Abstract
Background
Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes.
Methods
We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years, Modified Barthel Index (MBI) score 99±2.6). Frailty was defined by modified Fried criteria. Scores (range: 0–2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, muscle strength (grip strength, repeated chair stand test), physical performance (gait speed, Short Physical Performance Battery), function (MBI) and quality-of-life (EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education.
Results
Three distinct clusters were identified — Cluster 1: High IC/Robust (N=74, 37%); Cluster 2: Intermediate IC/Prefrail (N=73, 36.5%); and Cluster 3: Low IC/Prefrail-Frail (53, 26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in Cluster 1, intermediate in Cluster 2 and most impaired in Cluster 3. At one year, the proportion transitioning to frailty or remaining frail was highest in Cluster 3 compared to Cluster 2 and Cluster 1 (39% vs 6.9% vs 2.8%, P<0.001). Compared to Cluster 1, Cluster 3 experienced greatest declines in grip strength (β=−4.1, P<.001), MBI (β=−1.24, P=0.045) and EQ-5D utility scores (β=−0.053, P=0.005), with Cluster 2 intermediate between Cluster 1 and Cluster 3.
Conclusions
Amongst independent community-dwelling older adults, IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst prefrail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.
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References
WHO Decade of Healthy Ageing 2020–2030. https://www.who.int/ageing/decade-of-healthy-ageing. Accessed June 13, 2021.
Beard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open. 2019;9(11):e026119. doi:https://doi.org/10.1136/bmjopen-2018-026119
Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771–787. doi:https://doi.org/10.1007/s12603-019-1273-z
Belloni G, Cesari M. Frailty and Intrinsic Capacity: Two Distinct but Related Constructs. Front Med. 2019;6:133. doi:https://doi.org/10.3389/fmed.2019.00133
Chew J, Tay L, Lim JP, et al. Serum Myostatin and IGF-1 as Gender-Specific Biomarkers of Frailty and Low Muscle Mass in Community-Dwelling Older Adults. J Nutr Health Aging. 2019;23(10):979–986. doi:https://doi.org/10.1007/s12603-019-1255-1
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146–56. doi: https://doi.org/10.1093/gerona/56.3.m146
Chen L-K, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21(3):300–307.e2. doi:https://doi.org/10.1016/j.jamda.2019.12.012
Holbrook M, Skilbeck CE. An activities index for use with stroke patients. Age Ageing. 1983;12(2):166–170. doi:https://doi.org/10.1093/ageing/12.2.166
Radloff LS. The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Appl Psychol Meas. 1977;1(3):385–401. doi:https://doi.org/10.1177/014662167700100306
Sahadevan S, Lim PP, Tan NJ, Chan SP. Diagnostic performance of two mental status tests in the older chinese: influence of education and age on cutoff values. Int J Geriatr Psychiatry. 2000;15(3):234–241. doi:https://doi.org/10.1002/(sici)1099-1166(200003)15:3<234::aid-gps99>3.0.co;2-g
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49. doi:https://doi.org/10.1016/0022-3956(82)90033-4
Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutr Burbank Los Angel Cty Calif. 1999;15(2):116–122. doi:https://doi.org/10.1016/s0899-9007(98)00171-3
Giudici KV, de Souto Barreto P, Beard J, et al. Effect of long-term omega-3 supplementation and a lifestyle multidomain intervention on intrinsic capacity among community-dwelling older adults: Secondary analysis of a randomized, placebo-controlled trial (MAPT study). Maturitas. 2020;141:39–45. doi:https://doi.org/10.1016/j.maturitas.2020.06.012
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94. doi:https://doi.org/10.1093/geronj/49.2.m85
Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J. 1965;14:61–65.
Abdin E, Subramaniam M, Vaingankar JA, Luo N, Chong SA. Measuring health-related quality of life among adults in Singapore: population norms for the EQ-5D. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2013;22(10):2983–2991. doi:https://doi.org/10.1007/s11136-013-0405-x
Benassi M, Garofalo S, Ambrosini F, et al. Using Two-Step Cluster Analysis and Latent Class Cluster Analysis to Classify the Cognitive Heterogeneity of Cross-Diagnostic Psychiatric Inpatients. Front Psychol. 2020;11:1085. doi:https://doi.org/10.3389/fpsyg.2020.01085
Chiu T, Fang D, Chen J, Wang Y, Jeris C. A robust and scalable clustering algorithm for mixed type attributes in large database environment. In: KDD’ 01.; 2001. doi:https://doi.org/10.1145/502512.502549
Rousseeuw P. Silhouettes: a graphical aid to the interpretation and validation of cluster analysis. 1987. doi:https://doi.org/10.1016/0377-0427(87)90125-7
Finch CF, Stephan K, Shee AW, et al. Identifying clusters of falls-related hospital admissions to inform population targets for prioritising falls prevention programmes. Inj Prev. 2015;21(4):254–259. doi:https://doi.org/10.1136/injuryprev-2014-041351
Gutiérrez-Robledo LM, García-Chanes RE, González-Bautista E, Rosas-Carrasco O. Validation of Two Intrinsic Capacity Scales and Its Relationship with Frailty and Other Outcomes in Mexican Community-Dwelling Older Adults. J Nutr Health Aging. 2021;25(1):33–40. doi:https://doi.org/10.1007/s12603-020-1555-5
Prince MJ, Acosta D, Guerra M, et al. Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China. medRxiv. September 2019:19006403. doi:https://doi.org/10.1101/19006403
George PP, Lun P, Ong SP, Lim WS. A Rapid Review of the Measurement of Intrinsic Capacity in Older Adults. J Nutr Health Aging. 2021;25(6):774–782. doi:https://doi.org/10.1007/s12603-021-1622-6
Gutiérrez-Robledo LM, García-Chanes RE, Pérez-Zepeda MU. Allostatic Load as a Biological Substrate to Intrinsic Capacity: A Secondary Analysis of CRELES. J Nutr Health Aging. 2019;23(9):788–795. doi:https://doi.org/10.1007/s12603-019-1251-5
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–1492. doi:https://doi.org/10.1111/j.1532-5415.2012.04054.x
Woo J. Combating frailty and sarcopenia in aging populations: Switching to a more positive paradigm. Aging Med Milton NSW. 2019;2(1):7–10. doi:https://doi.org/10.1002/agm2.12052
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We would like to thank all participants who contributed to this study. This study was supported by the Lee Foundation Grant 2013.
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Chew, J., Lim, J.P., Yew, S. et al. Disentangling the Relationship between Frailty and Intrinsic Capacity in Healthy Community-Dwelling Older Adults: A Cluster Analysis. J Nutr Health Aging 25, 1112–1118 (2021). https://doi.org/10.1007/s12603-021-1679-2
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DOI: https://doi.org/10.1007/s12603-021-1679-2