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

Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.

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Declined intrinsic capacity and its influencing factors among older adults in China: a national cross-sectional survey

Fang,

Wang,

Qing

et al. 2024

Preprint

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Background The decline in intrinsic capacity (IC) among older adults is a significant global health challenge, impacting their well-being and quality of life. Despite global efforts to promote healthy aging, research on factors contributing to IC decline in the Chinese population is limited. This study aims to investigate the decline of intrinsic capacity in Chinese older adults and to explore the influence of sociodemographic, health status, and lifestyle factors on the decline of intrinsic capacity. Methods Prevalence of intrinsic capacity decline was described using frequency analysis, while chi-square tests were used to analyze its associations with sociodemographic characteristics, health status, and lifestyle factors. Binary logistic regression analysis was used to identify significant factors influencing the decline of intrinsic capacity (α = 0.05). Results Among 6,941 respondents aged 60 years and above, 83.8% reported a decline in intrinsic capacity. Cognitive impairment was predominant (71.8%), followed by psychological (40.4%), locomotion (19.8%), vitality (17.2%), and sensory impairments (8.9%). Sociodemographic factors associated with a decline in intrinsic capacity included female gender, age 80 and older, unmarried, divorced or widowed status, rural residence, low education, and lack of health or pension insurance (p < 0.05). From the perspective of health status, factors associated with higher rates of intrinsic capacity decline include poor self-rated health, multiple chronic conditions, recent falls, frequent physical pain, recent outpatient visits, hospitalizations, and pessimistic life expectancy (p < 0.05). Lifestyle factors such as alcohol consumption, lack of social participation, prolonged sleep duration, and no Internet use were also linked to higher rates of intrinsic capacity decline (p < 0.05). The results of the binary logistic regression indicated that age, marital status, residence address, education level, pension insurance status, self-rated health, the presence of multiple chronic conditions, frequency of perceived physical pain, subjective life expectancy, social participation, sleep duration, and Internet access significantly influenced the decline of intrinsic capacity in older adults (p < 0.05). Conclusions The decline in intrinsic capacity among older adults in China, particularly in cognitive impairment, is concerning. Targeted interventions are necessary for vulnerable populations, especially those who are older, divorced or widowed, living in rural areas, or have lower education levels. Enhancing social pensions, promoting social participation, encouraging healthy sleep patterns, and improving digital inclusion to improve intrinsic capacity among older adults is important.

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

Cited by 3 publications

References 52 publications

Decoding the phenotypic mosaic of aging

Decoding the phenotypic mosaic of aging

Frailty: a global health challenge in need of local action

Declined intrinsic capacity and its influencing factors among older adults in China: a national cross-sectional survey

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