Approaching person-centered clinical practice: A cluster analysis of older inpatients utilizing the measurements of intrinsic capacity

Abstract

BackgroundMaintaining the intrinsic capacity (IC) of older inpatients is a novel view in providing person-centered treatments in clinical practice. Uncertainty remains regarding the primary nature of IC among older hospitalized patients.ObjectivesWe aimed to understand the status of IC among older inpatients by a cluster analysis based on IC measurements.MethodsThis is a cross-sectional study conducted in the geriatric department of Beijing Hospital in China. Older inpatients who were older than 60 years and who underwent comprehensive geriatric assessments were included. The inpatients were classified into subgroups based on 13 measurements of IC according to unsupervised methods (K-means cluster analysis and t-SNE). Subgroup differences were investigated for domains of IC, age, sex, frailty, activities of daily living, and falls.ResultsA total of 909 inpatients with a mean age of 76.6 years were included. Almost 98% of the inpatients showed IC impairment. Locomotion impairment was the most prevalent problem (91.1%), followed by sensory impairment (61.4%), psychological impairment (57.3%), cognition decline (30.7%), and vitality problem (29.2%). A total of five clusters were obtained by classification: Cluster 1 (56.6% of the participants) showed high IC with fair impairment of locomotion and vision; clusters 2 and 3 (37.8 % of the participants) had additional impairment of sleep in the psychological domain; clusters 4 and 5 (5.6% of the participants) represented a severe loss of all the IC domains; and clusters 1–5 showed a gradual decline in the IC score and were significantly associated with increased age, frailty, decreased activities of daily living, and falls. Significant correlations among the domains were observed; the locomotion domain showed the strongest links to the others in network analysis.ConclusionsGreat declines in IC and disparities between IC domains were found in older inpatients. IC-based primary assessment and classification enabled us to identify the variation of functional abilities among the older inpatients, which is pivotal for designing integrated treatment or care models in clinical practice.

Factors associated with the intrinsic capacity in older adults: A scoping review

“…Thirteen studies (Beard et al., 2019; Beard et al., 2022; Campbell et al., 2022; Lin et al., 2022; Lu et al., 2021; Muneera et al., 2022; Prince et al., 2021; Tang et al., 2023; Yu et al., 2021; Yu et al., 2022b; Yu et al., 2023; Yu, Leung, et al., 2022; Zhao et al., 2021) found a significant association between sex and IC of older adults, with older females being more likely to have poorer IC. However, the other three studies (Jia et al., 2023; Wu et al., 2022; Yu et al., 2022a) did not observe such findings.…”

“…19 of the 29 studies looked at the effect of age on the IC of older adults, involving 95,732 participants. Eighteen studies (Beard et al., 2019; Beard et al., 2022; Campbell et al., 2022; Jia et al., 2023; Leung et al., 2022; Lin et al., 2022; Lu et al., 2021; Ma et al., 2021a; Muneera et al., 2022; Prince et al., 2021; Tang et al., 2023; Wu et al., 2022; Yu et al., 2021; Yu et al., 2022a; Yu et al., 2022b; Yu et al., 2022c; Yu et al., 2023; Zhao et al., 2021) discovered a significant association between age and IC of older adults, indicating that the younger old adults were likely to have a better IC. And only one study (Ma et al., 2021c) showed no differences between age and IC of older adults.…”

“…Four studies (Beard et al., 2019; Jia et al., 2023; Prince et al., 2021; Wu et al., 2022) with 21,308 participants explored the association between disability (ADL and IADL limitations) and IC, revealing that older adults without disabilities were less likely to have IC decline.…”

“…According to some studies, females are more likely to have impairments in IC (Beard et al, 2022;Mathur et al, 2022;Muneera et al, 2022). Several studies, however, found no significant relationship between sex and IC impairments (Jia et al, 2023;Wu et al, 2022). In addition, some studies revealed that older people with more chronic diseases were more likely to experience IC impairments (Beard et al, 2019;Ho et al, 2020;Zhao et al, 2021) while a few studies failed to detect the difference between chronic diseases and IC impairments (Jia et al, 2023;Lin et al, 2022).…”

Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity

“…The application of this concept represents several advantages for research and health policies in aging. First, intrinsic capacity is a comprehensive measure of health, which can be monitored throughout the life course and advocates for maintaining functional capacity in older adults, regardless of the presence of diseases [ 31 ]. Second, it focuses on functional capacity and its preservation rather than on the deficiencies of old age or the deterioration of bodily functions [ 32 ].…”