Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
J Am Med Dir Assoc. 2024 Sep;25(9):105146. doi: 10.1016/j.jamda.2024.105146. Epub 2024 Jul 10.
OBJECTIVE: Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DESIGN: Cohort study. SETTING AND PARTICIPANTS: A total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. METHODS: We derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0-8; IC2-Liu 2021, range: 0-4; IC3-ICOPE, range: 0-4; IC4-modified ICOPE, range: 0-8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. RESULTS: Among 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55-11.96; OR, 5.00; 95% CI, 1.75-14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45-12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18-0.19, P < .05). CONCLUSIONS AND IMPLICATIONS: Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.
目的：内在能力（IC）和脆弱性是两个互补的概念，它们包含了老年人的功能能力。尽管早期的研究表明，综合 IC 评分在预测脆弱风险方面具有一定的作用，但关键的差距仍然存在，例如缺乏不同 IC 量表之间的直接比较研究，以及缺乏基于世界卫生组织综合老年人护理（ICOPE）工具的综合评分。我们旨在比较不同的 IC 量表，包括基于 ICOPE 的量表，在预测健康社区居住的老年人 2 年内发生脆弱风险方面的能力。
设计：队列研究。
地点和参与者：共纳入来自 GeriLABS-2 队列研究的 230 名参与者（年龄：67.2±7.4 岁）。
方法：我们通过将 4 个 IC 领域（运动、认知、活力和心理）相加来得出综合评分。我们比较了 4 个量表的综合评分：IC1-Chew 2021，范围：0-8；IC2-Liu 2021，范围：0-4；IC3-ICOPE，范围：0-4；IC4-改良 ICOPE，范围：0-8。主要结局是使用改良 Fried 脆弱表型评估的脆弱风险。我们进行了逻辑回归分析，以检验基线综合 IC 与脆弱风险之间的关联。我们还研究了个体领域和受损领域数量对脆弱风险的影响。
结果：在完成 2 年随访的 193 名（83.9%）老年人中，有 20 名（10.4%）符合脆弱风险标准。调整协变量后，2 分制量表（IC1/IC4）预测脆弱风险增加（OR，4.31；95%CI，1.55-11.96；OR，5.00；95%CI，1.75-14.26）。进一步调整基线脆弱后，只有 IC4 仍然具有统计学意义（OR，4.28；95%CI，1.45-12.60）。在各领域中，运动和活力受损与脆弱风险相关。受损领域数量越多，脆弱风险越高（IC1/IC2：β=0.18-0.19，P<.05）。
结论和意义：基于 2 分制量表的基线综合 IC 评分能够更好地预测 2 年内的脆弱风险，其预测依据是运动/活力受损和受损领域数量增加。为了早期识别有脆弱风险的健康老年人，应考虑采用基于 ICOPE 的量表，因为它既有效又易于使用。
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