Skip to main content
SpringerLink
Log in

Towards Healthy Ageing: Using the Concept of Intrinsic Capacity in Frailty Prevention

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To examine whether intrinsic capacity (IC) could predict frailty, whether declines in specific domains of IC could lead to frailty, and whether different combinations of domains could represent different risks of developing frailty.

Setting

Community.

Participants

Chinese people aged 65 years and older.

Measurements

Using data from a prospective cohort study, we derived a summary score for IC and scores for the five domains (cognitive, locomotor, vitality, sensory, psychological) for each participant at baseline. Frailty was assessed according to the Fried’s frailty phenotype at baseline, 2- and 4-year follow-ups. Participants were classified as frail if they had ≥3 of the following criteria: weight loss, self-rated exhaustion, weakness, slow walking speed, and low physical activity.

Results

Four thousand participants were interviewed at baseline. Overall mean age was 72.5 years; 50% were women. Between baseline and the 2-year follow-up, 5.7% of non-frail participants developed frailty; between 2- and 4-year follow-ups, 5.7% of non-frail participants developed frailty. The average annual incidence rate of frailty was 2.9%. Higher scores on IC at baseline were associated with a lower risk of incident frailty at both follow-ups (year 2, odds ratio (OR)=0.64, 95% confidence interval (CI)=0.59–0.71); year 4, OR=0.64, 95%CI=0.58–0.71) after adjustment for age, sex, educational level, and chronic diseases. Across the five domains, vitality was the strongest predictor of incident frailty at each follow-up (year 2, OR=0.33, 95%CI=0.24–0.45; year 4, OR=0.33, 95%CI=0.23–0.46). Compared to other combinations of any two domains, having ‘high’ scores on both vitality and locomotor domains was associated with the lowest risk of incident frailty (year 2, OR=0.11, 95%CI=0.06–0.22, area under the curve (AUC)=0.770; year 4, OR=0.18, 95%CI=0.10–0.32, AUC=0.782).

Conclusion

This study provides evidence that IC was independently associated with incident frailty. It also finds that vitality was the domain most strongly associated with incident frailty. Finally, it suggests that optimizing multiple domains of IC, particularly vitality and locomotor, may prevent frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci Mar 2001;56(3):M146–157. doi:https://doi.org/10.1093/gerona/56.3.m146.

    Article  CAS  Google Scholar 

  2. Bandeen-Roche K, Xue QL, Ferrucci L et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci 2006;61(3):262–266. doi:https://doi.org/10.1093/gerona/61.3.262.

    Article  Google Scholar 

  3. Boyd CM, Xue QL, Simpson CF et al. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med 2005;118(11):1225–1231. doi:https://doi.org/10.1016/j.amjmed.2005.01.062.

    Article  Google Scholar 

  4. Makary MA, Segev DL, Pronovost PJ et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010;210(6):901–908. doi:https://doi.org/10.1016/j.jamcollsurg.2010.01.028.

    Article  Google Scholar 

  5. Fried LP, Cohen AA, Xue QL et al. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. Nat Aging 2021;1(1):36–46. doi:https://doi.org/10.1038/s43587-020-00017-z.

    Article  Google Scholar 

  6. Collard RM, Boter H, Schoevers RA et al. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc Aug 2012;60(8):1487–1492. doi:https://doi.org/10.1111/j.1532-5415.2012.04054.x.

    Article  Google Scholar 

  7. Siriwardhana DD, Hardoon S, Rait G et al. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018;8(3):e018195. doi:https://doi.org/10.1136/bmjopen-2017-018195.

    Article  Google Scholar 

  8. Rodriguez JJL, Prina AM, Acosta D et al. The prevalence and correlates of frailty in urban and rural populations in Latin America, China, and India: a 10/66 population-based survey. J Am Med Dir Assoc 2018;19(4):287–295.e284. doi:https://doi.org/10.1016/j.jamda.2017.09.026.

    Article  Google Scholar 

  9. Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 2014;43(6):744–747. doi:https://doi.org/10.1093/ageing/afu138.

    Article  Google Scholar 

  10. Dent E, Lien C, Lim WS et al. The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc 2017;18(7):564–575. doi:https://doi.org/10.1016/j.jamda.2017.04.018.

    Article  Google Scholar 

  11. WHO. (2015) World report on ageing and health 2015. Geneva: World Health Organization.

    Google Scholar 

  12. WHO. (2019) Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. Geneva: World Health Organization. License: CC BY-NC-SA 3.0 IGO (WHO/FWC/ALC/19.1).

    Google Scholar 

  13. González-Bautista E, de Souto Barreto P, Virecoulon Giudici K et al. Frequency of conditions associated with declines in intrinsic capacity according to a screening tool in the context of Integrated Care for Older People. J Frailty Aging 2021;10(2):94–102. doi:https://doi.org/10.14283/jfa.2020.42.

    PubMed  Google Scholar 

  14. Ma L, Chhetri JK, Zhang Y et al. Integrated Care for Older People screening tool for measuring intrinsic capacity: preliminary findings from ICOPE pilot in China. Front Med 2020;7doi:https://doi.org/10.3389/fmed.2020.576079.

  15. Gutiérrez-Robledo LM, García-Chanes RE, Pérez-Zepeda MU. Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study. Revista Panamericana de Salud Pública 2021;45:e121. doi:https://doi.org/10.26633/RPSP.2021.121.

    Article  Google Scholar 

  16. Beard JR, Amuthavalli Thiyagarajan J, Cesari M et al. 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.

    Article  Google Scholar 

  17. Yu R, Amuthavalli Thiyagarajan J, Leung J et al. Validation of the construct of intrinsic capacity in a longitudinal Chinese cohort. J Nutr Health Aging 2021;25:808–815. doi:https://doi.org/10.1007/s12603-021-1637-z.

    Article  CAS  Google Scholar 

  18. Morley JE, Vellas B, Van Kan GA et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14(6):392–397. doi:https://doi.org/10.1016/j.jamda.2013.03.022.

    Article  Google Scholar 

  19. Ma L, Chhetri JK, Zhang L et al. Cross-sectional study examining the status of intrinsic capacity decline in community-dwelling older adults in China: prevalence, associated factors and implications for clinical care. BMJ Open 2021;11(1):e043062. doi:https://doi.org/10.1136/bmjopen-2020-043062.

    Article  Google Scholar 

  20. González-Bautista E, de Souto Barreto P, Andrieu S et al. Screening for intrinsic capacity impairments as markers of increased risk of frailty and disability in the context of integrated care for older people: Secondary analysis of MAPT. Maturitas 2021;150:1–6. doi:https://doi.org/10.1016/j.maturitas.2021.05.011.

    Article  Google Scholar 

  21. Wong SYS, Kwok T, Woo J et al. Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong. Osteoporos Int 2005;16(12):1933–1938. doi:https://doi.org/10.1007/s00198-005-1968-3.

    Article  CAS  Google Scholar 

  22. Lee JSW, Auyeung TW, Leung J et al. Transitions in frailty states among community-living older adults and their associated factors. J Am Med Dir Assoc 2014;15(4):281–286. doi:https://doi.org/10.1016/j.jamda.2013.12.002.

    Article  Google Scholar 

  23. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–198. doi:https://doi.org/10.1016/0022-3956(75)90026-6.

    Article  CAS  Google Scholar 

  24. Chiu HFK, Lee HC, Chung WS et al. Reliability and validity of the Cantonese version of mini-mental state examination-a preliminary study. Hong Kong Journal of Psychiatry 1994;4(2):25.

    Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. Sheikh JA, Yesavage JA. (1986) Geriatric Depression Scale (GDS): recent findings and development of a shorter version In: Brink TL, editor., ed. Clinical Gerontology: A Guide to Assessment and Intervention. New York: Howarth Press.

    Google Scholar 

  27. Lee HCB, Chiu HFK, Kowk WY et al. Chinese elderly and the GDS short form: a preliminary study. Clinical Gerontologist: The Journal of Aging and Mental Health 1993.

  28. Fried LP, Xue QL, Cappola AR et al. Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment. J Gerontol A Biol Sci Med Sci 2009;64(10):1049–1057. doi:https://doi.org/10.1093/gerona/glp076.

    Article  Google Scholar 

  29. Cesari M, Landi F, Vellas B et al. Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci 2014;6:192. doi:https://doi.org/10.3389/fnagi.2014.00192.

    PubMed  PubMed Central  Google Scholar 

  30. Yu R, Tong C, Ho F et al. Effects of a multicomponent frailty prevention program in prefrail community-dwelling older persons: a randomized controlled trial. J Am Med Dir Assoc 2020;21(2):294. e291–294.e210. doi:https://doi.org/10.1016/j.jamda.2019.08.024.

    Article  Google Scholar 

  31. Oh G, Lee H, Park CM et al. Long-term effect of a 24-week multicomponent intervention on physical performance and frailty in community-dwelling older adults. Age Ageing 2021 doi:https://doi.org/10.1093/ageing/afab149.

  32. Dedeyne L, Deschodt M, Verschueren S et al. Effects of multi-domain interventions in (pre) frail elderly on frailty, functional, and cognitive status: a systematic review. Clin Interv Aging 2017;12:873. doi:https://doi.org/10.2147/CIA.S130794.

    Article  Google Scholar 

Download references

Funding

Funding: The work was supported by the National Institutes of Health R01 Grant AR049439-01A1 and the Chinese University of Hong Kong Research Grants Council Earmarked Grant CUHK4101/02M.

Author information

Authors and Affiliations

  1. Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Ruby Yu & J. Woo

  2. Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China

    Ruby Yu, G. Leung & J. Woo

  3. Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China

    J. Leung

Authors
  1. Ruby Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruby Yu.

Ethics declarations

Ethical standards: The study was approved by the Joint Chinese University of Hong Kong and New Territories East Cluster Clinical Research Ethics Committee in Hong Kong, which required informed consent to be obtained.

Conflict of Interest: The authors have declared that no competing interests exist.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, R., Leung, J., Leung, G. et al. Towards Healthy Ageing: Using the Concept of Intrinsic Capacity in Frailty Prevention. J Nutr Health Aging 26, 30–36 (2022). https://doi.org/10.1007/s12603-021-1715-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-021-1715-2

Key words

Search

Navigation