Pradeep Paul George, Health Services and Outcomes Research, National Healthcare Group, Singapore,
J Nutr Health Aging. 2021;25(6):774-782. doi: 10.1007/s12603-021-1622-6.
OBJECTIVES: This study aims to address the knowledge gap and summarise the measurement for intrinsic capacity for the five WHO domains across different populations. It specifically aims to identify measurement tools, methods used for computation of a composite intrinsic capacity index and factors associated with intrinsic capacity among older adults. METHODS: We performed literature review in Medline, including search terms "aged" or "elderly" and "intrinsic capacity" for articles published from 2000 - 2020 in English. Studies which assessed intrinsic capacity in the five WHO domains were included. Information pertaining to study setting, methods used for measuring the domains of intrinsic capacity, computation methods for composite intrinsic capacity index, and details on tool validation were extracted. RESULTS: Seven articles fulfilling the inclusion criteria were included in the review. Of these, the majority were conducted in community settings (n=5) and were retrospective studies (n=6). The most commonly used tools for assessing intrinsic capacity were gait speed test and chair stand test (locomotion); handgrip-strength and mini-nutritional assessment (vitality); Mini-Mental State Examination (cognition); Geriatric Depression Scale (GDS) and Center for Epidemiological Studies Depression Scale (CES-D) (psychological), and self-reported vision and health questionnaires (sensory). Among the tools used to operationalise the domains, we found variations and non-concordance, especially in the vitality and psychological domains, which make inter-study comparison difficult. Validated scales were less commonly used for vitality and sensory domains. Biomarkers were used for locomotion, vitality, and sensory domains. Self-reported measures were mostly used in the psychological and sensory domains. Three studies operationalised a global score for intrinsic capacity, whereby scores from the individual domains were used to create a composite intrinsic capacity index, using two approaches: a) Structural equation modelling, and b) Sub-scores for each domain which were combined either by arithmetic sum or average. CONCLUSION: We identified considerable variations in measurement instruments and processes which are used to assess intrinsic capacity, especially among the vitality and psychological domains. A standardized intrinsic capacity composite score for clinical or community settings has not been operationalised yet. Further validation via prospective studies of the intrinsic capacity concept and computation of composite score using validated scales are needed.
目的:本研究旨在填补知识空白,并总结五个世界卫生组织(WHO)领域内在能力的测量方法,涵盖不同人群。具体而言,本研究旨在确定用于评估老年人内在能力的测量工具、计算综合内在能力指数的方法以及与内在能力相关的因素。
方法:我们在 Medline 上进行了文献综述,使用了“aged”或“elderly”和“intrinsic capacity”等搜索词,检索 2000 年至 2020 年期间发表的英文文献。纳入评估五个 WHO 领域内在能力的研究。提取研究设置、内在能力领域测量方法、综合内在能力指数计算方法以及工具验证的详细信息。
结果:有 7 篇符合纳入标准的文章纳入了综述。其中,大多数研究在社区环境中进行(n=5),且为回顾性研究(n=6)。评估内在能力最常用的工具是步态速度测试和坐立测试(运动能力);握力测试和迷你营养评估(活力);简易精神状态检查(认知);老年抑郁量表(GDS)和流行病学研究中心抑郁量表(CES-D)(心理),以及自我报告的视力和健康问卷(感觉)。在所使用的操作化工具中,我们发现存在差异和不一致,尤其是在活力和心理领域,这使得难以进行研究间比较。较少使用经过验证的量表来评估活力和感觉领域。生物标志物用于评估运动能力、活力和感觉领域。自我报告的测量主要用于心理和感觉领域。有 3 项研究操作化了内在能力的综合评分,即将各领域的评分用于创建综合内在能力指数,采用了两种方法:a)结构方程建模,b)每个领域的子分数,通过算术总和或平均值进行组合。
结论:我们发现,用于评估内在能力的测量工具和方法存在很大差异,尤其是在活力和心理领域。尚未为临床或社区环境制定标准化的内在能力综合评分。需要通过前瞻性研究进一步验证内在能力概念,并使用经过验证的量表计算综合评分。
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