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Zhang N, Guo J, Zhang M, Yu Y, Guo M, Xu H, Wang Z, Wu L, Wang X, Jiang X. Sleep disturbances and intrinsic capacity trajectories among Chinese older adults: The Rugao Longevity and Ageing Study. Geriatr Nurs 2024; 60:150-155. [PMID: 39244801 DOI: 10.1016/j.gerinurse.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
Age related decline of intrinsic capacity (IC) is the core of the functional ability and risk factor of adverse outcomes such as disability, hospitalization, and mortality. However, the relationship between sleep disturbance and IC decline are largely unknown. We conducted a longitudinal study and used data of 1514 community elders from the aging arm of the Rugao Longevity and Ageing Study. We found that poor sleep quality is cross-sectional associated with an increased risk of lower IC. In longitudinal analysis, sleep disturbances were inversely associated with composite IC score changes after adjusting for confounders (PSQI>5 vs. PSQI≤5: mean difference [-0.23], P = 0.0005), suggesting that poor sleep quality was associated with a decline in IC during the follow-up period. In conclusion, sleep disturbances were associated with worse IC changes. The results suggest that improving sleep health may help prevent IC decline and hence decreasing the burden of geriatric nursing practice.
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Affiliation(s)
- Na Zhang
- Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 201203, China
| | - Jianghong Guo
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Mengya Zhang
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Yingmei Yu
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Mei Guo
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Hao Xu
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Zhendong Wang
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Linliang Wu
- Rugao People's Hospital, Rugao, Jiangsu, China; Fudan University- the People's hospital of Rugao Joint Research Institute of Longevity and Aging, China
| | - Xiaofeng Wang
- Human Phenome Institute, Fudan University, 825 Zhangheng Road, Shanghai, China; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Jiang
- State Key Laboratory of Cardiology, Department of Pathology and Pathophysiology, School of Medicine, Tongji University, Shanghai 200092, China.
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Li N, Wang N, Lin S, Yuan Y, Huang F, Zhu P. A latent profile analysis of rest-activity behavior patterns among community-dwelling older adults and its relationship with intrinsic capacity. Sci Rep 2024; 14:18786. [PMID: 39138254 PMCID: PMC11322643 DOI: 10.1038/s41598-024-69114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
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.
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Affiliation(s)
- Na Li
- The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
- Department of Nursing, Fujian Provincial Hospital, Fuzhou, People's Republic of China
- The School of Nursing, Fujian Medical University, Fuzhou, People's Republic of China
| | - Nan Wang
- The School of Nursing, Fujian Medical University, Fuzhou, People's Republic of China
| | - Siyang Lin
- The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
| | - Yin Yuan
- The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, People's Republic of China
| | - Feng Huang
- The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, People's Republic of China.
- Fujian Provincial Center of Geriatrics, Fuzhou, People's Republic of China.
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.
| | - Pengli Zhu
- The Shengli Clinical Medical College of Fujian Medical University, Fuzhou, People's Republic of China.
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, People's Republic of China.
- Fujian Provincial Center of Geriatrics, Fuzhou, People's Republic of China.
- Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, People's Republic of China.
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Tan F, Wei X, Zhang J, Zhao Y, Tong X, Michel JP, Shao R, Gong E. The assessment and detection rate of intrinsic capacity deficits among older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:485. [PMID: 38831281 PMCID: PMC11149255 DOI: 10.1186/s12877-024-05088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
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.
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Affiliation(s)
- Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xiaoxia Wei
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Ji Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Yihao Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China
| | - Xunliang Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jean-Pierre Michel
- University of Geneva, Geneva, Switzerland
- French Academy of Medicine, Paris, France
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, 31, Beijige 3 Aly, Dongcheng District, Beijing, China.
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Wei X, Chen Y, Qin J, Yang Y, Yang T, Yan F, Zhang Z, Han L, Ma Y. Factors associated with the intrinsic capacity in older adults: A scoping review. J Clin Nurs 2024; 33:1739-1750. [PMID: 38345142 DOI: 10.1111/jocn.17017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 04/04/2024]
Abstract
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.
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Affiliation(s)
- Xiaoqin Wei
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yajing Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Jiangxia Qin
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Tingting Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Ziyao Zhang
- Lanzhou University of Arts and Science, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
- Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
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Li X, Ma L. From biological aging to functional decline: Insights into chronic inflammation and intrinsic capacity. Ageing Res Rev 2024; 93:102175. [PMID: 38145874 DOI: 10.1016/j.arr.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
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.
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Affiliation(s)
- Xiaxia Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China.
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Muneera K, Muhammad T, Pai M, Ahmed W, Althaf S. Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India. Sci Rep 2023; 13:9829. [PMID: 37330570 PMCID: PMC10276857 DOI: 10.1038/s41598-023-37097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/15/2023] [Indexed: 06/19/2023] Open
Abstract
The construct of intrinsic capacity (IC) in the context of integrated care for older adults emphasizes functional assessment from a holistic perspective. It provides reliable and comparable insights on subsequent functioning and disability. Given the paucity of research on IC and health outcomes in low- and middle-income countries (LMICs), the present study examined the association of IC with geriatric conditions of functional limitations and multiple fall outcomes among older adults in India. The data used for analysis come from the first wave of the Longitudinal Aging Study in India (LASI), 2017-2018. The final sample size contains 24,136 older adults (11,871 males and 12,265 females) age 60 years or above. Multivariable binary logistic regression is employed to examine the association of IC and other explanatory factors with outcome variables of difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, fall injury, and multiple falls. Of the total sample, 24.56% of older adults were observed to be in the high IC category. The prevalence of ADL difficulty, IADL difficulty, falls, multiple falls and fall-related injury is estimated to be 19.89%, 45.00%, 12.36%, 5.49% and 5.57%, respectively. Older adults who reported high IC had a significantly lower prevalence of ADL difficulty (12.26% vs 22.38%) and IADL difficulty (31.13% vs 49.52%) than those who reported low IC. Similarly, a lower prevalence of falls (9.42% vs 13.34%), fall-related injury (4.10% vs 6.06%) and multiple falls (3.46% vs 6.16%) were reported among those who had high IC. After adjusting for a large number of confounders such as age, sex, health-related attributes and lifestyle behaviors, older adults with high IC had significantly lower odds of ADL difficulty [aOR: 0.63, CI: 0.52-0.76], IADL difficulty [aOR: 0.71, CI: 0.60-0.83], falls [aOR: 0.80, CI: 0.67-0.96], multiple falls [aOR: 0.73, CI: 0.58-0.96] and fall-related injury [aOR: 0.78, CI: 0.61-0.99]. That a high IC was independently associated with a lower risk of functional difficulty and fall outcomes in later life is of enormous value in predicting subsequent functional care needs. More specifically, the findings here imply that because regular IC monitoring can predict poor health outcomes in older adults, improvements in IC should be prioritized while formulating disability and fall prevention strategies.
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Affiliation(s)
- K Muneera
- National Institute of Technology, Calicut, Kerala, 673601, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - S Althaf
- National Institute of Technology, Calicut, Kerala, 673601, India
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Liang Y, Shang S, Gao Y, Zhai J, Cheng X, Yang C, Zhang R. Measurements of Intrinsic Capacity in Older Adults: A Scoping Review and Quality Assessment. J Am Med Dir Assoc 2023; 24:267-276.e2. [PMID: 36332688 DOI: 10.1016/j.jamda.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Yetian Liang
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | | | - Yaxuan Gao
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China; Hebei Puai Aged Care Ltd. Co., Shijiazhuang, Hebei Province, PR China
| | - Jiahui Zhai
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Xiaohan Cheng
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Chen Yang
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Ruili Zhang
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China.
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Intrinsic Capacity to Predict Future Adverse Health Outcomes in Older Adults: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11040450. [PMID: 36832984 PMCID: PMC9957180 DOI: 10.3390/healthcare11040450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Intrinsic capacity is recognized as an important determinant of healthy aging and well-being of older adults; however, relatively little is known about the intrinsic capacity of older adults to predict adverse health outcomes. The study aimed to examine which adverse health outcomes of older adults can be predicted by intrinsic capacity. METHODS The study was conducted using the scoping review methodological framework of Arksey and O'Malley. A systematic literature search of nine electronic databases (i.e., Pubmed, Embase, Cochrane library, Web of science, CINAHL, China National Knowledge Infrastructure, VIP, Wanfang, and the Chinese Biological Medical Literature Database) were performed from the database's inception to 1 March 2022. RESULTS Fifteen longitudinal studies were included. A series of adverse health outcomes were assessed, including physical function (n = 12), frailty (n = 3), falls (n = 3), mortality (n = 6), quality of life (n = 2) and other adverse health outcomes (n = 4). CONCLUSIONS Intrinsic capacity could predict some adverse health outcomes of different follow-up times for older adults; however, due to the small number of studies and sample size, more high-quality studies are necessary to explore the longitudinal relationships between intrinsic capacity and adverse health outcomes in the future.
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Tang WH, Yu TH, Lee HL, Lee YJ. Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2023; 15:1. [PMID: 36588165 PMCID: PMC9806894 DOI: 10.1186/s13098-022-00975-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, 98142 Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304 Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, 82445 Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Hui-Lan Lee
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, 10320 Taiwan
| | - Yau-Jiunn Lee
- Lee’s Endocrinologic Clinic, No. 130 Min-Tzu Rd, Pingtung, 90000 Taiwan
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Zhu L, Zong X, Shi X, Ouyang X. Association between Intrinsic Capacity and Sarcopenia in Hospitalized Older Patients. J Nutr Health Aging 2023; 27:542-549. [PMID: 37498101 DOI: 10.1007/s12603-023-1946-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/11/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES This study aimed to clarify the association between intrinsic capacity (IC) and sarcopenia in hospitalized older patients. DESIGN A cross-sectional study. SETTING Hospital-based. PARTICIPANTS This study included 381 inpatients aged ≥ 60 years (225 men and 156 women). MEASUREMENTS IC was evaluated in five domains defined by the World Health Organization: cognition (Mini-Mental State Examination), locomotion (Short Physical Performance Battery test), vitality (Short-Form Mini Nutritional Assessment), sensory (self-reported hearing and vision) and psychological (5-item Geriatric Depression Scale) capacities. IC composite score (0-5) was calculated based on five domains, with lower scores representing greater IC. Sarcopenia was defined in accordance with the criteria recommended by the Asian Working Group for Sarcopenia (AWGS) 2019. Multiple linear and logistic regressions were performed to explore the associations between IC composite score and IC domains with sarcopenia and its defining components. RESULTS The mean age of 381 patients included was 81.95±8.42 years. Of them, 128 (33.6%) patients had sarcopenia. The median IC composite score was 1 (1, 2). Cognition, locomotion, vitality, sensory and psychological capacities were impaired in 22.6%, 63.5%, 18.9%, 27.3% and 11.3% of patients. Multiple linear regression analyses showed that favorable IC domain scores in cognition, locomotion and vitality were associated with a stronger handgrip strength. A higher vitality score was associated with a greater appendicular skeletal muscle mass index (ASMI), and a higher locomotion score was associated with a greater gait speed. The multiple logistic regression analysis showed that only vitality impairment was associated with sarcopenia. A higher IC composite score was associated with higher risks of sarcopenia, as well as low ASMI, handgrip strength and gait speed. CONCLUSION This study indicated that a more serious impairment of IC was associated with a greater risk of sarcopenia. Vitality was the domain most strongly associated with sarcopenia. IC may be employed to detect and manage sarcopenia.
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Affiliation(s)
- L Zhu
- Xiaojun Ouyang, Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China, E-mail:
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Sum G, Lau LK, Jabbar KA, Lun P, George PP, Munro YL, Ding YY. The World Health Organization (WHO) Integrated Care for Older People (ICOPE) Framework: A Narrative Review on Its Adoption Worldwide and Lessons Learnt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:154. [PMID: 36612480 PMCID: PMC9819593 DOI: 10.3390/ijerph20010154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
The World Health Organization (WHO) recently published guidelines on the implementation of a new Integrated Care for Older People (ICOPE) framework in 2017-2019. It is an integrated care framework for the screening, assessment, and management of intrinsic capacity (IC) declines. We aimed to examine where the early adopters of ICOPE are across the world, how these study teams and sites plan to apply the framework or have applied it, and the lessons learnt for future adopters. We systematically searched electronic medical and social sciences databases and grey literature published between 31 October 2017 and 31 March 2022. Records were systematically selected using precise inclusion criteria. There were 18 ICOPE study teams and sites across the 29 selected records. Of the 18 study teams and sites, seven were in the development stage, seven conducted feasibility studies, and four have commenced implementation of interventions that applied the ICOPE framework. Future ICOPE adopters may need to make certain decisions. These include whether to adopt ICOPE in the community setting or other settings, whether to adopt only Step 1 on IC screening or additional ICOPE Steps, whether the ICOPE IC screening tool requires modifications, and whether to use digital health technology. We propose the key factors needed to make these decisions and future research needed.
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Affiliation(s)
- Grace Sum
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | - Lay Khoon Lau
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | | | - Penny Lun
- Geriatric Education and Research Institute, Singapore 768024, Singapore
| | - Pradeep Paul George
- Geriatric Education and Research Institute, Singapore 768024, Singapore
- National Healthcare Group, Health Services and Outcomes Research, Singapore 138543, Singapore
| | - Yasmin Lynda Munro
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Yew Yoong Ding
- Geriatric Education and Research Institute, Singapore 768024, Singapore
- Department of Geriatric Medicine & Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Muneera K, Muhammad T, Althaf S. Socio-demographic and lifestyle factors associated with intrinsic capacity among older adults: evidence from India. BMC Geriatr 2022; 22:851. [PMID: 36368936 PMCID: PMC9652958 DOI: 10.1186/s12877-022-03558-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the traditional models missed the possibility of formulating personalised programs centred on a person's priorities and values, it was a pressing priority to shift from traditional disease-centred to a function-based approach of healthy ageing, which is defined as 'the process of developing and maintaining the functional ability that enables well-being in older age'. The present study aimed to assess the prevalence of high intrinsic capacity (IC) of older adults and to examine the socio-demographic and lifestyle factors associated with IC among older adults in India. METHODS The study utilises the individual-level data from the first wave of the Longitudinal Aging Study in India (LASI) conducted during 2017-18. The total sample size for the present study was 24,136 older adults (11,871 males and 12,265 females) aged 60 years and above. Descriptive statistics, along with bivariate analysis, was employed to present the preliminary results. Additionally, multivariable linear and logistic regression analyses were conducted to find out the association of socio-demographic and lifestyle factors with IC and its components. RESULTS The mean IC score was found to be 7.37 (SD = 1.6) in this study. A proportion of 24.56% of older adults was observed to be in the higher IC category. Increasing age was negatively associated with high IC for older men and women. Older people who smoke tobacco (β = -0.23; CI: -0.32--0.13) and chew tobacco (β = -0.11; CI: -0.18--0.03) were less likely to experience high IC compared to their respective counterparts. Older adults who reported episodic alcohol drinking were less likely to have high IC (β = -0.20; CI:-0.32--0.07). The engagement in moderate physical activity (β = 0.12; CI:0.01-0.23), vigorous physical activity (β = 0.12; CI:0.05-0.20) and yoga-related activity (β = 0.18; CI:0.09-0.26) were significantly positively associated with high IC. Among the five domains of IC, education was significantly associated with higher capacity in each domain, and increasing age was found to be a significant predictor of lower capacity in each IC domain except locomotion. Older men and women engaged in vigorous physical activity had 35 and 19% significantly higher odds of high capacity in sensory (aOR = 1.35; CI: 1.12-1.62) and psychological (aOR = 1.19; CI: 1.06-1.34) domains, respectively. CONCLUSIONS The study revealed that lifestyle behaviours including tobacco use, episodic alcohol drinking and physical activity are strongly associated with IC among older adults in India. The findings suggest that healthy lifestyle behaviours should be encouraged among older adults as an effort to improve their IC, which is the key determinant of functional ability and quality of life in later years of life.
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Affiliation(s)
- K. Muneera
- National Institute of Technology, Calicut, 673601 Kerala India
| | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - S Althaf
- National Institute of Technology, Calicut, 673601 Kerala India
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13
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Lin S, Wang F, Zheng J, Yuan Y, Huang F, Zhu P. Intrinsic Capacity Declines with Elevated Homocysteine in Community-Dwelling Chinese Older Adults. Clin Interv Aging 2022; 17:1057-1068. [PMID: 35832608 PMCID: PMC9272847 DOI: 10.2147/cia.s370930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/26/2022] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Siyang Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
| | - Fang Wang
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Health College, Fuzhou, Fujian, People's Republic of China.,Nursing School of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jiaxin Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
| | - Yin Yuan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, Fujian, People's Republic of China
| | - Feng Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, Fujian, People's Republic of China
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Center for Geriatrics, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, Fujian, People's Republic of China
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14
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Koivunen K, Schaap LA, Hoogendijk EO, Schoonmade LJ, Huisman M, van Schoor NM. Exploring the conceptual framework and measurement model of intrinsic capacity defined by the World Health Organization: A scoping review. Ageing Res Rev 2022; 80:101685. [PMID: 35830956 DOI: 10.1016/j.arr.2022.101685] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 01/04/2023]
Abstract
WHO has defined intrinsic capacity (IC) as the composite of all physical and mental capacities of an individual covering five subdomains: cognition, locomotion, sensory, vitality, and psychological. Despite this well accepted definition, the conceptual and measurement model of IC remains unclear, which hampers a standardized operationalization of the construct. We performed a scoping review to give a comprehensive overview of the extent to which the current literature of IC addresses and assumes the conceptual framework and measurement model of IC as reflective or formative. For inclusion, we considered all types of articles that were published in peer-reviewed journals except for protocol articles. A systematic search of 6 databases from different disciplines led to the inclusion of 31 papers. We found inconsistency and gaps in the descriptions of IC. Most of the papers did not define the measurement model. In the conceptual background and validation articles, we identified descriptions of both reflective and formative measurement models while in empirical studies applying IC measurements the underlying assumptions remained mainly unclear. Defining a measurement model is not merely a theoretical matter but influences the operationalization and validation processes of the construct. This study raised questions about the most fundamental features of the IC construct and discusses whether IC should be considered as an underlying latent trait of all capacities (reflective construct) or an aggregate summary measure of the subdomain capacities (formative construct).
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Affiliation(s)
- K Koivunen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan, 1117, Amsterdam, the Netherlands; Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Rautpohjankatu 8, P.O. Box 35, FI-40014, Finland.
| | - L A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, the Netherlands
| | - E O Hoogendijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands, De Boelelaan 1117, Amsterdam, the Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - M Huisman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - N M van Schoor
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands, De Boelelaan 1117, Amsterdam, the Netherlands
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15
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López-Ortiz S, Lista S, Peñín-Grandes S, Pinto-Fraga J, Valenzuela PL, Nisticò R, Emanuele E, Lucia A, Santos-Lozano A. Defining and assessing intrinsic capacity in older people: A systematic review and a proposed scoring system. Ageing Res Rev 2022; 79:101640. [PMID: 35569785 DOI: 10.1016/j.arr.2022.101640] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The World Health Organization has introduced the term 'intrinsic capacity' (IC) as a marker of healthy ageing. However, controversy exists on the definition and assessment of IC. We aimed to review the definitions and methods used for the assessment of IC in older adults. In addition, we proposed a new IC scoring method. METHODS A systematic search was performed in PubMed, Web of Science, Cochrane Library, Scopus and SPORTDiscus (up to February 10th, 2022) for studies assesing IC in older adults (>60 years). RESULTS Thirty-three studies were included. There is overall consensus on the definition of IC as well as on its different dimensions, that is: locomotion, vitality, sensory, cognition and psychological. However, the methods for assessing each of these five dimensions differ substantially across studies and there is no consensus on the best method to compute an eventual global compound score to evaluate IC taking into account all its different dimensions. CONCLUSIONS The IC represents a highly relevant clinical concept that has been unfortunately underutilized. We propose a standardization for the assessment of each dimension of IC, with a global 0 (worst) to 10 (highest) score.
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16
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Zhou Y, Ma L. Intrinsic Capacity in Older Adults: Recent Advances. Aging Dis 2022; 13:353-359. [PMID: 35371613 PMCID: PMC8947834 DOI: 10.14336/ad.2021.0818] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
The global increase in the aging population is expected to result in a shift from disease-centered to function-centered approaches in response to intensive aging. Thus, the World Health Organization (WHO) has proposed a novel concept, intrinsic capacity (IC), which refers to the combination of one’s physical and mental abilities. The IC framework comprises cognition, mobility, psychological, vitality, and sensory functions. WHO also issued the Guidelines on Integrated Care for Older People (ICOPE) in 2017 and the Handbook: Guidance on person-centred assessment and pathways in primary carein 2019 to provide recommendations for community-level interventions and clinical practice, respectively. Recently, studies on the assessment of IC and verification of IC measurement have been proliferating. In this study, we reviewed the recent advances in IC research with older adults.
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Affiliation(s)
- Yaru Zhou
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
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17
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Meng LC, Hsiao FY, Huang ST, Lu WH, Peng LN, Chen LK. Intrinsic Capacity Impairment Patterns and their Associations with Unfavorable Medication Utilization: A Nationwide Population-Based Study of 37,993 Community-Dwelling Older Adults. J Nutr Health Aging 2022; 26:918-925. [PMID: 36259580 DOI: 10.1007/s12603-022-1847-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
OBJECTIVES Our aim was to explore the patterns of intrinsic capacity (IC) impairments among community-dwelling older adults and the associations of these different patterns with excessive polypharmacy, potentially inappropriate medications, and adverse drug reactions in a nationwide population-based study. DESIGN A cross-sectional study included older adults from the Taiwan Integrated Care for Older People (ICOPE) program in 2020. SETTING AND PARTICIPANTS The study subjects comprised 38,308 adults aged 65 years and older who participated in the ICOPE Step 1 screening and assessed six domains of IC following the World Health Organization (WHO) ICOPE approach. METHODS Latent class analysis was adopted to identify distinct subgroups with different IC impairments patterns. The associations between different IC impairments patterns and unfavorable medication utilization, including excess polypharmacy (EPP), potentially inappropriate medications (PIMs), and adverse drug reactions (ADRs), were assessed by multivariate logistic regression models. RESULTS Latent class analysis identified five distinct subgroups with different IC impairment patterns: robust (latent class prevalence: 59.4%), visual impairment (17.7%), physio-cognitive decline (PCD) with sensory impairment (12.3%), depression with cognitive impairment (7.7%), and impairments in all domains (2.9%). Compared to the robust group, all other groups were at higher odds for unfavorable medication utilization. The "depression with cognitive impairment" group (EPP: aOR=4.35, 95% CI 3.52-5.39, p<0.01; PIMs: aOR=2.73, 95% CI 2.46-3.02, p<0.01) and the "impairment in all domains" group (EPP: aOR=9.02, 95% CI 7.16-11.37, p<0.01; PIMs: aOR=3.75, 95% CI 3.24-4.34, p<0.01) remained at higher odds for EPP and PIMs after adjustment. CONCLUSIONS We identified five distinct impairment patterns of IC, and each impairment pattern, particularly the "depression with cognitive impairment" and "impairment in all domains", was associated with higher odds of EPP and PIMs. Further longitudinal and intervention studies are needed to explore long-term outcomes of different impairment pattern and their reversibility.
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Affiliation(s)
- L-C Meng
- Li-Ning Peng, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2 Shih-Pai Road, Taipei, Taiwan, TEL: +886-2-28757830, FAX: +886-2-28757711,
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18
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Liu S, Kang L, Liu X, Zhao S, Wang X, Li J, Jiang S. Trajectory and Correlation of Intrinsic Capacity and Frailty in a Beijing Elderly Community. Front Med (Lausanne) 2021; 8:751586. [PMID: 34957141 PMCID: PMC8695757 DOI: 10.3389/fmed.2021.751586] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The World Health Organization proposed intrinsic capacity (IC) model to guide the implementation of person-centered care plan aimed at preserving or reserving functional ability, especially in frail older adults. We aimed to show the trajectory of IC and the overlap between IC impairment and frailty and investigate the correlation between IC domains and frailty status transitions. Method: Longitudinal observational study covering 230 community-dwelling older adults (mean age 84.0 ± 4.5 years) at baseline, and transition information at 2-year follow-up (n = 196). IC was measured by five domains: locomotion, cognition, vitality, psychological, and sensory. Frailty was defined by FRAIL Scale. IC and frailty status transitions were assessed. Logistic regression, odds ratios (OR) and 95% confidence interval (CI) were used for the analysis. Results: The prevalence of frailty was 23.0% and increased up to 41.8% over two years. Regarding frailty transitions, 38.3% of older adults progressed to more frailty status, and 8.6% regressed to lesser frailty status. The prevalence of IC impairment was 67.9% and increased to 81.6% over two years. Regarding IC transitions, 49.2% of adults with no IC impairment at baseline kept stable, and 50.8% developed new IC impairment. Among individuals with IC impairment at baseline, 57.9% worsened, and 13.5% improved. Importantly, IC impairment at baseline existed in 42.4% robust adults, 83.3% pre-frail adults, and 93.3% frail adults. 47.1% individuals who kept non-frail status within two years experienced IC worsened transition. Univariable analysis illustrated that new impaired locomotion, vitality, cognition, and sensory domains increased the risk of non-frail progressed to frail status. After adjusting for covariables, new impaired locomotion (OR = 3.625, 95% CI: 1.348–9.747) and vitality domains (OR = 3.034, 95% CI: 1.229–7.487) were associated with a higher possibility of non-frail progressed to frail status. Conclusion: IC impairment and frailty overlap and co-exist in older adults. IC impairment, especially new impairment in locomotion and vitality are associated with the transitions from non-frail to frail status. It is important that geriatricians tightly monitor IC trajectory and find the new impaired domains to take early action to minimize the public health burden of frailty.
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Affiliation(s)
- Shuo Liu
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - XiaoHong Liu
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - SongQi Zhao
- Taikang Yanyuan Continuing Care Retirement Community, Beijing, China.,Yanyuan Rehabilitation Hospital, Beijing, China
| | - XuePing Wang
- Department of Geriatrics, Affiliated Hospital of QingHai University, Xining, China
| | - JiaoJiao Li
- Department of Geriatrics, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shan Jiang
- Department of Geriatrics, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Muscari A, Bianchi G, Forti P, Magalotti D, Pandolfi P, Zoli M. The association of proBNPage with manifestations of age-related cardiovascular, physical, and psychological impairment in community-dwelling older adults. GeroScience 2021; 43:2087-2100. [PMID: 33987773 PMCID: PMC8492850 DOI: 10.1007/s11357-021-00381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
NT-proB-type natriuretic peptide (NT-proBNP) serum concentration can be transformed by simple formulas into proBNPage, a surrogate of biological age strongly associated with chronological age, all-cause mortality, and disease count. This cross-sectional study aimed to assess whether proBNPage is also associated with other manifestations of the aging process in comparison with other variables. The study included 1117 noninstitutionalized older adults (73.1 ± 5.6 years, 537 men). Baseline measurements of serum NT-proBNP, erythrocyte sedimentation rate, hemoglobin, lymphocytes, and creatinine, which have previously been shown to be highly associated with both age and all-cause mortality, were performed. These variables were compared between subjects with and without manifestations of cardiovascular impairment (myocardial infarction (MI), stroke, peripheral artery disease (PAD), arterial revascularizations (AR)), physical impairment (long step test duration (LSTD), walking problems, falls, deficit in one or more activities of daily living), and psychological impairment (poor self-rating of health (PSRH), anxiety/depression, Mini Mental State Examination (MMSE) score < 24). ProBNPage (years) was independently associated (OR, 95% CI) with MI (1.08, 1.07-1.10), stroke (1.02, 1.00-1.05), PAD (1.04, 1.01-1.06), AR (1.06, 1.04-1.08), LSTD (1.03, 1.02-1.04), walking problems (1.02, 1.01-1.03), and PSRH (1.02, 1.01-1.02). For 5 of these 7 associations, the relationship was stronger than that of chronological age. In addition, proBNPage was univariately associated with MMSE score < 24, anxiety/depression, and falls. None of the other variables provided comparable performances. Thus, in addition to the known associations with mortality and disease count, proBNPage is also associated with cardiovascular manifestations as well as noncardiovascular manifestations of the aging process.
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Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni, 15 40138 Bologna, Italy
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni, 15 40138 Bologna, Italy
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni, 15 40138 Bologna, Italy
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Donatella Magalotti
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Pandolfi
- Epidemiological and Health Promotion Unit, Department of Public Health, AUSL Bologna, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni, 15 40138 Bologna, Italy
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - the Pianoro Study Group
- Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni, 15 40138 Bologna, Italy
- Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Epidemiological and Health Promotion Unit, Department of Public Health, AUSL Bologna, Bologna, Italy
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20
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Abstract
Although geriatric research in general has increased in recent years, there is no effective treatment for frailty. Among older adults, those with frailty have an increased risk of falls, disability, and death. The population of older adults has increased rapidly in China, and resulting in an increased demand for medical care services for older adults, including those with frailty. However, much of the research on frailty has been conducted in Europe and the United States, and European and American standards for frailty are not always applicable to Chinese individuals. Clinicians and researchers in China have shown increasing interest in frailty in recent years. Here, we reviewed the current state of frailty research in China.
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Affiliation(s)
- L Ma
- Dr. Lina Ma, Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China, E-mail:
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