ORCID Profile
0000-0001-7895-788X
Current Organisation
World Health Organization
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Publisher: WHO Press
Date: 11-2017
Publisher: WHO Press
Date: 26-05-2017
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.JAMDA.2015.12.016
Abstract: The absolute and relative increases in the number of older persons are evident worldwide, from the most developed countries to the lowest-income regions. Multimorbidity and need for social support increase with age. Age-related conditions and, in particular, disabilities are a significant burden for the person, his or her family, and public health care systems. To guarantee the sustainability of public health systems and improve the quality of care provided, it is becoming urgent to act to prevent and delay the disabling cascade. Current evidence shows that too large a proportion of community-dwelling older people present risk factors for major health-related events and unmet clinical needs. In this scenario, the "frailty syndrome" is a condition of special interest. Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the in idual to a higher risk of negative health-related outcomes. Frailty may represent a transition phase between successful aging and disability, and a condition to target for restoring robustness in the in idual at risk. Given its syndromic nature, targeting frailty requires a comprehensive approach. The identification of frailty as a target for implementing preventive interventions against age-related conditions is pivotal. Every effort should be made by health care authorities to maximize efforts in this field, balancing priorities, needs, and resources. Raising awareness about frailty and age-related conditions in the population is important for effective prevention, and should lead to the promotion of lifelong healthy behaviors and lifestyle.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2018-026119
Abstract: To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains and to assess whether total capacity predicted subsequent care dependence. Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence. Community, United Kingdom. 2560 eligible participants aged over 60 years. Activities of daily living (ADL) and instrumental activities of daily living (IADL). One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive psychological sensory and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ 2 =71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation ( RMSEA ) =0.02 ( 90% CI 0.001 to 0.05 ) and RMSEA=0.008 ( 90% CI0.001 to 0.03 ) respectively— and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity. The WHO construct of intrinsic capacity appears to provide valuable predictive information on an in idual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
Publisher: WHO Press
Date: 10-2201
Publisher: Elsevier BV
Date: 05-2016
Publisher: Oxford University Press (OUP)
Date: 02-02-2018
Abstract: Healthy ageing can be defined as "the process of developing and maintaining the functional ability that enables wellbeing in older age". Functional ability (i.e., the health-related attributes that enable people to be and to do what they have reason to value) is determined by intrinsic capacity (i.e., the composite of all the physical and mental capacities of an in idual), the environment (i.e., all the factors in the extrinsic world that form the context of an in idual's life), and the interactions between the two. This innovative model recently proposed by the World Health Organization has the potential to substantially modify the way in which clinical practice is currently conducted, shifting from disease-centered toward function-centered paradigms. By overcoming the multiple limitations affecting the construct of disease, this novel framework may allow the worldwide dissemination of a more proactive and function-based approach toward achieving optimal health status. In order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs. In this article, we consider intrinsic capacity. Using the International Classification of Functioning, Disability and Health (ICF) framework as background and taking into account available evidence, five domains (i.e., locomotion, vitality, cognition, psychological, sensory) are identified as pivotal for capturing the in idual's intrinsic capacity (and therefore also reserves) and, through this, pave the way for its objective measurement.
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2021-054492
Abstract: The global population is rapidly ageing. To tackle the increasing prevalence of older adults’ chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO’s public health framework of healthy ageing. Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting. Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). The identified interventions are erse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
Publisher: Public Library of Science (PLoS)
Date: 18-10-2019
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: Start date not available
End Date: End date not available
Funder: Wellcome Trust
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