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Cacciatore S, Marzetti E, Calvani R, Picca A, Salini S, Russo A, Tosato M, Landi F. Intrinsic capacity and recent falls in adults 80 years and older living in the community: results from the ilSIRENTE Study. Aging Clin Exp Res 2024; 36:169. [PMID: 39126523 DOI: 10.1007/s40520-024-02822-7] [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: 05/06/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. AIMS To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. METHODS The Minimum Data Set for Home Care (MDS-HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0-100). RESULTS The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94-0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93-0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16-0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15-0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16-0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97-0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96-0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96-0.99, p < 0.001). DISCUSSION This is the first study using an MDS-HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. CONCLUSIONS Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians.
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Affiliation(s)
- Stefano Cacciatore
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome, 00168, Italy.
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy.
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome, 00168, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome, 00168, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
- Department of Medicine and Surgery, LUM University, SS100 km 18, Casamassima, 70100, Italy
| | - Sara Salini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
| | - Andrea Russo
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome, 00168, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, L.go A. Gemelli 8, Rome, 00168, Italy
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Sánchez-Sánchez JL, Lu WH, Gallardo-Gómez D, Del Pozo Cruz B, de Souto Barreto P, Lucia A, Valenzuela PL. Association of intrinsic capacity with functional decline and mortality in older adults: a systematic review and meta-analysis of longitudinal studies. THE LANCET. HEALTHY LONGEVITY 2024; 5:e480-e492. [PMID: 38945130 DOI: 10.1016/s2666-7568(24)00092-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults. METHODS In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482. FINDINGS We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial. INTERPRETATION Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations. FUNDING None. TRANSLATIONS For the Spanish and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- Institute of Aging, Toulouse University Hospital, Toulouse, France; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; IHU HealthAge, Toulouse, France.
| | - Wan-Hsuan Lu
- Institute of Aging, Toulouse University Hospital, Toulouse, France; IHU HealthAge, Toulouse, France
| | - Daniel Gallardo-Gómez
- Epidemiology of Physical Activity and Fitness Across Lifespan Research Group, Department of Physical Education and Sports, Faculty of Education, University of Seville, Seville, Spain
| | - Borja Del Pozo Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain; Faculty of Education, Department of Physical Education, University of Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz Research Unit, University of Cádiz, Spain; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Philipe de Souto Barreto
- Institute of Aging, Toulouse University Hospital, Toulouse, France; IHU HealthAge, Toulouse, France; CERPOP UMR 1295, Inserm, Paul Sabatier University, Toulouse, France
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Physical Activity and Health Research Group, Research Institute of 12 de Octubre University Hospital, Madrid, Spain
| | - Pedro L Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain; Physical Activity and Health Research Group, Research Institute of 12 de Octubre University Hospital, Madrid, Spain; Department of Systems Biology, University of Alcalá, Madrid, Spain
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Gonzalez-Bautista E, Beard J. The Challenge of Measuring Intrinsic Capacity. J Nutr Health Aging 2023; 27:806-807. [PMID: 38216222 DOI: 10.1007/s12603-023-2012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 01/14/2024]
Affiliation(s)
- E Gonzalez-Bautista
- Gerontopole of Toulouse University Hospital, Institute on Aging. Research and Clinical Alzheimer's Disease Center, CMRR, Toulouse, France; Maintain Aging Research team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - JohnR Beard
- Butler Columbia Aging Center. Mailman School of Public Health, Columbia University, New York, USA.
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