Association Between Intrinsic Capacity and Mortality in Older Adults After Emergency Hospitalization

Introduction: Intrinsic capacity (IC)—the integrated sum of an individual’s locomotor, cognitive, psychological, vitality, and sensory abilities—captures physiological reserve. However, its impact following an acute illness is not fully elucidated. We hypothesized that impaired intrinsic capacity among older adults, assessed in the emergency department (ED), would independently predict 365-day mortality after emergency hospital admission.


Methods: This was a secondary analysis of a prospective cohort of patients aged ≥65 years admitted from the ED of a medical center between March and August 2022. Patients who were bedridden, unable to communicate, or required immediate intensive care were excluded. Intrinsic capacity was assessed using the WHO-ICOPE framework, generating a composite score from 0 (lowest) to 5 (highest). The primary endpoint was 365-day all-cause mortality. We used univariable Cox proportional-hazards to evaluate associations with 365-day mortality and calculated the Restricted Mean Survival Time (RMST) to estimate the absolute difference in event-free days between intrinsic capacity levels.


Results: The final cohort included 784 patients (mean 78.3 ± 8.8 y; 40.7 % men). The median composite intrinsic capacity (IC) score was 3 (IQR 2–4); mobility limitation (82 %), cognitive impairment (56 %), and malnutrition (56 %) were prevalent. IC was independently and inversely related to mortality; each 1-point increase in the composite IC score was associated with a 16% reduction in the hazard of death (HR, 0.84; 95% CI, 0.76-0.92; P<.001). After adjusting for demographic and clinical covariates, high IC was associated with a significantly longer RMST, yielding a 26.8-day survival gain at 365 days (95% CI, 10.90-42.70), and this association remained significant with a 21.5-day gain (95% CI, 3.57-39.40) after further adjustment for key biomarkers.


Conclusions: Intrinsic capacity assessed in the ED is a potent, independent factor of short- and long-term mortality in older adults after emergency hospital admission. It provides significant prognostic information beyond traditional physiologic severity and comorbidity scores. Routine IC screening could enable function-centered evaluation and help guide interventions aimed at preserving physiological reserve in this vulnerable population.