The mediating role of activities of daily living in the association between intrinsic capacity and health-related quality of life: evidence from the WHO ICOPE pilot in China.
Intrinsic capacity (IC) is a core concept of the World Health Organization's (WHO) Integrated Care for Older People (ICOPE), representing the composite of an individual's physical and mental reserves. While deficits in IC are associated with reduced health-related quality of life (HRQoL), the functional mechanisms underlying this relationship, particularly the role of functional independence as measured by activities of daily living (ADL) remains underexplored. We investigated whether ADL performance mediates the association between IC and HRQoL among Chinese older adults.
In this cross-sectional analysis, 468 community-dwelling and institutionalized adults aged 60 years and older were recruited from the WHO ICOPE pilot in Lianyungang, China. Cumulative IC impairment was evaluated across five domains (cognition, locomotion, nutrition, sensory function, and psychology) using the ICOPE screening tool. ADL dependence was quantified by the Modified Barthel Index, and HRQoL was measured using the EQ-5D-3 L instrument. Multivariable logistic regression was employed to estimate the association between IC and HRQoL, adjusting for sociodemographic and clinical covariates. A nonparametric bootstrap mediation analysis (5000 resamples) quantified the indirect effect of IC on HRQoL via ADL.
After adjusting for covariates, each one-point increase in Cumulative IC Impairment Score was associated with 46% higher odds of impaired HRQoL (adjusted OR = 1.46; 95% CI: 1.26-1.69; p < 0.001). ADL dependence mediated approximately 34.1% of this association (indirect effect = 0.028; 95% CI: 0.006-0.050; p = 0.013). Subgroup analyses revealed that the IC-HRQoL association was significantly stronger among urban residents compared to suburban residents (interaction p = 0.004) and among community-dwelling older adults compared to nursing home residents (interaction p = 0.043).
Intrinsic capacity impairment is associated with compromised HRQoL both directly and indirectly by exacerbating functional dependence. Preserving functional independence serves as a key pathway connecting intrinsic capacity to well-being. These findings highlight the imperative for integrated interventions that simultaneously bolster intrinsic capacity and support daily functional ability, tailored to diverse living environments to promote healthy aging.
In this cross-sectional analysis, 468 community-dwelling and institutionalized adults aged 60 years and older were recruited from the WHO ICOPE pilot in Lianyungang, China. Cumulative IC impairment was evaluated across five domains (cognition, locomotion, nutrition, sensory function, and psychology) using the ICOPE screening tool. ADL dependence was quantified by the Modified Barthel Index, and HRQoL was measured using the EQ-5D-3 L instrument. Multivariable logistic regression was employed to estimate the association between IC and HRQoL, adjusting for sociodemographic and clinical covariates. A nonparametric bootstrap mediation analysis (5000 resamples) quantified the indirect effect of IC on HRQoL via ADL.
After adjusting for covariates, each one-point increase in Cumulative IC Impairment Score was associated with 46% higher odds of impaired HRQoL (adjusted OR = 1.46; 95% CI: 1.26-1.69; p < 0.001). ADL dependence mediated approximately 34.1% of this association (indirect effect = 0.028; 95% CI: 0.006-0.050; p = 0.013). Subgroup analyses revealed that the IC-HRQoL association was significantly stronger among urban residents compared to suburban residents (interaction p = 0.004) and among community-dwelling older adults compared to nursing home residents (interaction p = 0.043).
Intrinsic capacity impairment is associated with compromised HRQoL both directly and indirectly by exacerbating functional dependence. Preserving functional independence serves as a key pathway connecting intrinsic capacity to well-being. These findings highlight the imperative for integrated interventions that simultaneously bolster intrinsic capacity and support daily functional ability, tailored to diverse living environments to promote healthy aging.
Authors
Wu Wu, Zhao Zhao, Dong Dong, Yang Yang, Li Li, Jin Jin, Yang Yang, Xiao Xiao, Hu Hu, Dong Dong
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