This prospective cohort study assessed the impact of intrinsic capacity on hospital admissions among older adults after an Emergency Department (ED) visit. Assessing 1132 patients according to WHO’s Integrated Care for Older People guidelines between March 1 and August 30, 2022, we found that 784 (69.26%) were admitted. The admission group demonstrated significantly lower intrinsic capacity scores (mean ± SD, 2.92 ± 1.29) compared to the discharge group (3.44 ± 1.23; p < .001). Multivariable logistic regression showed that higher intrinsic capacity scores were associated with lower odds of admission (adjusted odds ratio [aOR] = 0.81; 95% CI: 0.71–0.92; p < .001). Notably, patients with malnutrition had significantly higher odds of admission (OR = 3.12; 95% CI: 2.16–4.50; p < .001). These findings underscore the importance of integrating the intrinsic capacity assessment with traditional clinical indicators in the emergency care of older adults.
AminzadehF.DalzielW. B. (2002). Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Annals of Emergency Medicine, 39(3), 238–247. https://doi.org/10.1067/mem.2002.121523
3.
BahrmannA.BennerL.ChristM.BertschT.SieberC. C.KatusH.BahrmannP. (2019). The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department. Aging clinical and experimental research, 31(9), 1233–1242. https://doi.org/10.1007/s40520-018-1067-x
4.
BautmansI.KnoopV.Amuthavalli ThiyagarajanJ.MaierA. B.BeardJ. R.FreibergerE.BelskyD.Aubertin-LeheudreM.MiktonC.CesariM.SumiY.DiazT.BanerjeeA.WHO Working Group on Vitality Capacity. (2022). WHO working definition of vitality capacity for healthy longevity monitoring. The Lancet Healthy Longevity, 3(11), e789–e796. https://doi.org/10.1016/S2666-7568(22)00200-8
5.
BeardJ. R.SiY.LiuZ.ChenowethL.HanewaldK. (2022). Intrinsic capacity: Validation of a new WHO concept for healthy aging in a longitudinal Chinese study. The Journals of Gerontology: Series A, 77(1), 94–100. https://doi.org/10.1093/gerona/glab226
6.
BriggsA. M.ValentijnP. P.ThiyagarajanJ. A.Araujo de CarvalhoI. (2018). Elements of integrated care approaches for older people: A review of reviews. BMJ Open, 8(4), Article e021194. https://doi.org/10.1136/bmjopen-2017-021194
7.
BrinkA.AlsmaJ.van AttekumL. A.BramerW. M.ZietseR.LingsmaH.SchuitS. C. (2022). Predicting inhospital admission at the emergency department: A systematic review. Emergency medicine journal, 39(3), 191–198. https://doi.org/10.1136/emermed-2020-210902
8.
BurksC. E.JonesC. W.BrazV. A.SworR. A.RichmondN. L.HwangK. S.HollowellA. G.WeaverM. A.Platts-MillsT. F. (2017). Risk factors for malnutrition among older adults in the emergency department: A multicenter study. Journal of the American Geriatrics Society, 65(8), 1741–1747. https://doi.org/10.1111/jgs.14862
9.
CameronA.RodgersK.IrelandA.JamdarR.McKayG. A. (2015). A simple tool to predict admission at the time of triage. Emergency medicine journal, 32(3), 174–179. https://doi.org/10.1136/emermed-2013-203200
10.
CesariM.Araujo de CarvalhoI.Amuthavalli ThiyagarajanJ.CooperC.MartinF. C.ReginsterJ. Y.VellasB.BeardJ. R. (2018). Evidence for the domains supporting the construct of intrinsic capacity. The Journals of Gerontology: Series A, 73(12), 1653–1660. https://doi.org/10.1093/gerona/gly011
11.
CesariM.SadanaR.SumiY.Amuthavalli ThiyagarajanJ.BanerjeeA. (2022). What is intrinsic capacity and why should nutrition Be included in the vitality domain?The Journals of Gerontology: Series A, 77(1), 91–93. https://doi.org/10.1093/gerona/glab318
12.
ChanA. C.-M. (1996). Clinical validation of the geriatric depression scale (GDS):Chinese version. Journal of Aging and Health, 8(2), 238–253. https://doi.org/10.1177/089826439600800205
13.
ChowdhuryM. Z. I.TurinT. C. (2020). Variable selection strategies and its importance in clinical prediction modelling. Family Medicine and Community Health, 8(1), e000262. https://doi.org/10.1136/fmch-2019-000262
14.
CohenI.SangalR. B.TaylorR. A.CrawfordA.LaiJ. M.MartinP.PalleschiS.RothenbergC.TomasinoD.HwangU. (2024). Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition. Journal of the American Geriatrics Society, 72(7), 2017–2026. https://doi.org/10.1111/jgs.18908
15.
DresdenS. M.HwangU.GarridoM. M.SzeJ.KangR.Vargas-TorresC.CourtneyD. M.LooG.RosenbergM.RichardsonL. (2020). Geriatric emergency department innovations: The impact of transitional care nurses on 30-day readmissions for older adults. Academic Emergency Medicine, 27(1), 43–53. https://doi.org/10.1111/acem.13880
16.
FimognariF.-L.LelliD.LandiF.Antonelli IncalziR. (2022). Association of age with emergency department visits and hospital admissions: A nationwide study. Geriatrics and Gerontology International, 22(11), 917–923. https://doi.org/10.1111/ggi.14481
17.
Gonzalez-BautistaE.de Souto BarretoP.Virecoulon GiudiciK.AndrieuS.RollandY.VellasB. (2021). Frequency of conditions associated with declines in intrinsic capacity according to a screening tool in the context of integrated care for older people. The Journal of Frailty & Aging, 10(2), 94–102. https://doi.org/10.14283/jfa.2020.42
18.
Gonzalez-BautistaE.Llibre-GuerraJ. J.SosaA. L.AcostaI.AndrieuS.AcostaD.Llibre-RodríguezJ. d. J.PrinaM. (2023). Exploring the natural history of intrinsic capacity impairments: Longitudinal patterns in the 10/66 study. Age and Ageing, 52(7), afad137. https://doi.org/10.1093/ageing/afad137
19.
GriffinA.O'NeillA.O'ConnorM.RyanD.TierneyA.GalvinR. (2020). The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: A secondary analysis of the OPTI-MEND trial. BMC Geriatrics, 20(1), 455. https://doi.org/10.1186/s12877-020-01852-w
20.
GuralnikJ. M.SimonsickE. M.FerrucciL.GlynnR. J.BerkmanL. F.BlazerD. G.ScherrP. A.WallaceR. B. (1994). A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology, 49(2), M85–M94. https://doi.org/10.1093/geronj/49.2.m85
21.
JiaS.ZhaoW.GeM.XiaX.HuF.HaoQ.ZhangY.YangM.YueJ.DongB. (2023). Associations between transitions of intrinsic capacity and frailty status, and 3-year disability. BMC Geriatrics, 23(1), 96. https://doi.org/10.1186/s12877-023-03795-4
22.
KoivunenK.SchaapL. A.HoogendijkE. O.SchoonmadeL. J.HuismanM.van SchoorN. M. (2022). Exploring the conceptual framework and measurement model of intrinsic capacity defined by the World health organization: A scoping review. Ageing Research Reviews, 80, 101685. https://doi.org/10.1016/j.arr.2022.101685
23.
LeeW.-J.PengL.-N.LinM.-H.LohC.-H.HsiaoF.-Y.ChenL.-K. (2023). Intrinsic capacity differs from functional ability in predicting 10-year mortality and biological features in healthy aging: Results from the I-lan longitudinal aging study. Aging, 15(3), 748–764. https://doi.org/10.18632/aging.204508
24.
LeungA. Y. M.SuJ. J.LeeE. S. H.FungJ. T. S.MolassiotisA. (2022). Intrinsic capacity of older people in the community using WHO integrated care for older people (ICOPE) framework: A cross-sectional study. BMC Geriatrics, 22(1), 304. https://doi.org/10.1186/s12877-022-02980-1
25.
LimpawattanaP.PhungoenP.MitsungnernT.LaosuangkoonW.TansangwornN. (2016). Atypical presentations of older adults at the emergency department and associated factors. Archives of Gerontology and Geriatrics, 62, 97–102. https://doi.org/10.1016/j.archger.2015.08.016
26.
Lopez-OrtizS.ListaS.Penin-GrandesS.Pinto-FragaJ.ValenzuelaP. L.NisticoR.EmanueleE.LuciaA.Santos-LozanoA. (2022). Defining and assessing intrinsic capacity in older people: A systematic review and a proposed scoring system. Ageing Research Reviews, 79, 101640. https://doi.org/10.1016/j.arr.2022.101640
27.
LuF.LiuS.LiuX.LiJ.JiangS.SunX.HuangX.WangX. (2023). Comparison of the predictive value of intrinsic capacity and comorbidity on adverse health outcome in community-dwelling older adults. Geriatric Nursing, 50, 222–226. https://doi.org/10.1016/j.gerinurse.2023.02.001
28.
LuW.-H.González-BautistaE.GuyonnetS.MartinezL. O.LucasA.PariniA.RollandY.VellasB.de Souto BarretoP.MAPT/DSA Group (2023). Investigating three ways of measuring the intrinsic capacity domain of vitality: Nutritional status, handgrip strength and ageing biomarkers. Age and Ageing, 52(7), afad133. https://doi.org/10.1093/ageing/afad133
29.
MaL.ChhetriJ. K.ZhangL.SunF.LiY.TangZ. (2021). Cross-sectional study examining the status of intrinsic capacity decline in community-dwelling older adults in China: Prevalence, associated factors and implications for clinical care. BMJ Open, 11(1), e043062. https://doi.org/10.1136/bmjopen-2020-043062
30.
MaL.ChhetriJ. K.ZhangY.LiuP.ChenY.LiY.ChanP. (2020). Integrated care for older people screening tool for measuring intrinsic capacity: Preliminary findings from ICOPE pilot in China. Frontiers of Medicine, 7, 576079. https://doi.org/10.3389/fmed.2020.576079
31.
MathurA.BhardwajP.JoshiN. K.JainY. K.SinghK. (2022). Intrinsic capacity of rural elderly in thar desert using WHO ICOPE (integrated care for older persons) screening tool: A pilot study. medRxiv. https://doi.org/10.1101/2022.02.04.22270231
32.
MengL. C.HsiaoF. Y.HuangS. T.LuW. H.PengL. N.ChenL. K. (2022). Intrinsic capacity impairment patterns and their associations with unfavorable medication utilization: A nationwide population-based study of 37,993 community-dwelling older adults. The Journal of Nutrition, Health & Aging, 26(10), 918–925. https://doi.org/10.1007/s12603-022-1847-z
33.
ParkS. H.KwakM. J. (2021). Performance of the geriatric depression scale-15 with older adults aged over 65 Years: An updated review 2000-2019. Clinical Gerontologist, 44(2), 83–96. https://doi.org/10.1080/07317115.2020.1839992
34.
PfeifferE. (1975). A short portable mental status Questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(10), 433–441. https://doi.org/10.1111/j.1532-5415.1975.tb00927.x
35.
PinesJ. M.MullinsP. M.CooperJ. K.FengL. B.RothK. E. (2013). National trends in emergency department use, care patterns, and quality of care of older adults in the United States. Journal of the American Geriatrics Society, 61(1), 12–17. https://doi.org/10.1111/jgs.12072
36.
Rarajam RaoA.WarisM.SainiM.ThakralM.HegdeK.BhagwasiaM.AdikariP.KostkaT. (2023). Prevalence and factors associated with impairment in intrinsic capacity among community-dwelling older adults: An observational study from south India. Current Gerontology and Geriatrics Research, 2023, 4386415–4386419. https://doi.org/10.1155/2023/4386415
37.
RockwoodK.SongX.MacKnightC.BergmanH.HoganD. B.McDowellI.MitnitskiA. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489–495. https://doi.org/10.1503/cmaj.050051
38.
RojanoI.LuqueX.Blancafort-AliasS.Prat CasanovasS.ForneS.Martin VergaraN.Fabregat PovillP.Vila RoyoM.SerranoR.Sanchez-RodriguezD.Vilchez SaldanaM.MartinezI.Dominguez LopezM.Riba PorquetF.Intxaurrondo GonzalezA.Salva CasanovasA. (2023). Identification of decreased intrinsic capacity: Performance of diagnostic measures of the ICOPE Screening tool in community dwelling older people in the VIMCI study. BMC Geriatrics, 23(1), 106. https://doi.org/10.1186/s12877-023-03799-0
39.
RottlerM.OcskayK.SiposZ.GorbeA.ViragM.HegyiP.MolnarT.ErossB.LeinerT.MolnarZ. (2022). Clinical frailty scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: A systematic review and meta-analysis. Annals of Intensive Care, 12(1), 17. https://doi.org/10.1186/s13613-021-00977-4
40.
RubensteinL. Z.HarkerJ. O.SalvàA.GuigozY.VellasB. (2001). Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF). The Journals of Gerontology: Series A, 56(6), M366–M372. https://doi.org/10.1093/gerona/56.6.M366
41.
TavassoliN.de Souto BarretoP.BerbonC.MathieuC.de KerimelJ.LafontC.TakedaC.CarrieI.PiauA.JouffreyT.AndrieuS.NourhashemiF.BeardJ. R.Soto MartinM. E.VellasB. (2022). Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: A prospective study. The Lancet Healthy Longevity, 3(6), e394–e404. https://doi.org/10.1016/S2666-7568(22)00097-6
42.
TayL.TayE. L.MahS. M.LatibA.KohC.NgY. S. (2023). Association of intrinsic capacity with frailty, physical fitness and adverse health outcomes in community-dwelling older adults. J Frailty Aging, 12(1), 7–15. https://doi.org/10.14283/jfa.2022.28
43.
VivantiA. P.McDonaldC. K.PalmerM. A.SinnottM. (2009). Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department. Emergency Medicine Australasia, 21(5), 386–394. https://doi.org/10.1111/j.1742-6723.2009.01223.x
44.
World Health Organization. (2017). Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity. https://apps.who.int/iris/handle/10665/258981
YuJ.SiH.JinY.QiaoX.JiL.BianY.LiuQ.WangW.WangC. (2022). Patterns of intrinsic capacity among community-dwelling older adults: Identification by latent class analysis and association with one-year adverse outcomes. Geriatric Nursing, 45, 223–229. https://doi.org/10.1016/j.gerinurse.2022.04.021
48.
YuR.LaiE. T.-C.LeungG.HoS. C.WooJ. (2022). Intrinsic capacity and 10-year mortality: Findings from a cohort of older people. Experimental Gerontology, 167, 111926. https://doi.org/10.1016/j.exger.2022.111926
49.
YuR.LeungG.LeungJ.ChengC.KongS.TamL. Y.WooJ. (2022). Prevalence and distribution of intrinsic capacity and its associations with health outcomes in older people: The jockey club community eHealth care project in Hong Kong. The Journal of Frailty and Aging, 11(3), 302–308. https://doi.org/10.14283/jfa.2022.19
50.
YuR.LeungJ.LeungG.WooJ. (2022). Towards healthy ageing: Using the concept of intrinsic capacity in frailty prevention. The Journal of Nutrition, Health and Aging, 26(1), 30–36. https://doi.org/10.1007/s12603-021-1715-2
51.
ZhuL.ZongX.ShiX.OuyangX. (2023). Association between intrinsic capacity and sarcopenia in hospitalized older patients. The Journal of Nutrition, Health and Aging, 27(7), 542–549. https://doi.org/10.1007/s12603-023-1946-5
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