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Roles of Baseline Intrinsic Capacity and its Subdomains on the Overall Efficacy of Multidomain Intervention in Promoting Healthy Aging among Community-Dwelling Older Adults: Analysis from a Nationwide Cluster-Randomized Controlled Trial

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Abstract

Background

Impaired intrinsic capacity (IC), which affects approximately 90% of older adults, is associated with a significantly heightened risk of frailty and cognitive decline. Existing evidence suggests that multidomain interventions have the potential to enhance cognitive performance and yield positive effects on physical frailty.

Objective

To examine roles of baseline IC and its subdomains on the efficacy of multidomain interventions in promoting healthy aging in older adults.

Design

A cluster-randomized controlled trial. Setting and Participants: 1,054 community-dwelling older adults from 40 community-based clusters across Taiwan.

Intervention

A 12-month pragmatic multidomain intervention of exercise, cognitive training, nutritional counseling and chronic condition management.

Measurements

Baseline IC was measured by 5 subdomains, including cognition (Montreal Cognitive Assessment, MoCA), sensory (visual and hearing impairment), vitality (handgrip strength or Mini-Nutritional Assessment-short form), psychological well-being (Geriatric Depression Scale-5), and locomotion (6m gait speed). Outcomes of interest were cognitive performance (MoCA scores) and physical frailty (CHS frailty score) over a follow-up period of 6 and 12 months.

Results

Of all participants (mean age:75.1±6.4 years, 68.6% female), about 90% participants had IC impairment at baseline (2.0±1.2 subdomains). After covariate adjustment using a generalized linear mixed model (GLMM), the multidomain intervention significantly prevented cognitive declines and physical frailty, particularly in those with IC impairment ≥ 3 subdomains (MoCA: coefficient: 1.909, 95% CI: 0.736 ∼ 3.083; CHS frailty scores: coefficient = −0.405, 95% CI: −0.715 ∼ −0.095). To assess the associations between baseline poor capacity in each IC subdomain and MoCA/CHS frailty scores over follow-up, a 3-way interaction terms (time*intervention*each poorer IC subdomains) were added to GLMM models. Significant improvements in MoCA scores were shown for participants with poorer baseline cognition (coefficient= 1.138, 95% CI: 0.080 ∼ 2.195) and vitality domains (coefficient= 1.651, 95% CI: 0.541 ∼ 2.760). The poor vitality domain also had a significant modulating effect on the reduction of CHS frailty score after the 6- and 12-month intervention period (6 months: coefficient= −0.311, 95% CI: −0.554 ∼ −0.068; 12 months: coefficient= −0.257, 95% CI: −0.513 ∼ −0.001).

Conclusion and Implications

A multidomain intervention in community-dwelling older adults improves cognitive decline and physical frailty, with its effectiveness influenced by baseline IC, highlighting the importance of personalized strategies for healthy aging.

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Acknowledgements

The Taiwan Health Promotion Intervention Study for Elders received funding from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan (MOHW105-HPA-H-124-144101). It is important to note that the research funder played no role in the study design, data collection or analysis, manuscript preparation, or the decision to publish. Authors would like to thank the Interdisciplinary Research Center for Healthy Longevity of National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan for supporting the research work, too.

Funding

Funding Source and Sponsor’s Role: The Taiwan Health Promotion Intervention Study for Elders received funding from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan (MOHW105-HPA-H-124-144101). It is important to note that the research funder did not participate in the study design, data collection or analysis, manuscript preparation, or the decision to publish the findings.

Author information

Authors and Affiliations

  1. Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    C.-K. Liang & M.-Y. Chou

  2. Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan

    C.-K. Liang, W.-J. Lee, M.-Y. Chou, A.-C. Hwang, L.-N. Peng & Liang-Kung Chen

  3. Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    C.-K. Liang, W.-J. Lee, M.-Y. Chou, A.-C. Hwang, L.-N. Peng & Liang-Kung Chen

  4. Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan

    C.-K. Liang

  5. Institute of Public Health, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan

    W.-J. Lee

  6. Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Taipei, Taiwan

    W.-J. Lee

  7. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan

    A.-C. Hwang, L.-N. Peng & Liang-Kung Chen

  8. Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    C.-S. Lin

  9. Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan

    C.-S. Lin

  10. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan

    C.-S. Lin

  11. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    F.-Y. Hsiao

  12. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

    F.-Y. Hsiao

  13. School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    F.-Y. Hsiao

  14. School of Medicine, Tzu Chi University, Hualien, Taiwan

    C.-H. Loh

  15. Department of Geriatrics and Gerontology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

    C.-H. Loh

  16. Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan

    Liang-Kung Chen

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  1. C.-K. Liang
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Correspondence to Liang-Kung Chen.

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Conflict of Interest: All authors declare no competing interests.

Ethical standards: The THISCE study followed ethical principles in accordance with the 1964 Declaration of Helsinki and national regulations, obtaining approval from the Joint Institutional Review Board of Taiwan (JIRB No. 14-001-A) and written informed consent from participants, and was registered at ClinicalTrials. gov (NCT03056768).

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Liang, CK., Lee, WJ., Chou, MY. et al. Roles of Baseline Intrinsic Capacity and its Subdomains on the Overall Efficacy of Multidomain Intervention in Promoting Healthy Aging among Community-Dwelling Older Adults: Analysis from a Nationwide Cluster-Randomized Controlled Trial. J Prev Alzheimers Dis 11, 356–365 (2024). https://doi.org/10.14283/jpad.2024.20

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