The Impact of Intrinsic Capacity on Adverse Outcomes in Older Hospitalized Patients: A One-Year Follow-Up Study

Zeng, Xingkun; Shen, Shanshan; Xu, Liyu; Wang, Yanyan; Yang, Yinghong; Chen, Lingyan; Guan, Huilan; Zhang, Jingmei; Chen, Xujiao

doi:10.1159/000512794

Cited by 45 publications

(38 citation statements)

References 50 publications

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“…Additionally, a prediction model of one-year mortality was also developed based on these risk factors, including age, length of stay, malnutrition, multi-morbidities, and previous admission history. In previous reports, mortality rates were found to be approximately 6% to 22% in older hospitalized patients one year after discharge [24,25]. In our study, the mortality rate was 7.7%, which was approximately equal to the result seen in previous studies.…”

Section: Discussionsupporting

confidence: 80%

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

Lin

Lee

et al. 2022

IJERPH

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Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0–86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.

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Section: Discussionsupporting

confidence: 80%

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

Lin

Lee

et al. 2022

IJERPH

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“…Our study is the first attempt to predict negative health outcomes based on repeatedly measured IC. Whereas previous studies relied on one-time assessments of IC [8][9][10], we could show that IC declines progressively and the current (or last) IC value predicts future negative health outcomes. The IC therefore could be used to predict probabilities for medium-and long-term negative health outcomes dynamically and to update prognoses, which may act as an early warning system and support medical decision making.…”

Section: Discussioncontrasting

confidence: 79%

“…Although there is solid evidence [4][5][6][7] that indicators associated with IC-domains such as grip strength (vitality) or gait speed (locomotor) predict adverse health outcomes, few studies, to date [8][9][10], have assessed the predictive ability of the overall IC construct. Moreover, these studies were either cross-sectional [8], or assessed only the association of between-person differences in IC at baseline with the incidence of disability in activities of daily living (ADL) [9,10] and mortality [10]. Thus, it is currently unclear how IC changes over time and whether longitudinal monitoring of IC is informative with regard to the prediction of negative health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Intrinsic capacity predicts negative health outcomes in older adults

Stolz

Mayerl

Freidl

et al. 2021

Preprint

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BACKGROUND: Monitoring trajectories of intrinsic capacity (IC) in older adults has been suggested by the WHO as a means to inform prevention to avoid or delay negative health outcomes. Due to a lack of longitudinal studies, it is currently unclear how IC changes over time and whether repeatedly measured IC predicts negative health outcomes. METHODS: Based on 4,751 repeated observations of IC (range=0-100) during 21 years of follow-up among 754 older adults 70+ years, we assessed longitudinal trajectories of IC, and whether time-varying IC predicted the risk of chronic ADL disability, long-term nursing home stay, and mortality using joint models for longitudinal and time-to-event data. RESULTS: Average IC declined progressively from 77 to 11 points during follow-up, with substantial heterogeneity between older adults. Adjusted for socio-demographics and chronic diseases, a one-point lower IC value was associated with a 7% increase in the risk of ADL disability, a 6% increase in the risk of a nursing home stay, and a 5% increase in mortality. Accuracy for 5- and 10-year predictions based on up to three repeated measurements of IC ranged between moderate and good (AUC = 0.76-0.82). DISCUSSION: Our study indicates that IC declines progressively and that it predicts negative health outcomes among older adults. Therefore, regular monitoring of IC could work as an early warning system informing preventive efforts.

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“…At the time of analysis, only 50% had completed 1-year follow-up with at least a telephone interview. There was no difference in age and baseline frailty status between those with and without follow-up, However, there were significantly more men in the group without follow-up data (28.0% vs 21.1%, p=0.021), which also had higher baseline composite IC compared with the follow-up group [9 ( 7 – 10 ) vs 8 ( 7 – 9 ), p=0.038]. While the potential influence of the differential baseline characteristics on examined outcomes cannot be dismissed, gender was not associated with frailty progression or any of the outcomes evaluated.…”

Section: Discussionmentioning

confidence: 99%

Association of Intrinsic Capacity with Frailty, Physical Fitness and Adverse Health Outcomes in Community-Dwelling Older Adults

Tay

Mah

et al. 2022

J Frailty Aging

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Background Intrinsic capacity (IC) and frailty are complementary in advancing disability prevention through maintaining functionality. Objectives We examined the relationship between IC and frailty status at baseline and 1-year, and evaluated if IC decline predicts frailty onset among robust older adults. The secondary objectives investigated associations between IC, physical fitness and health-related outcomes. Design Prospective cohort study. Setting Community-based assessments. Participants Older adults aged>55 years, who were independent in ambulation (walking aids permitted). Measurements 5 domains of IC were assessed at baseline: locomotion (Short Physical Performance Battery, 6-minute walk test), vitality (nutritional status, muscle mass), sensory (self-reported hearing and vision), cognition (self-reported memory, age- and education adjusted cognitive performance), psychological (Geriatric Depression Scale-15, self-reported anxiety/depression). Composite IC (0–10) was calculated, with higher scores representing greater IC. Frailty status was based on modified Fried criteria, with frailty progression defined as incremental Fried score at 1-year. Results 809 participants (67.6+6.8 years) had complete data for all 5 IC domains. 489 (60.4%) participants were robust but only 213 (26.3%) had no decline in any IC domain. Pre-frail and frail participants were more likely to exhibit decline in all 5 IC domains (p<0.05), with decremental composite IC [9 (8–9), 8 (6–9), 5.5 (4–7.5), p<0.001] across robust, prefrail and frail. IC was significantly associated with fitness performance, independent of age and gender. Higher composite IC reduced risk for frailty progression (OR=0.62, 95% CI 0.48–0.80), and reduced frailty onset among robust older adults (OR=0.53, 95% CI 0.37–0.77), independent of age, comorbidities and social vulnerability. Participants with higher IC were less likely to experience health deterioration (OR=0.70, 95% CI 0.58–0.83), falls (OR=0.76, 95% CI 0.65–0.90) and functional decline (OR=0.64, 95% CI 0.50–0.83) at 1-year. Conclusion Declining IC may present before frailty becomes clinically manifest, increasing risk for poor outcomes. Monitoring of IC domains potentially facilitates personalized interventions to avoid progressive frailty. Electronic Supplementary Material Supplementary material is available for this article at 10.14283/jfa.2022.28 and is accessible for authorized users.

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The Impact of Intrinsic Capacity on Adverse Outcomes in Older Hospitalized Patients: A One-Year Follow-Up Study

Cited by 45 publications

References 50 publications

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment

Intrinsic capacity predicts negative health outcomes in older adults

Association of Intrinsic Capacity with Frailty, Physical Fitness and Adverse Health Outcomes in Community-Dwelling Older Adults

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