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.
Highlights
Population aging is accelerating rapidly worldwide, which brought a marked rise in the number of older adults with frailty [1]
The present study investigated the natural trajectories of Intrinsic capacity (IC) and frailty status, the main changes of IC domain, and its correlation with frailty status transitions in community-dwelling older adults
The result is consistent with the finding from a meta-analysis, which found that the prevalence of frailty among Chinese community-dwelling older adults aged over 80 years was 21.6% [25]
Summary
Population aging is accelerating rapidly worldwide, which brought a marked rise in the number of older adults with frailty [1]. China is home to the largest population of older adults in the world [2], with the prevalence of frailty in older communitydwelling adults ranging from 5.9 to 17.4% [3]. Previous relevant studies have revealed that higher age is related to higher frailty level [4]. According to several common frailty assessment tools, there is a universal description with three health statuses: robust, pre-frail, and frail. Based on these three statuses, much research exploring the trajectory of frailty demonstrates that it is a treatable and reversible clinical condition [8]. The detection of frailty should instead represent the entry point for more in-depth analysis with the aim of identifying the causes of an individual’s increased vulnerability and implementing a person-centered care plan
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