Intrinsic capacity decline and its associations in community-dwelling older adults in Kedah, Malaysia

PurposeTo assess the relative role of handgrip strength (HGS), quadriceps muscle power (Pmax), and optimal shortening velocity (υopt) in maintaining functional abilities (FAs) in older adults living in a long-term care home over a 1-year follow-up.Subjects and methodsForty-one inactive older institutionalized adults aged 69.8±9.0 years participated in this study. HGS, Pmax, υopt, cognitive function using the Mini-Mental State Examination, depressive symptoms using the Geriatric Depression Scale, nutritional status using the Mini Nutritional Assessment (MNA), and physical activity (PA) using the Seven-Day Physical Activity Recall Questionnaire were assessed at baseline and at 1-year follow-up. FAs were assessed with activities of daily living (ADL), instrumental ADL, and Timed Up & Go test.ResultsBoth at baseline and at follow-up, FAs were related to age, HGS, Pmax/kg, υopt, MNA, and PA. These associations were generally similar in both sexes. As revealed in multiple regression analysis, υopt was the strongest predictor of FA, followed by Pmax/kg, PA, and MNA. FA deteriorated after 1 year as measured by ADL and Timed Up & Go test. Pmax and υopt, but not HGS, also decreased significantly after 1 year. Nevertheless, 1-year changes in FAs were not related to changes in HGS, Pmax, υopt, or PA.ConclusionThe 1-year period of physical inactivity among older institutionalized adults was found to have a negative effect on their FAs, Pmax, and υopt. The present study demonstrates that Pmax and, especially, υopt correlated with FAs of older adults more than HGS, both at baseline and at follow-up. Despite this, 1-year natural fluctuations of PA, Pmax, and υopt are not significant enough to influence FAs in inactive institutionalized older adults.

Functional ability and intrinsic capacity (IC) have been proposed as determinants of healthy aging, but the extent to which these indicators are affected by biological aging remains unknown. We explored the association of biological age acceleration (BAA) with functional ability and IC in older adults with physical and cognitive impairments. This cross-sectional study used data from 163 individuals (84.0 ± 5.2years [range 72-99], 61.8% women) of the COGFRAIL cohort. Functional ability on basic (BADL-Katz Index) and instrumental activities of daily living (IADL-Lawton Index) was assessed. IC was measured as a composite score (0-100, higher is better) including the locomotion, cognition, psychology, sensory, and vitality domains. BAA was assessed by Horvath's, Hannum's, PhenoAge, and GrimAge epigenetic clocks. In the fully adjusted model, higher BAAPhenoAGe was associated to lower functional ability in BADLs (β = - 0.021, 95% confidence interval = - 0.038 to - 0.003, p = 0.022), with no significant results observed for the remaining clocks. No significant association was found between BAA and IC, but some associations were found with specific IC domains. Particularly, BAAGrimAge was associated with lower locomotion scores (β = - 1.179, 2.286 to - 0.072, p = 0.037), while BAAPhenoAge tended to be associated with lower scores in vitality (β = - 0.257, - 0.539 to 0.025, p = 0.073). Higher BAAPhenoage was associated with lower functional ability in very old adults with frailty and cognitive impairment. Although no biological clock was associated with a composite IC score, some associations were found between second-generation epigenetic clocks and specific IC domains.

Objectives This study evaluated the role of personality in predicting functional ability (FA) in older adults using self-report, collateral report, and performance-based measures of FA. Methods Participants included older adults (N = 131) who completed a personality measure (NEO-FFI), a self-report of FA (OARS ADL), and participated in a performance-based assessment of FA (DAFS-R). In addition, each participant had a collateral complete a collateral report of FA (OARS ADL). Bivariate correlations were computed to assess how Five Factor Model traits were related to self-report, collateral, and performance-based measures of FA. Results Neuroticism was negatively related to self-reported FA (r = − .27) and collateral-reported FA (r = − .18) and Conscientiousness was positively related to self-reported FA (r = .25). None of the traits were significantly related to the performance-based measure of FA. Conclusions These results suggest that personality traits can impact self-reported FA in older adults and underscore the importance of assessing FA in older adults using multiple methods, particularly performance-based measures. Clinical Implications Clinicians should consider how personality may impact FA in older adults and multiple methods of FA performance should be examined to better tailor recommendations.

A-17 * Delay and Probability Discounting are Markers of Functional Ability in Community-Dwelling Older Adults

PurposeThe effects of aging on physical and mental health may be ameliorated by regular participation in physical activity (PA). There is also evidence for the benefits of various training modalities on cognition and functional ability in older adults. The aim of this study was to compare effects of a 12-week active video gaming intervention (X Box Kinect Sports) to conventional multimodal supervised exercise on fitness, functional ability and cognitive performance in older adults with memory complaints.MethodsParticipants (n = 45, 72±5 yrs.) were recruited from 6 retirement homes and cluster-randomized into the Interactive Video Gaming (IVG) group (N = 23) or Conventional Multimodal (CM) group (N = 22), meeting 2 x 1 hour sessions, weekly for 12 weeks. Pre-post measures included: 6 min walk, timed up and go, dynamic balance, functional reach, Mini-Mental State Examination, N-back Task and the Modified Stroop task.ResultsThe IVG group demonstrated significant improvement in the total number correct responses on the Stroop task (P = 0.028) and for average reaction time of correct colour-words (P = 0.024), compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-min walk (P = 0.017), dynamic balance (P = 0.03), timed up and go (P<0.001) and functional reach (P<0.0010).ConclusionAn active interactive video gaming intervention was more effective than conventional multimodal exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints.Trial registrationPan African Clinical Trial Registry—PACTR202008547335106.

BackgroundThe World Health Organization (WHO) has proposed healthy aging framework, supposing that intrinsic capacity (IC), environment and their interaction may have influence on functional ability (FA). It was still unclear how the IC level and age-friendly living environment impact on FA. This study aims to confirm the relationship between the IC level and age-friendly living environment with FA, especially in older adults with low IC.MethodsFour hundred eighty-five community-dwelling residents aged ≥ 60 years were enrolled. IC constructed by locomotion, cognition, psychological, vitality, and sensory domains was assessed using full assessment tools recommended by WHO. Age-friendly living environment was measured with 12 questions adapted from the spatial indicators framework of age-friendly cities. FA was assessed using activities of daily living (ADL) and one question about mobile payment ability. Multivariate logistic regression was used to explore the association between IC, environment and FA. The influence of the environment on electronic payment and ADL under the IC layer was assessed.ResultsOf 485 respondents, 89 (18.4%) had ADL impairment, and 166 (34.2%) had mobile payment function impairment. Limited IC (odds ratio [OR] = 0.783, 95% confidence interval [CI] = 0.621–0.988) and poor environment (OR = 0.839, 95% CI = 0.733–0.960) were associated with mobile payment ability impairment. Our results suggested that a supportive age-friendly living environment influenced FA was more prominent in older adults with poor IC (OR = 0.650, 95% CI = 0.491–0.861).ConclusionsOur results confirmed IC and the environment had an impact on mobile payment ability. The relationship between environment and FA showed differences according to IC level. These findings suggest that an age-friendly living environment is important to maintain and enhance elders’ FA, especially in those with poor IC.

Chronic inflammation is a hallmark of aging, but its association with indicators of healthy aging such as intrinsic capacity (IC) and functional ability remains unknown. We explored the association of an inflammation-based aging clock (iAge) with these indicators in older adults. Using data from the COGFRAIL cohort, we analyzed 226 participants (82.5 ± 5.1 years, 64% women) with prefrailty/frailty and mild cognitive and functional impairment. Biological age acceleration was measured at baseline through the inflammatory clock iAge (BAAiAge). Functional ability on basic (BADL) and instrumental activities of daily living (IADL) as well as IC (a composite score [from 0 to 100] including the locomotion, cognition, psychology, sensory and vitality domains) were determined at baseline and during a 24.5-month follow-up. During the follow-up, a significant decline was observed in BADL (β = -0.4, 95% confidence interval -0.5 to -0.3, p < 0.001), IADL (β = -1.5; 95% CI = -1.7 to -1.2, p < 0.001) and IC (β = -2.0, 95% CI = -3.7 to -0.3, p = 0.025). Although baseline IC was positively associated with both BADL and IADL in cross-sectional (p = 0.002 and p < 0.001) and longitudinal analyses (p = 0.011 and p = 0.070), no association was found between BAAiAge and any of BADL/IADL, IC or IC domains in cross-sectional or longitudinal analyses. BAAiAge seems not to be associated with IC or functional ability in this cohort of very old adults with mild cognitive and functional impairment. Future research should confirm these findings in other cohorts with varying functional status.

Ageing in place has been promoted in the Netherlands to encourage optimal functional ability (FA) and independent living among older adults. FA is likely dependent on intrinsic capacity (IC), a composite measure of an individual's mental and physical capacities-and its interaction with the physical environment in which people live. This study aimed to examine the association between IC and FA, as well as to explore how the physical environment may modify this relationship in older adults. Data of older adults of the Longitudinal Aging Study Amsterdam were used (n=1,637). FA was assessed as six-year functional decline (yes/no). IC scores (0-100) and characteristics of the physical environment, i.e., urbanisation, air pollution (particulate matter (PM10) and nitrogen dioxide (NO2)), area-level socio-economic status, and neighbourhood walkability, were assessed at baseline. Multiple logistic regression analyses were conducted to investigate the association between IC and functional decline, and the modifying effect of each environmental variable. The mean age at baseline was 69.39 years (SD=7.51) and 54.7% were women. Higher IC was associated with lower odds of functional decline (OR: 0.90, 95% CI: 0.88-0.93). Stratified analyses showed a stronger inverse association between IC and functional decline in lower PM10 (OR: 0.84, 95% CI: 0.76-0.92), compared to higher PM10 environments (OR: 0.92, 95% CI: 0.89-0.95) in fully adjusted models. Higher IC was related to less functional decline. Exposure to higher levels of PM10 appears to mitigate the protective association between IC and FA in older adults.

Intrinsic capacity is crucial for older adults to maintain their functional independence and quality of life. Despite previous research have identified some environmental factors that impact intrinsic capacity, the associations between age-friendly communities and intrinsic capacity remained underexplored. To examine the relationship between the level of age-friendly communities and intrinsic capacity, in 2023, we conducted a cross-sectional study among 413 cognitively intact Chinese older adults from six age-friendly communities. Intrinsic capacity was measured with the Barthel Index (locomotion), Cornell Medical Index (vitality), Short-Form Mini-Nutritional Assessment (nutrition), Geriatric Depression Scale-15 (psychological health), and Mini-Mental State Examination (cognition). Community age-friendliness was assessed by the Age-Friendly Community Rating Scale. Covariates included demographics and health-related factors. Linear regression was used for analysis. These participants were aged between 65 and 94 years old, and male (52.06%). The level of age-friendly community was significantly associated with the intrinsic capacity of older adults (Standardized Beta = 0.776). The level of age-friendly community was associated with the intrinsic capacity scores in the unadjusted model (Beta = 0.861, P &amp;lt; 0.001) and the full-adjusted models (Beta = 0.609, P &amp;lt; 0.001). Additionally, the number of chronic diseases (Beta = -20.355, P &amp;lt; 0.001) and body mass index (Beta = -5.044, P &amp;lt; 0.05) were associated with lower scores of intrinsic capacity. Our findings suggest that the level of age-friendly communities is a protective factor for intrinsic capacity in older adults. Future research should focus on interventions to enhance community age-friendliness, thereby improving intrinsic capacity in community-dwelling older adults.

To examine the effects of a Physiotherapy-led, Person-Centred Integrated Care (PTICOPE) programme on intrinsic capacity (IC) (locomotion, vitality, psychological, cognitive, vision, hearing), and quality of life (QoL) among community-dwelling older adults. Seventy-one older adults were randomised to PTICOPE (n = 35) or control health education (n = 36) for 12weeks. PTICOPE included centre-based physiotherapy and home-based multidomain activities targeting all IC domains. IC was assessed using the Short Physical Performance Battery, Mini-Mental State Examination, Mini Nutritional Assessment-Short Form, Geriatric Depression Scale-15, Snellen acuity, and whispered-voice test at baseline and Weeks 4, 8, and 12. QoL was measured using the World Health Organization Quality of Life-Brief Version at baseline and Week 12. Primary analyses used intention-to-treat linear mixed-effects models adjusting for baseline values and education level. Per-protocol analyses included participants attending ≥10 sessions. PTICOPE improved locomotion (0.87; P = .030; ηp2 = 0.13), with smaller significant gains in vitality (0.67; P = .014; ηp2 = 0.09) and cognition (1.09; P = .035; ηp2 = 0.01). Changes in the psychological, visual, and auditory domains were not clinically meaningful. QoL improved across all domains: physical health (+6.2), psychological (+4.9), social relationships (+4.0), and environment (+4.1), all P < .001 with medium-to-large effect sizes. Sensitivity analyses confirmed similar patterns. PTICOPE enhanced key IC domains, locomotion, vitality, and cognition, and produced meaningful improvements in QoL. These findings support physiotherapy-led, person-centred care as an effective community strategy for healthy ageing. Thai Clinical Trials (Number: TCTR20241029007).

Predicting the value of the Mini Nutritional Assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study).

Intrinsic capacity (IC) is a multidimensional construct defined by the World Health Organization. Although IC has been established as a significant predictor of functional decline in older adults, emerging evidence suggests that functional impairment may, in turn, accelerate the degradation of IC, indicating a potential bidirectional relationship. Therefore, this study aims to systematically examine the potential bidirectional relationship between IC and functional ability. This study analyzed longitudinal data from 2233 adults aged 60 and above from the China Health and Retirement Longitudinal Study (2011-2015). Cross-lagged panel models (CLPMs) and random-intercept cross-lagged panel models (RI-CLPMs) were used to examine bidirectional associations between IC and functional ability. Intrinsic capacity (0-100) was assessed across 5 domains: locomotion, cognition, psychological well-being, vitality, and sensory function. Functional ability was measured using scores for basic (basic activities of daily living [BADL]: 0-18) and instrumental (IADL: 0-15) activities of daily living at 3 timepoints. Models were adjusted for sociodemographic, health, and behavioral factors. Compared to CLPM, RI-CLPM better captured the dynamic trajectory of functional status in older adults. Intrinsic capacity decline significantly predicted BADL deterioration (β = 0.089-0.109, p < .05), but BADL changes did not significantly affect IC. A bidirectional relationship existed between IC and IADL, with IC's effect on IADL (β = 0.206-0.236, p < .001) being stronger than the reverse (β = 0.093-0.100, p < .001). This study employed CLPM and RI-CLPM to investigate the dynamic relationship between IC and functional ability. These results offer new directions for developing interventions to promote healthy aging.

AimsTo investigate the association between intrinsic capacity (IC) and sarcopenia among older adults with type 2 diabetes mellitus (T2D).MethodsThis cross-sectional study included 409 community-dwelling older adults with T2D (mean age: 71.2 ± 5.8 years; 207 men, 202 women). IC was assessed using the WHO framework across five domains: cognition (Brain Health Test), locomotion (Short Physical Performance Battery), vitality (Mini Nutritional Assessment–Short Form), sensory (vision and hearing tests), and psychological function (15-item Geriatric Depression Scale). Each impaired domain contributed one point to the total IC impairment score (range: 0–5), with higher scores indicating greater IC decline. Sarcopenia was defined based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, including muscle mass, grip strength, and physical performance. Multiple logistic regression was used to examine associations between IC impairment and sarcopenia.ResultsThe prevalence of sarcopenia was 13.4%, and the average IC impairment score was 0.8 ± 0.8. The most common impairments were hearing (42.1%) and vision (13.2%). Participants with sarcopenia had a significantly higher number of IC impairments. A greater number of impaired IC domains was associated with increased odds of sarcopenia. While locomotion and visual impairments showed a positive association, they were not statistically significant after adjusting for confounders.ConclusionsDeclines in IC, particularly in locomotion and sensory domains, were associated with higher likelihood of sarcopenia in older adults with T2D. Routine IC assessment may support early detection and preventive interventions in this high-risk population.

Resistance training commenced late in life has proven to be a safe and effective means of increasing muscle function and functional ability in older adults. While most research has investigated strength training, it has recently been suggested that muscle power (the product of force and the rate at which force is produced) training may be more important given that power declines at a greater rate than strength with age and that muscle power is significantly associated with activities of daily living. Interventions that have used high¬velocity varied resistance protocols in older adults report substantial increases in muscle power. However, no studies are currently available investigating whether this form of training produces greater physiological benefit than that of a conventional strength or functional training program. Furthermore, the impact of these training regimes on a subsequent period of activity cessation has important implications for individuals foreseeing a period of enforced inactivity. While research suggests a significant loss in muscle strength and functional performance following detraining, to date, no data are available for muscle power. A further consideration is the effect of increased physical activity on the quality of life of the older individual. While research has failed to show an association in community-dwelling older adults commencing exercise, the appropriateness of the instruments employed to measure quality of life is questionable. To address these research shortcomings, 3 resistance-based interventions and the analysis of a new quality of life instrument were undertaken using community-dwelling older adults: Study 1 compared 24-weeks of conventional muscle strength (ST) and high¬velocity varied resistance muscle power (HV) training to a group of non-training controls (CO), Study 2 investigated a subsequent 24-week period of detraining followed by 12 weeks retraining in the ST and HV groups, and Study 3 compared the short-term (8 weeks) outcomes for the ST, HV and CO group to a combined (CB) training group who undertook once weekly high-velocity varied resistance and once weekly functional training. In addition, a new quality of life questionnaire, the University of Queensland Quality of Life instrument (UQQoL), informed by focus groups among older adults, was exercising older adults displaying an improvement in quality of life following 24 weeks of training. These studies indicate that significant and comparable increases in muscle function and functional ability can be achieved by older adults undertaking resistance training using varied protocols. In addition, while declines in strength and power result following detraining, high-intensity training undertaken prior to training cessation may help preserve functional status in older adults expecting an extended period of inactivity. These studies reinforce the effectiveness of resistance training to aid in prolonging functional well-being in the older population.

PURPOSE: Regular physical activity (PA) is beneficial for older adults but is often affected by chronic diseases and physical impairments. The purpose of this investigation was to evaluate the impact of chronic disease on physical activity and perceived functional ability in older adults METHODS: Questionnaires were mailed to retired non-faculty staff members from a large university with questions on demographics, PA, perceived functional ability (PFA), and health. Participants included 1,091 (53.8% female) older adults (65-98 years, M age=75.47+6.67) Subjects were asked if they had been diagnosed with any of the following chronic conditions: Arthritis, heart trouble (HRT), hypertension (HTN), circulation trouble (CIRC), diabetes, cancer, stroke, asthma, or no medical problems. RESULTS: All subjects reporting a chronic disease had lower PFA, but subjects reporting HTN, diabetes, cancer, or stroke had PA levels similar to those reporting no medical problems. CONCLUSIONS: Subjects reporting any chronic disease had lower PFA. However, subjects reporting HTN, diabetes, or cancer were able to maintain PA better than other chronic diseases.Table