Evidence mapPaperPMID 41703373Full record

ArticleAging clinical and experimental research2026

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.

Zhen Wu, Haijun Zhao, Jiacheng Dong, Ping Yang, YinXia Li, Zhe Jin, Yiying Yang, Lulu Xiao, Linlin Hu, Yan Dong

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Article in Aging clinical and experimental research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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10 authors.

Zhen Wu *School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
Haijun Zhao *People's Hospital of Ganyun County, 222130, Lianyungang, Jiangsu, China.
Jiacheng Dong *Chengdu Medical College, 610500, Chengdu, Sichuan, China.
Ping Yang *Nanjing Medical University Clinical Medical College, Xuzhou Medical University Affiliated Hospital,Nanjing Medical University  Kangda College  First Affiliated  Hospital,The First People's Hospital of Lianyungang, 222002, Lianyungang, Jiangsu, China.
YinXia LiPeople's Hospital of Wuwei, 733000, Wuwei, Gansu, China. m13893550001@163.com.
Zhe JinBeijing Geriatric Hospital, 100095, Beijing, China. 15901448405@163.com.
Yiying YangSchool of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
Lulu XiaoSchool of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China.
Linlin HuSchool of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, Beijing, China. hulinlin@sph.pumc.edu.cn.
Yan DongNanjing Medical University Clinical Medical College, Xuzhou Medical University Affiliated Hospital,Nanjing Medical University  Kangda College  First Affiliated  Hospital,The First People's Hospital of Lianyungang, 222002, Lianyungang, Jiangsu, China. dylzu_lnyx@163.com.

Funding

2025 Lianyungang Science & Technology Program (Project: Clinical Application of Foreign-Expert-Guided Integrated Care for Older People in the Department of Geriatrics; Grant No. WZ2501) WZ2501he 2025 National Standardization Pilot Project (Health and Wellness Field) (Project: Standardization Pilot Project for Integrated Elderly Care at the First People's Hospital of Lianyungang, Jiangsu Province; Grant No. 2025203-WJ-32) 2025203-WJ-32the 2023 Lianyungang Health Science and Technology Project 202307the Key Project of the National Natural Science Foundation of China (Grant No. 72034005) 72034005
6 · The paper itself

Abstract

backgroundIntrinsic 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.

methodsIn 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.

resultsAfter 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).

conclusionsIntrinsic 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.

Indexed as

Activities of Daily LivingQuality of LifeAgedAged, 80 and overChinaCross-Sectional StudiesFemaleGeriatric AssessmentHumansIndependent LivingMaleMiddle AgedPilot ProjectsWorld Health OrganizationActivities of daily livingHealth-related quality of lifeHealthy agingICOPE programIntrinsic capacityMediation analysis

Identifiers

PMID41703373
PMCPMC12960387

What Socratic holds

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.