Study On The Evaluation Of Intrinsic Ability Of Elderly Community Residents And Its Predictive Value For Adverse Outcome

Part Ⅰ Diagnostic performance analysis of ICOPE screening tool for identifying intrinsic capacity declineBackground:The World Health Organization(WHO)recommended a two-step approach to assess intrinsic capacity(IC)decline in older people.Step 1 involves screening with the Integrated Care for Older People(ICOPE)screening tool,and step 2 involves a detailed assessment using an evaluation tool for older people with identified problems.The ability of ICOPE screening tool as a simple preliminary screening to identify IC decline among community-dwelling older people was rarely reported in China.Objectives:Evaluate the diagnostic performance of the ICOPE screening tool in identifying IC decline in community-dwelling older people,including sensitivity,specificity,and diagnostic accuracy.Methods:This study included community-dwelling older people aged ≥75 who completed IC evaluation according to the WHO IC assessment pathway.Sensitivity,specificity,and diagnostic accuracy of the ICOPE screening tool were calculated using 2x2 table and receiver operating characteristic curve.Results:A total of 228 individuals were enrolled in this study,with a mean age of 84.0±4.4 years and 131(57.5%)female.The proportion of possible IC decline identified by the ICOPE screening tool was 79.4%,while actual IC decline assessed by detailed assessments was 73.2%,mainly in locomotion.The ICOPE screening tool showed a sensitivity of 94.6%and specificity of 62.3%in identifying IC decline,with an overall diagnostic accuracy of 86.0%.Except for the sensory dimension,the sensitivity of the ICOPE screening tool in diagnosing impairments in each dimension of IC was highest in the cognition domain(100%)and lowest in the vitality(51.3%),while the specificity was highest in the vitality(94.7%)and lowest in the cognition(55.6%).Conclusions:The ICOPE screening tool had high sensitivity and can be promoted for use as an IC screening scale in community-dwelling older adults.However,further improvements are needed in the vitality domain of the ICOPE screening tool to enhance the sensitivity in identifying individuals at risk of malnutrition.Part Ⅱ Comparison of the Predictive Value of Intrinsic Capacity and Comorbidity for All-Cause Mortality and Falls in Community-Dwelling Older PeopleBackground:The community health service model in China has always been centered around disease management.However,with the extension of life expectancy,the fragmented medical model centered around disease management can no longer keep up with the trend of global aging.From the perspective of individual defense systems,preventing and delaying the functional decline of older people is crucial for coping with population aging and optimizing resource allocation.Studies have found that IC decline in older people had better predictive value than comorbidity.However,whether IC can better predict all-cause mortality and falls in community-dwelling older people in China compared to comorbidity remains to be confirmed.Objective:To compare the predictive value of IC and comorbidity for all-cause mortality and falls in community-dwelling older people.Methods:This study is a prospective cohort study that included individuals aged≥75 years old living independently in the Beijing Taikang Yanyuan community from July to September 2018.Comprehensive geriatric assessments were conducted,and IC of older people was evaluated using the detailed assessment method recommended by the WHO,while comorbidity was evaluated using the Cumulative Illness Rating Scale for Geriatrics(CIRS-G).Follow-up was conducted for 3 years,and the occurrence of all-cause mortality and falls was recorded.The receiver operating characteristic(ROC)curve was used to analyze the predictive ability of intrinsic capacity and comorbidity for adverse health outcomes,and the DeLong test was used to compare the area under the curve(AUC)of the two.The relationship between the domains of IC and adverse health outcomes was analyzed by logistic regression.Results:This study included a total of 220 elderly individuals(mean age 84.0±4.4 years),of whom 127(57.7%)were female.The IC score was 1(range 0-2)and the incidence of IC decline was 72.3%.The comorbidity score was 5(range 3-7).During the 3-year follow-up period,26 cases(11.8%)of all-cause mortality and 101 cases(45.9%)of falls occurred.In terms of predicting all-cause mortality,IC(AUC=0.78,95%CI:0.72-0.83)was superior to comorbidity(AUC=0.67,95%CI:0.61-0.74),p=0.033.In terms of predicting falls,IC(AUC=0.69,95%CI:0.63-0.75)was also superior to comorbidity(AUC=0.61,95%CI:0.54-0.67),p=0.032.Multivariate logistic regression analysis showed that after adjusting for age,sex,and comorbidity,the vitality domain(OR=2.70,95%CI:1.01-7.28)and cognitive domain(OR=3.37,95%CI:1.13-10.10)were independently associated with an increased risk of all-cause mortality,while the locomotion domain(OR=2.60,95%CI:1.35-4.99)was independently associated with an increased risk of fall.Conclusions:A function-centered approach may be superior to a disease-centered care model,and in community health services for older people,it is important to focus on maintaining function.The vitality,locomotion,and cognitive domains should be given more attention.Part Ⅲ Predictive Value of Different Levels of Intrinsic Capacity(IC)for Adverse Health Outcomes Using the Comprehensive IC ScoreMethodBackground:Currently,there is no consensus on the scoring criteria for IC.IC is a comprehensive indicator that reflects individual reserve function and represents the positive attributes of an individual.Each dimension may interact and influence each other and cannot independently represent an individual’s level of IC.Therefore,a comprehensive scoring standard for IC still needs to be developed.In 2022,Spanish scholars proposed a comprehensive score for IC and a severity grading system for IC decline,but their application in community-dwelling older people is still lacking.Objective:Using the comprehensive grading scoring method for IC,to explore the predictive value of different levels of IC for adverse health outcomes(all-cause mortality and falls).Methods:This study is a prospective cohort study.The study subjects were recruited from the independent living area of Beijing Taikang Yanyuan from July to September 2018,and included elderly individuals aged ≥75 years who were evaluated using the comprehensive grading scoring method for IC.The relationship between the severity of IC decline and the risk of adverse health outcomes were explored by Cox proportional hazards regression models.Kaplan-Meier curves were constructed in different IC level groups to establish survival curves for all-cause mortality and fall incidence,and log-rank tests were used to compare the differences in survival time between the curves.Results:This study included 220 elderly individuals(84.0±4.4 years),of whom 127(57.7%)were females.They were divided into three groups based on their IC level:108 individuals(49.1%)with stable intrinsic capacity,98 individuals(44.5%)with mild to moderate decline,and 14 individuals(6.4%)with severe decline.The COX proportional hazards regression model showed that,after adjusting for age,gender,and comorbidity,the group with severe IC decline had a significantly increased risk of all-cause mortality(HR=7.83,95%CI:1.72-35.56).Compared to the group with stable IC,the mild-to-moderate IC decline group had an increased risk of falls by approximately 0.9 times(HR=1.85,95%CI:1.12-3.05),but the difference between different degrees of decline lost statistical significance.Kaplan-Meier curves showed that as IC level decreased,the mortality rate increased(log-rank test:p<0.001).Conclusions:In the community-dwelling older people,IC decline is an independent risk factor for both all-cause mortality and falls.Grading the level of IC through a comprehensive score is conducive to risk-stratified management of community-dwelling older people,which is more in line with value-based healthcare.