School of Nursing, Capital Medical University, Beijing, China.
Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China.
J Glob Health. 2024 Oct 11;14:04159. doi: 10.7189/jogh.14.04159.
BACKGROUND: Global population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability. METHODS: We conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population. RESULTS: The average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001). CONCLUSIONS: Observing IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.
背景：全球人口老龄化给老年人护理带来了新的挑战。探索内在能力（IC）随时间的变化，这是衡量个体身体和精神能力的综合指标，对于促进健康老龄化和预防残疾至关重要，例如日常生活活动（ADL）残疾引起的残疾。我们旨在确定并研究 IC 轨迹和 ADL 残疾发病的类别的差异。
方法：我们使用中国健康与退休纵向研究的三个波次（2011-15 年）的数据进行了一项观察性研究，共包含 2609 名参与者，共进行了 6034 次观察。IC 通过五个领域进行测量，包括运动能力、认知能力、心理、感官能力和活力。我们使用联合潜在类别建模来识别具有相似 IC 轨迹和 ADL 残疾发病模式的不同类别，并探讨 IC 轨迹的变化，并考虑到老年人群体的异质性，预测五年 ADL 残疾的风险。
结果：平均基线 IC 得分为 7.15（范围：0-15）。我们观察到 IC 得分随年龄缓慢下降，17.25%的参与者发生 ADL 残疾。我们确定了三种 IC 类别，可以描述为中等健康（第 1 类：n=1634，62.63%）、有风险（第 2 类：n=716，27.44%；ADL 残疾的风险最高）和最佳健康（第 3 类：n=259，9.93%；ADL 残疾的基线风险最低）。情绪问题使中等健康类别的可能性降低最多（优势比（OR）=0.219；P<0.001）。自评生活水平较差会大大降低中等（OR=0.308；P=0.001）和最佳健康（OR=0.110；P<0.001）的机会。
结论：观察 IC 轨迹和 ADL 残疾的发病可以将老年人分为不同的亚组，并为实施以患者为中心的护理计划提供数据，以扭转趋势并在临床实践中延迟不良结果。
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