia (MMSE 24-30, age 60-74 years, n = 643, Arkhangelsk, Russia). Participants were divided by sex and into three groups according to the delayed memory performance: recall of 0-1, 2, and 3 out of 3 words. The median of serum creatinine was 82 μmol/L in men who recalled 2 words and both medians in those recalling 3 and 0-1 words were 87 μmol/L. The 90th percentile for creatinine in men recalling 0-1 words (115.0 μmol/L) exceeded the upper limit of the normal range (110.5 μmol/L), while those who recalled 3 and 2 words had 90th percentiles within the normal range (109 and 101 μmol/L, respectively). Glomerular filtration rates were normal (≥60 mL/min/1.73 m2) with a median of 92.0 mL/min/1.73 m2 in men who recalled 2 words, 84.4 and 84.9 mL/min/1.73 m2 in men who recalled 3 and 0-1 words, respectively. None of these associations were observed in women. A reduced serum creatinine in older non-demented men may indicate the initial stages of memory decline, while the increased creatinine may reflect further stages of memory impairment.

Exploratory graph analysis on the Connor-Davidson Resilience Scale (CD-RISC) among older adults in China

It is important for healthy aging to understand resilience in depth. This study aims to examine the dimensional structure underlying the Connor-Davidson Resilience Scale (CD-RISC) among Chinese older adults. Exploratory Graph Analysis (EGA) was used to evaluate the dimensional structure of CD-RISC in two large samples: training sample (n = 11,493) and cross-validation sample (n = 7662). Then, Confirmatory Factor Analysis (CFA) was used to compare the fit of the theoretical dimensions with the EGA dimensions. Finially, Generalized Linear Model was used to examine the association between resilience scores and self-rated health (SRH) after controlling other covariates in order to evaluate the predictive value of the EGA dimensions. The EGA indicated two demensions(named foresight and self-adjustment) of the 25-item CD-RISC. The CFA comparison found that the two-demension structure of CD-RISC fit significantly better than the theoretical three-demension structure. After controlling for sociodemographic characteristics, generalized linear model showed that the EGA dimensions has better protective value with SRH. Compared with older adults with lowest quartile of foresight, those with second (odds ratio, OR = 0.68, 95% CI = 0.62 ~ 0.75), third (OR = 0.50, 95% CI = 0.45 ~ 0.56) and fourth quartile (OR = 0.42, 95% CI  =  0.37 ~ 0.48) of foresight had lower odds ratio of poor SRH. Similarly, older adults with the second (OR = 1.11, 95% CI = 1.01 ~ 1.23) and fourth (OR = 0.79, 95% CI = 0.69 ~ 0.90) quartile of self-adjustment also had lower OR of poor SRH than those with lowest quartile of self-adjustment. These findings show that EGA outperforms the traditional methods, which may be helpful to understand resilience deeply. CD-RISC should be interpreted into two aspects among community-dwelling older adults in China, highlighting the significance of the practical value and cultural context of resilience.

Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults

BACKGROUND

The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework.

OBJECTIVE

The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity.

METHODS

A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021.

RESULTS

The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff.

CONCLUSIONS

There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults.

Associations of intrinsic capacity, fall risk and frailty in old inpatients

Introduction

This study explored the associations of intrinsic capacity (IC), fall risk, and frailty in geriatric inpatients.

Methods

A total of 703 hospitalized patients aged 75 years or older were recruited for this retrospective observational study from Zhejiang Hospital using a comprehensive geriatric assessment. The IC composite score was constructed from the scores of the Chinese version of the Mini-Mental State Examination, Short Physical Performance Battery, Short Form Mini Nutritional Assessment, 15-item Geriatric Depression Scale, and self-reported hearing and vision impairment. Adverse outcomes were recorded as the fall risk and frailty using the Morse Fall Scale and the Clinical Frailty Scale. Spearman's correlation coefficient analyses and multivariate logistic regression models were used to explore the associations between IC, high fall risk, and frailty.

Results

Declined IC composite scores were associated with increased risks of falls [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.57-0.72] and frailty (OR = 0.45, 95%CI: 0.37-0.54) among older hospitalized patients after adjusting for the related potential confounders. In addition, decreased cognitive, vitality, locomotion, and psychological scores were associated with increased adverse health conditions, with ORs ranging from 0.26 to 0.70. Vision impairment was observed to increase the risk of frailty (OR = 0.42, 95%CI: 0.23-0.76) after adjusting for the related potential confounders.

Discussion

This study indicated that declined IC was associated with fall risk and frailty in older inpatients. Further prospective studies are needed to explore the longitudinal associations between baseline IC and subsequent risk of falls and frailty.

Association between sleep health and intrinsic capacity among older adults in Taiwan

Although the association between poor sleep quality and frailty has been previously reported, the relationship between sleep health and intrinsic capacity (IC) remains largely unknown. We aimed to examine the association between sleep health and IC among older adults. This was a cross-sectional study, and 1268 eligible participants completed a questionnaire collecting information on demographic, socioeconomic, lifestyle, sleep health, and IC. Sleep health was measured by the RU-SATED V2.0 scale. High, moderate, and low levels of IC were defined using the Integrated Care for Older People Screening Tool for Taiwanese. The ordinal logistic regression model estimated the odds ratio and corresponding 95% confidence interval. Low IC was significantly associated with age of 80 years or above, female, currently unmarried, uneducated, currently not working, financially dependent, and having emotional disorders. A one-point increase in sleep health was significantly associated with a 9% reduction in the odds of poor IC. An increase in daytime alertness was related to the greatest reduction in poor IC (aOR, 0.64; 95% CI, 0.52-0.79). In addition, the subitems sleep regularity (aOR, 0.77; 95% CI, 0.60-0.99), sleep timing (aOR, 0.80; 95% CI, 0.65-0.99), and sleep duration (aOR, 0.77; 95% CI, 0.61-0.96) were associated with a reduced OR of poor IC but with marginal statistical significance. Our findings showed that sleep health across multiple dimensions is related to IC, particularly daytime alertness in older adults. We suggest developing interventions to improve sleep health and prevent IC decline, which is crucial in causing poor health outcomes.

Evaluating the design of the Integrated Care for Older People: a theory of change approach

Introduction

Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City.

Methods

Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus.

Results

The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results.

Discussion

We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.

Intrinsic Capacity Declines with Elevated Homocysteine in Community-Dwelling Chinese Older Adults

Purpose

Intrinsic capacity (IC) reflects the overall health status of older adults and has great public health significance. But few studies described the related biomarkers for IC. The aim of this study was to investigate the association between homocysteine (Hcy) and IC in older adults.

Participants and Methods

This cross-sectional study included 1927 community-dwelling Chinese older adults aged 60–98 years from May 2020 to December 2020. Data were collected through interviews, physical examinations, and laboratory tests. IC involved five domains of cognition, locomotion, sensory, vitality, and psychology evaluated by the Mini-cog scale, 4-m walk test, self-reported visual and hearing conditions, MNA-SF scale, and GDS-4 scale, respectively. The score of each domain dichotomized as 0 (normal) and 1 (impaired) was added together to an IC total score. Low IC was defined as a score of 3–5, and high IC as 0–2. Hcy was measured by a two-reagent enzymatic assay. A restricted cubic spline regression model was used to explore the non-linear relationship between Hcy and low IC.

Results

Hcy was higher in the low IC group than in the high IC group. Restricted cubic spline analysis revealed a J-shaped nonlinear association between Hcy and low IC. The risk of IC decline was slowly decreased until 8.53 µmol/L of Hcy (OR=0.753, 95% CI=0.520–1.091, P=0.132), and increased with elevations of per 5 µmol/L Hcy afterwards (OR=1.176, 95% CI=1.059–1.327, P=0.005). Among the five domains of IC, Hcy had ORs of 1.116 (1.009–1.247) for cognition impairment, 1.167 (1.055–1.305) for vitality, and 1.160 (1.034–1.303) for psychology per 5 µmol/L increase in Hcy above the change point. Additional sensitivity analysis also demonstrated the nonlinear association between Hcy and low IC.

Conclusion

Hcy had a J-shaped association with low IC. Higher Hcy (Hcy ≥8.53µmol/L) might provide clinical implications for early identifying the risk of low IC.