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      Intrinsic Capacity as a Determinant of Physical Resilience in Older Adults

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          Abstract

          The traditional disease-oriented model of healthcare is inadequate to address the needs of the older population. Greater attention should be given to strategies that promote healthy aging. Recently proposed constructs of intrinsic capacity (IC) and physical resilience (PR) hold great potential to reshape geriatric medicine and aging research. These constructs accentuate the positive health attributes of older people in contrast to the popular frailty construct that is centered on functional deficits. IC was introduced by the World Health Organization (WHO) as a composite of all the physical and mental capacities. WHO has emphasized enhancement of IC throughout the life course so as to maintain functional ability in old age. PR, recently highlighted by the National Institute on Aging, is the ability to successfully cope with stressors. High levels of resilience can result in desirable clinical and functional outcomes after stressors. Therefore, it is important to understand the underlying physiology of PR and the risk factors contributing to diminished PR. The main goal of this article is to explore the potential relationship between IC and PR. Based on a classical theory of aging, we postulate that IC is a determinant of PR and is also a high-level integrative measure of physiologic reserve which is the fundamental factor underlying one’s ability to withstand stressors. A major implication of our postulates is that even though IC is only one of the many determinants of PR, it could serve as an important intervenable target for enhancing resilience in older adults.

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          Frailty in Older Adults: Evidence for a Phenotype

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            Recovery of activities of daily living in older adults after hospitalization for acute medical illness.

            To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. Observational. Tertiary care hospital, community teaching hospital. Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998). Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.
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              Conventional wisdom on measurement: A structural equation perspective.

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                Author and article information

                Contributors
                chhetri_jk@hotmail.com
                ravi.varadhan@jhu.edu
                Journal
                J Nutr Health Aging
                J Nutr Health Aging
                The Journal of Nutrition, Health & Aging
                Springer Paris (Paris )
                1279-7707
                1760-4788
                10 April 2021
                : 1-6
                Affiliations
                [1 ]GRID grid.413259.8, ISNI 0000 0004 0632 3337, Department of Neurobiology, Neurology and Geriatrics, , Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, ; No. 45 Changchun Street, Xicheng District, Beijing, 100053 China
                [2 ]National Clinical Research Center for Geriatric Disorders, Beijing, China
                [3 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Medicine, Division of Geriatric Medicine and Gerontology, School of Medicine, , Johns Hopkins University, ; Baltimore, MD USA
                [4 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Center on Aging and Health, , Johns Hopkins Medical Institutions, ; Baltimore, USA
                [5 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, , Johns Hopkins School of Medicine, ; 550 N. Broadway, Suite 1103-A, Baltimore, MD 21205 USA
                Article
                1629
                10.1007/s12603-021-1629-z
                8035602
                34545921
                555f6cbc-34b1-4b10-bc02-0ceb31c64a2b
                © Serdi and Springer-Verlag International SAS, part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 14 December 2020
                : 28 December 2020
                Categories
                Article

                resilience,physiologic reserve,integrated care,aging,frailty

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