| Part 1 Comparison of Intrinsic Capacity and Frailty for Predicting Adverse Outcomes in Community-dwelling Older AdultsBackground:In 2015,the World Health Organization(WHO)proposed the goal of Healthy Ageing to focus on maintaining Intrinsic Capacity(IC)of older adults,and promoting Functional Ability through the support of environment to avoid adverse outcomes such as falls and disability.IC represents the composite of physical and mental capacities.Regarding the occurrence of adverse outcomes in older adults,the current research mainly focuses on the physical,cognitive and psychological function,comorbidity,or frailty.While there are few studies on the predictive value of IC as a whole on adverse outcomes,and even fewer from the mainland of China.To verify the WHO’s active health,prevention-first recommendation,we investigated the predictive value of IC on adverse outcomes in the age-friendly community,and compare its performance with frailty,to obtain a simple and effective evaluation and intervention program in community-dwelling older adults.Method:This observational cohort study was conducted in the Beijing Taikang Yanyuan community characterized with the stable and age-friendly environment.All the residents aged 75 and above who lived in the active area from June to August 2018 were recruited consecutively.Social-demographic data and Comprehensive Geriatric Assessment(CGA)were collected at baseline.Frailty was evaluated by Fried phenotype,IC was assessed by IC scale,and activities of daily living(ADL)was measured by Physical SelfMaintenance Scale.Adverse outcomes,namely functional decline(a decline of at least one point on the ADL index at 2-year follow-up compared with baseline)and falls were evaluated after 2-year follow-up(September 2020).All data were recorded in CGA electronic data capture system.Logistic regression was used to analyze the relationship between IC,frailty,and adverse outcomes.The area under the curve(AUC),95%confidence interval(CI),and odds ratio(OR)were acquired.According to the DeLong test,the differences in AUC before and after adjusting for co-factors were compared for IC and frailty,respectively.Results:A total of 230 older adults were enrolled at baseline,and 212 completed a 2-year follow-up.Among the 212 older adults,the mean age was 83.8±4.4 years,and 59.4%(126)were female.The prevalence of impaired IC and frailty were 77.4%(164/212)and 29.7%(63/212),respectively.At 2-year follow-up,109(51.4%)adults experienced functional decline,and 71(33.5%)suffered from falls.Logistic regression analysis showed that orientation impairment(OR=4.970,95%CI:1.548-15.952)and memory impairment(OR=2.805,95%CI:1.378-5.710)can predict functional decline independently.Impaired chair rise test(OR=3.102,95%CI:1.406-6.845),weight loss(OR=6.282,95%CI:1.203-32.802),and little interest in doing things(OR=2.708,95%CI:1.183-6.202)can predict the occurrence of falls.The AUC showed that IC was better at predicting functional decline(0.814 vs 0.738)and falls(0.806 vs 0.766)than frailty.Comparing the AUC before and after adjusting for co-variables,there was no significant difference in the predictive value of IC(functional decline:0.814 vs 0.834,p=0.117;falls:0.806 vs 0.834,p=0.091),and there was a significant difference in the predictive value of frailty(functional decline:0.738 vs 0.795,p=0.013;falls:0.766 vs 0.815,p=0.026).Conclusions:The community-dwelling older adults generally have impaired IC.Compared with frailty,IC scale can accurately identify the impaired IC domain,and effectively predict functional decline and falls independent of social-demographic factors,which guides healthcare workers to develop the personalized integrated care plan for older adults.Part 2 The Effect of Intrinsic capacity and Comorbidity Affecting Adverse outcomes in Community-dwelling Older Adults:Path Analysis Based on Structure Equation ModelBackground:Chronic non-communicable diseases are the main causes of disability and death in older adults,and about half of them have comorbidity.With the population aging,WHO advocates that the healthcare work should be transformed from a disease-centered diagnosis and treatment model to a patient-oriented integrated care model to maintain Intrinsic Capacity(IC),delay functional decline,and avoid adverse outcomes in older adults.While,in the management of adverse outcomes in community-dwelling older adults,the evidence on the effect of IC,comorbidity,and their interaction on adverse outcomes is still in its infancy.Thus,we aim to explore the effect of IC,comorbidity,and their interaction on the occurrence of adverse outcomes to help healthcare workers to clarify the focus of health management in community-dwelling older adults.Method:The participants were 230 residents aged 75 and above who lived in the Beijing Taikang Yanyaun community active area from June to August 2018.Social-demographic data and comprehensive geriatric assessment(CGA)were collected at baseline,in which IC was measured by IC scale,and the Charlson Comorbidity Index(CCI)was used for comorbidity.Adverse outcomes,including functional decline and falls,were evaluated at 2-year follow-up(September 2020).All data were recorded in CGA electronic data capture system.IC and CCI were used as mediating factors.The standardized coefficients were calculated using Structural Equation Model(SEM)path analysis to explore the direct and indirect effects of IC and comorbidity on adverse outcomes in older adults.Results:212 older adults completed 2-year follow-up.109(51.4%)of them had functional decline and 71(33.5%)of them had falls.According to path analysis,the direct effects of IC on functional decline and falls were significantly positive,and the standardized coefficients were 0.430 and 0.369 respectively,but the effect of CCI was not significant.Based on the logistic regression model to analyze the effect,the total effect of IC on functional decline and falls was still significantly positive,which were 1.184 and 0.915,respectively,after controlling for age,sex,marriage,and education level.CCI,as a mediating factor,its indirect effect on functional decline and falls accounted for 5.4%(0.064)and 0.8%(0.007),respectively.In the path of age affecting adverse outcomes,the indirect effect of IC(functional decline:0.018;falls:0.015)was significantly higher than the indirect effect of CCI(functional decline:0.002;fall:0.000).Conclusions:IC can significantly affect the incidence of adverse outcomes in community-dwelling older adults,and play a key role.While comorbidity measured by CCI influences the occurrence of functional decline and falls weakly.In the health management of community-dwelling older adults,especially the elderly with comorbidity,IC should be screened and evaluated routinely.Part 3 Trajectory and Correlation of Intrinsic Capacity and Frailty in Community-dwelling Older AdultsBackground:In order to prolong the self-maintenance time for frail older adults,WHO recommends that the maintenance of intrinsic capacity(IC)be the core to guide the implementation of person-centered integrated care plan,which is the key component of healthy ageing.Frailty is considered as a stage in the trajectory of IC decline and is closely associated with multiple adverse outcomes in older adults.So far,there is still a blank in the domestic research on the trajectory and correlation of IC and frailty.This study observes the 2-year trajectory of IC and frailty,and explores the relationship between them,to guide the healthcare workers to formulate integrated care for frail older adults to avoid adverse outcomes.Method:This study continuously recruited 230 older adults aged above 75 years who lived in Beijing Taikang Yanyuan community active area from June to August 2018.Social-demographic data were collected.IC was measured by IC scale,including 5 domains of locomotion,vitality,cognition,sensory,and psychological.Impaired function in any one domain is defined as IC impairment.Frailty was defined by FRAIL Scale.Participants who were robust or pre-frail were deemed as non-frail.IC and frailty were reassessed 2 years later(September 2020).Trajectories of IC and frailty were recorded,and functional changes in IC domain after 2 years were defined as new-onset impairment and improvement.Multi-variable logistic regression was used to analyze the relationship between changes in IC and frailty.Odds ratios(OR)and 95%confidence interval(CI)were observed.Results:A total of 196 older adults completed 2-year follow-up,the mean age(SD)was 83.7(4.4)years and 116(59.2%)participants were female.The prevalence of frailty was 23.0%(45/196)at baseline,and increased up to 41.8%(82/196)over two years.The prevalence of IC impairment was 67.9%(63/196)at baseline,and increased to 81.6%(160/196)over two years.Regarding 2-year trajectory of frailty,54.1%(46/85)of robust adults continued to keep robust,54.5%(36/66)of pre-frail adults progressed to frail status,and 22.2%(10/45)of frail adults regressed to pre-frail status.From 2-year trajectory of IC,50.8%(32/63)of adults without IC impairment at baseline developed new IC impairment,and 57.9%(77/133)of adults with IC impairment at baseline were impaired further.After 2 years,25.0%(49/196)of adults developed new-onset impairment in cognition,21.4%(42/196)in vitality domain,15.3%(30/196)in locomotion and psychological domain,and 9.7%(19/196)in sensory domain.Multi-variable analysis showed that new-onset impairment in locomotion(OR=3.625,95%CI:1.348-9.747)and vitality domain(OR=3.034,95%CI:1.229-7.487)were closely associated with the progression of non-frail to frail status in older adults.The non-frail older adults developed new-onset impairment in ≥2 domains,which was related to the occurrence of frail,and the OR was 1.981(95%CI:1.424-2.756).Conclusions:During ageing,IC shows a dynamic decline in older adults.New-onset impairment in locomotion and vitality domain are associated with the transition from non-frail to frail status.Healthcare workers should pay attention to locomotion and vitality function,monitor the trajectory of IC closely,and make personalized integrated care plan to prolong the self-maintenance time at home and achieve healthy ageing. |
