Frailty, Successful Aging, Resilience, and Intrinsic Capacity: a Cross-disciplinary Discourse of the Aging Process

Factors Associated with the Deterioration of Intrinsic Capacity among Older Adults in Mexico and Colombia

BACKGROUND

Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia.

METHODS

This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed.

RESULTS

The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity).

CONCLUSION

Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Agency and Mental Health Among Peruvian Older Adults During the COVID-19 Lockdown

OBJECTIVES

To explore the experiences of older Peruvian adults living in urban areas of Lima under lockdown due to the National COVID-19 Emergency, this study analyzes how older adults (aged 60 and older) exercise agency while also living with the negative impacts of coronavirus disease 2019 (COVID-19) and related control measures.

METHODS

Between August and December 2020, our research team conducted a telephone-based, qualitative study, in which we undertook semistructured interviews with a purposive sample of low-income older adults living with chronic multimorbidities and limited resources. Forty older adults, 24 women and 16 men, with a mean age of 72 years, participated in the study. For data analysis, we employed thematic analysis with a predominantly inductive approach.

RESULTS

Older adults demonstrated several forms of agency to regulate emotions, maintain crucial bonds, foster social relationships, and seek economic and food security. Older adults experienced entertainment and support by caring for pets, undertaking farm work, and practicing their religious beliefs. For several participants and their families, quarantine was an opportunity to strengthen family relationships and learn new technologies. Older adults and their families reorganized themselves to assume new roles and perform activities that improved self-worth and confidence, thereby improving their well-being and mental health.

DISCUSSION

Peruvian older adults exerted agency in different ways to respond to and sustain their mental health during the COVID-19 lockdown. Policymakers should value and recognize the agency of older adults when planning future health responses.

Readiness to Plan for Aging and Frailty: Examining Contextual Factors

As older adults live longer, individual and societal efforts must be directed toward strategies to promote healthy and successful aging. Planning for aging and frailty offers an opportunity for older adults to optimize their well-being and proactively prepare across their aging trajectory. The current study evaluated the relationship between contextual factors (functional status, frailty, health status, social support) that influence older adults' readiness to engage in planning in five domains of aging (communication, environmental, financial, physical care, cognitive) through the transtheoretical stages of change. Results showed that factors influencing active planning include older age, vulnerability, living situation, and social support. These results add to the discourse on future care planning through a comprehensive approach to planning across a life course perspective, while highlighting the importance of future research at individual and societal levels. Gerontological nurses are well-positioned to lead planning efforts for older adults that promote well-being, patient-centered care, and healthy aging. [Journal of Gerontological Nursing, 49(2), 27-35.].

Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai

BACKGROUND

Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults.

SETTING AND PARTICIPANTS

A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older.

METHODS

This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes.

RESULTS

A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach's α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54-0.58 and an area under the curve of 0.87-0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability.

CONCLUSIONS

The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.

Exploring the conceptual framework and measurement model of intrinsic capacity defined by the World Health Organization: A scoping review

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).

Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis

An age-friendly environment is one of the measures of healthy aging. However, there is scarce evidence of the relationship between the age-friendliness of communities (AFC) and frailty status among Chinese older adults. This study aims to examine this relationship using a multilevel analysis with the data of a cross-sectional study conducted among 10,958 older adults living in 43 communities in four cities in China. The validated Age-friendly Community Evaluation Scale and Chinese frailty screening-10 Scale (CFS-10) were used to measure AFC and Frailty. Multilevel regression analyses were performed to examine the relationship between the AFC in two assessments of individual- and community-level and frailty status. After controlling for individual-level socio-demographic, health status, and lifestyle variables, compared with older adults in the lowest quartile of the individual-level perception of AFC, the frailty odds ratios for those in the top three quartiles were 0.69 (95% confidence interval [CI]: 0.56–0.83), 0.75 (95% CI: 0.61–0.91), and 0.56 (95% CI: 0.48–0.74). However, there was no association between the community-level AFC and frailty. A higher level of age-friendliness in the community is associated with lower frailty odds. Therefore, building age-friendly communities may be an important measure to prevent frailty among Chinese older adults.

Defining and assessing intrinsic capacity in older people: A systematic review and a proposed scoring system

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.

Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: The Role of Frailty

OBJECTIVES

To investigate whether frailty modifies the association of systolic blood pressure (SBP) with cardiovascular mortality and all-cause mortality in community-dwelling older adults.

DESIGN

A prospective cohort study.

SETTING

A population-based study of nationally representative older Chinese adults in a community setting.

PARTICIPANTS

This study included participants aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey 2002-2014 and followed up to 2018.

MEASUREMENTS

Participants were divided into two groups according to a frailty index based on the accumulation of a 44-items deficits model. The association between SBP and mortality was analyzed using multivariable-adjusted Cox proportional hazards models.

RESULTS

Among 18,503 participants included, the mean age was 87.2 years and the overall median follow-up time was 42.7 months. We identified 7808 (42.2%) frail participants (mean frailty index=0.33), in which 7533 (96.5%) died during the follow-up. Effect modification by frailty was detected (P for interaction=0.032). Among frail participants, a U-shaped association was found with hazard ratios of 1.16 (95% CI, 1.02-1.32) for SBP < 100 mmHg, and 1.11 (95% CI, 1.00-1.24) for SBP ≥ 150 mmHg compared with SBP 120-130 mmHg. For non-frail older adults, a tendency toward higher risk among those with SBP ≥ 130 mmHg was observed. The analyses towards cardiovascular mortality showed similar results.

CONCLUSION

Our results suggest the presence of effect modification by frailty indicating a possible negative effect for elevated SBP in non-frail older adults and a U-shaped relationship of SBP in frail older adults with respect to mortality even after adjusting for diastolic blood pressure.

Association between resilience and frailty among Chinese older adults

PURPOSE

Resilience is a multidimensional concept determining healthy aging, however, there were limited studies examining the association between frailty and resilience in detail. In this study, we aimed to examine the association of frailty with three dimensions of resilience-strength, optimism, and tenacity among Chinese older adults.

METHODS

A cross-sectional study was conducted among 10,209 participants who were sampled by three-stage sampling method, from three cities in China from June 2020 to July 2021. The Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience's 3 dimensions (strength, optimism and tenacity), which were converted into quartiles for the analysis. Frailty status was measured using the Chinese version of the FRAIL scale, categorized into robustness, pre-frailty and frailty. Multinomial logistic regression was used to examine associations between frailty status with strength, optimism and tenacity.

RESULTS

The overall proportions of robustness, pre-frailty, and frailty were 42.7, 48.7, and 8.6%, respectively. After controlling for sociodemographic characteristics, self-rated health, and health behaviors, compared with older adults with the lowest quartile of strength, older adults with the second quartile (odds ratio, OR = 0.67, 95% CI: 0.57-0.78), third quartile (OR = 0.60, 95% CI: 0.50-0.72), and fourth quartile (OR = 0.58, 95% CI: 0.46-0.73) of strength had lower ORs for pre-frailty, and who also had lower ORs (0.44, 95% CI: 0.33-0.58; 0.42, 95% CI: 0.30-0.59; 0.34, 95% CI: 0.20-0.56, respectively) for frailty. There were no homogeneous associations between optimism and tenacity with frailty status.

CONCLUSION

Higher strength was associated with lower chance of being pre-frail and frail among Chinese older adults. This finding implies that community-based training programs aiming to enhance psychological resilience, especially strength, may contribute to healthy aging. Future studies should examine the effects of resilience on frailty using longitudinal or experimental study designs in cross-cultural contexts.

Trajectory and Correlation of Intrinsic Capacity and Frailty in a Beijing Elderly Community

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.

Designing a nurse-led assessment and care planning intervention to support frail older people in primary care: An e-Delphi study

Aim

To identify and establish expert consensus on important and feasible components of a nurse‐led, comprehensive geriatric assessment (CGA)‐based intervention for community‐dwelling older people who live with frailty.

Design

A three‐round modified e‐Delphi survey.

Methods

An expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three‐round e‐Delphi survey over a 12‐month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus.

Results

In round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility.

Conclusion

Based on expert panel opinion, the content of a nurse‐led CGA‐based intervention was established, with the aim of future feasibility testing in a randomized controlled trial.

Impact

This study provides feasible components of a CGA‐based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community‐dwelling frail older people.

Predictive value of intrinsic capacity on adverse outcomes among community-dwelling older adults

OBJECTIVE

To examine the predictive value of intrinsic capacity on one-year incident adverse outcomes among community-dwelling older adults.

METHODS

A total of 756 community-dwelling older adults aged ≥ 60 years were followed up after 1 year. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. Adverse outcomes included incident disability, recurrent falls, hospitalization, emergency department visits, and poor quality of life. Multivariate logistic regression models were performed to evaluate the predictive value of intrinsic capacity domains on adverse outcomes.

RESULTS

Cognitive decline, limited mobility, visual impairment and depressive symptoms predicted incident disability. Visual impairment predicted recurrent falls. Cognitive decline and limited mobility predicted emergency department visits. Limited mobility predicted poor quality of life.

DISCUSSION

Intrinsic capacity could predict incident adverse outcomes among community-dwelling older adults. Assessing intrinsic capacity would facilitate early identification of older adults at high risk of adverse outcomes and prompt targeted interventions.

[Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]

Objetivo.

Determinar si existe relación entre la movilidad física y la falta de soporte social en personas mayores que viven en comunidades altoandinas de Perú.

Métodos.

Estudio observacional, analítico y retrospectivo a partir de la base de datos de una investigación previa de corte trasversal con información de 449 personas de 60 años o más participantes en el proyecto ANDES-FRAIL. La variable dependiente fue la movilidad, evaluada según el instrumento Short Physical Performance Battery; la variable independiente fue el soporte social, evaluado mediante un ítem del cuestionario de fragilidad de Edmonton. Como covariables se utilizaron parámetros sociodemográficos, comorbilidades, el número de fármacos de consumo habitual y los puntajes recibidos en varios instrumentos: el índice de Barthel para determinar la funcionalidad en personas mayores, el cuestionario de Yesavage para evaluar la depresión en ancianos, entre otros. Se calcularon las frecuencias y los porcentajes de las variables categóricas. Se elaboró un modelo ajustado con las variables que resultaron estadísticamente significativas en el análisis de regresión logística bifactorial.

Resultados.

La frecuencia de movilidad limitada en la población estudiada fue 58,6% (n = 263) y la de inadecuado soporte social fue 58,1% (n = 261). Los participantes con inadecuado soporte social tuvieron una frecuencia de movilidad limitada del 70,7% (n = 186). Según el modelo de regresión ajustado, el soporte social inadecuado incrementaría en 2,5 veces (IC95%: 1,3-4,5) las probabilidades de tener movilidad limitada, independientemente de las covariables confusoras.

Conclusiones.

La falta de apoyo social está asociada con la movilidad limitada de las personas mayores que habitan en comunidades altoandinas peruanas.

Embodied Conversational Agents for Patients With Dementia: Thematic Literature Analysis

Background

As the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia, which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of embodied conversational agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date.

Objective

The aim of this thematic literature analysis was to map current studies in the field of designing ECAs for patients with dementia in order to identify the existing research trend and possible gaps that need to be covered in the near future. The review questions in this study were as follows: (1) what research frameworks are used to study the interaction between patients with dementia and ECAs? (2) what are the findings? and (3) what are the barriers reported in these studies?

Methods

Separate literature searches were conducted in PubMed, Web of Science, Scopus, and Embase databases by using specific umbrella phrases to target the population (patients with dementia) and the technology-based intervention (embodied conversational agent). Studies that met the inclusion criteria were appraised through the Mixed Methods Appraisal Tool and then discussed in a thematic analysis.

Results

The search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 papers remained for the initial screening. A total of 7 studies were finally included in the qualitative synthesis. A thematic analysis of the reviewed studies identified major themes and subthemes: the research frameworks used to gather users’ perspectives on ECAs (theme 1), the insights shared by the 7 studies as well as the value of user involvement in the development phases and the challenge of matching the system functionalities with the users’ needs (theme 2), and the main methodological and technical problems faced by each study team (theme 3).

Conclusions

Our thematic literature analysis shows that the field of ECAs is novel and poorly discussed in the scientific community and that more sophisticated study designs and proofs of efficacy of the approach are required. Therefore, by analyzing the main topic of the narrative review, this study underscores the challenge of synchronizing and harmonizing knowledge, efforts, and challenges in the dementia care field and its person-centered paradigm through the user-centered design approach. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults.

Plasma N-Terminal Pro-B-Type Natriuretic Peptide Is Associated with Intrinsic Capacity Decline in an Older Population

OBJECTIVES

To determine the association between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and intrinsic capacity in an older population.

METHOD

We recruited 283 participants aged 60-97 years (mean 77.42±4.08 years). Intrinsic capacity was assessed with the World Health Organization Integrated Care for Older People (ICOPE) screening tool including six domains: cognition, locomotion, vitality, hearing, vision, and psychology. Multimorbidity, polypharmacy, gait speed, physical activity, lifestyles, and chronic inflammation were assessed. We used multivariate logistic regression and the Spearman's correlation to assess the association between plasma NT-proBNP and intrinsic capacity.

RESULTS

The average intrinsic capacity score was 4.53±1.34. The percentage of decreased intrinsic capacity was 75.3%. Participants with decreased intrinsic capacity were older, with more cardiovascular and cerebrovascular diseases and polypharmacy, and had lower gait speed and higher C-reactive protein. Plasma NT-proBNP was significantly higher in the decreased intrinsic capacity group (128.0[56.8-280.8] pg/mL vs. 72.6[39.7-120.0] pg/mL, p<0.001). Multivariate logistic regression analysis revealed that NT-proBNP was the only independent risk factor for decreased intrinsic capacity among multiple covariates (odds ratio=1.005, p=0.038). Elevated NT-proBNP levels were associated with abnormal locomotion, hearing, vision, and psychology domains. Additionally, NT-proBNP levels were inversely correlated with the intrinsic capacity score adjusted for both age and coronary artery disease (r=-0.371, p< 0.001).

CONCLUSION

Elevated NT-proBNP levels were associated with decreased intrinsic capacity in older persons, independent of age, multimorbidity, polypharmacy, and chronic inflammation. Further longitudinal studies are required to explore the predictive role of NT-proBNP on declines in intrinsic capacity.

Promising biomarkers of human aging: In search of a multi-omics panel to understand the aging process from a multidimensional perspective

The aging process has been linked to the occurrence of chronic diseases and functional impairments, including cancer, sarcopenia, frailty, metabolic, cardiovascular, and neurodegenerative diseases. Nonetheless, aging is highly variable and heterogeneous and represents a challenge for its characterization. In this sense, intrinsic capacity (IC) stands as a novel perspective by the World Health Organization, which integrates the individual wellbeing, environment, and risk factors to understand aging. However, there is a lack of quantitative and qualitative attributes to define it objectively. Therefore, in this review we attempt to summarize the most relevant and promising biomarkers described in clinical studies at date over different molecular levels, including epigenomics, transcriptomics, proteomics, metabolomics, and the microbiome. To aid gerontologists, geriatricians, and biomedical researchers to understand the aging process through the IC. Aging biomarkers reflect the physiological state of individuals and the underlying mechanisms related to homeostatic changes throughout an individual lifespan; they demonstrated that aging could be measured independently of time (that may explain its heterogeneity) and to be helpful to predict age-related syndromes and mortality. In summary, we highlight the areas of opportunity and gaps of knowledge that must be addressed to fully integrate biomedical findings into clinically useful tools and interventions.

Frailty in People Living with HIV

PURPOSE OF REVIEW

Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH.

RECENT FINDINGS

Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.

Effect of Various Exercises on Intrinsic Capacity in Older Adults With Subjective Cognitive Concerns

OBJECTIVES

Physical activity is associated with improvement in overall health and well-being, but robust evidence with comprehensive assessment of general health is lacking. This study aimed to clarify the effects of physical activity on intrinsic capacity among community-dwelling older adults with subjective memory concerns.

DESIGN

A single-blind randomized controlled trial compared aerobic training (AT), resistance training (RT), and combined training (AT+RT) programs for improving general health evaluated by intrinsic capacity.

SETTING

Toyota, Japan.

PARTICIPANTS

Residents (65-85 years old) who screened positive for subjective memory concerns using the Kihon checklist were invited for eligibility assessment. In total, 415 community-dwelling older adults were enrolled and randomized into the AT, RT, AT+RT, and control groups.

METHODS

Participants in the intervention groups underwent a group training program and self-paced home training for 26 weeks. The control group received lectures about health promotion. Intrinsic capacity (IC), constructed based on locomotion, cognition, psychological function, and vitality domains, was used to assess general health at baseline, week 26, and week 52. Between-group differences were exhibited with Z-score change in individual domain and combination of all domains.

RESULTS

At baseline, mean age of all participants (47% women) was 72.3 ± 4.6 years, with a mean composited IC Z-score of -0.2 ± 0.5. Overall, AT and RT improved composite IC Z-scores by 0.17 (95% confidence interval [CI] 0.03-0.30) and 0.17 (95% CI 0.05-0.28) at week 26, respectively, but the beneficial effects waned at week 52. No significant differences in composite IC Z-scores were found in the AT+RT group at weeks 26 and 52.

CONCLUSIONS AND IMPLICATIONS

Twenty-six-week AT with self-paced home training and RT with self-paced home training improve IC among community-dwelling older adults with subjective memory concerns, but the benefits waned subsequently. It will be required to develop optimal interventions that have a continuous beneficial effect on IC among community-dwelling older adults.

Frailty and Intrinsic Capacity: Two Distinct but Related Constructs

Frailty is a clinical condition characterized by the individual's increased vulnerability to endogenous and exogenous stressors. It is determined by the reduction of homeostatic capacities of the organism and responsible for a marked risk of adverse health outcomes (including functional loss and mortality). Frailty originates from the geriatric background and may pave the way toward a model of care centered on the person, deviating from the traditional and obsolete disease-focused approach. Unfortunately, many controversies have affected the field of frailty over the years and ambiguities have been growing. In particular, the common use of frailty as condition to "exclude" from interventions is a worrisome trend. In fact, the detection of frailty should instead represent the entry point for a more in-depth analysis with the aim of identifying the causes of individual's increased vulnerability and implementing a person-tailored intervention plan. With the aim of promoting a more comprehensive and appropriate assessment of the aging population, the World Health Organization introduced the concept of intrinsic capacity (IC), defined as the composite of all physical and mental capacities that an individual can draw upon during his/her life. Frailty and IC are two constructs stemming from the same need of overcoming traditional medical paradigms that negatively impact on the correct way clinical and research practice should be conducted in older persons. In this article, we describe the similarities and differences between the two constructs, highlighting how geriatric medicine contributed to their development and will be crucial for their further integration in future healthcare models.