Association of Sociodemographic, Clinical factors, and Self-Care with Intrinsic Capacity in Older Adults with Heart Failure

Association of Sociodemographic, Clinical factors, and Self-Care with Intrinsic Capacity in Older Adults with Heart Failure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Sociodemographic, Clinical factors, and Self-Care with Intrinsic Capacity in Older Adults with Heart Failure Ronggang PENG, Fang YANG, Xia WAN, Yanhua XU, Qing ZHAO This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5476128/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to examine the association between sociodemographic and clinical characteristics, self-care practices, and intrinsic capacity in older adults with heart failure. Methods A total of 215 heart failure patients aged 60 years or older were recruited from two tertiary hospitals in Wuxi, China. The intrinsic capacity composite score was derived from scores on the Montreal Cognitive Assessment (MoCA), Short Physical Performance Battery (SPPB), Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Depression Scale-15 (GDS-15), and self-reported visual or hearing impairments. Self-care was assessed using the Self-Care Heart Failure Index (SCHFI). Sociodemographic and clinical data were collected via a self-designed questionnaire. The associations between sociodemographic and clinical characteristics, self-care, and intrinsic capacity were explored using binary analysis, Spearman’s correlation coefficient analysis, and multiple linear regression analysis. Results 98.1% of participants experienced a decline in at least one domain of intrinsic capacity. The most affected domains were vitality (87.9%) and cognition (60.95%). Reduced intrinsic capacity composite scores were associated with older age (β = 0.138, t = 2.163, p = 0.032), higher NYHA class grade (β = 0.466, t = 8.032, p < 0.001), and poorer self-care (β = -0.133, t = -2.140, p = 0.033). Conclusion Intrinsic capacity in older adults with heart failure was found to be related to age, NYHA class grade, and self-care practices. Healthcare professionals should focus on these factors and implement targeted interventions to support this population. heart failure intrinsic capacity self-care older adults Figures Figure 1 1. Introduction Heart failure is a progressive cardiovascular disease characterized by the heart's inability to pump blood efficiently to meet the body's needs [ 1 ] . Approximately 1%-2% of adults globally and an estimated 12.1 million individuals in China are affected with heart failure [ 2 ] . The prevalence of heart failure rises significantly with age, reaching nearly 10% in people aged 70 and older [ 3 ] . Despite advances in treatment, the five-year survival rate remains around 50% once diagnosed [ 4 ] . Patients with heart failure experience a considerable burden of symptoms, including physical debilitation, psychological distress, and a diminished quality of life [ 5 , 6 ] . This underscores the critical need for effective management strategies for these individuals. Self-care behaviors, which encompass complex actions to maintain physiological stability and manage symptoms, are considered the cornerstone of effective management [ 7 ] . These behaviors include medication adherence, symptom monitoring, attending medical appointments, and seeking timely care when symptoms worsen [ 8 , 9 ] . Effective self-care has been shown to improve quality of life, reduce hospital readmissions, and lower mortality rates in patients with heart failure [ 10 ] . However, despite the positive impact of self-care on health outcomes, many patients with heart failure struggle to engage in adequate self-care, which remains a significant barrier to optimal outcomes [ 11 ] . Intrinsic capacity, a concept introduced by the World Health Organization, refers to the comprehensive capacity of all physical and mental capacities that an individual could draw on [ 12 ] . It consists of multiple domains, including locomotion, vitality, cognition, psychological well-being, and sensory function [ 13 ] . Maintaining optimal intrinsic capacity is of great significance for promoting healthy aging and preserving functional independence in older adults [ 14 – 16 ] . Declines in intrinsic capacity have been linked to worsened clinical outcomes, reduced physiological function and quality of life, and higher risks of mortality and hospital utilization [ 17 ] . In heart failure management, international guidelines recommend cardiac rehabilitation, particularly emphasizing exercise and nutritional counselling as key intervention strategies [ 18 ] . These interventions align with key domains of intrinsic capacity, particularly locomotion and nutrition, which are critical to maintaining functional independence in heart failure patients. As the WHO emphasizes the importance of functional performance for healthy aging [ 19 ] , understanding and optimizing intrinsic capacity in older adults with heart failure is essential for developing interventions that improve quality of life and maintain independence. Sociodemographic factors, such as age, gender, and educational level, as well as clinical characteristics like comorbidities and disease severity, have been shown to influence intrinsic capacity in older adults [ 20 , 21 ] . Additionally, intrinsic capacity has been associated with self-care abilities, particularly in performing activities of daily living [ 22 ] . For patients with heart failure, intrinsic capacity may act as a mediating factor between heart failure symptoms and functional ability [ 23 ] . Cognitive function, a key domain of intrinsic capacity, is especially relevant, as it can significantly impact self-care behaviours in older adults with heart failure [ 24 ] . Despite these insights, research exploring the relationships among sociodemographic factors, clinical characteristics, self-care, and intrinsic capacity in older adults with heart failure remains limited. This gap limits the development of individualized care plans that address the complex needs of older adults with heart failure. Therefore, the current study aims to fill this gap by examining the association between sociodemographic and clinical characteristics, self-care, and intrinsic capacity in older adults with heart failure, so as to provide valuable insights for early identification of those at risk for diminished intrinsic capacity and for designing effective self-care interventions. 2. Methods 2.1 Study design and participants This was a cross-sectional study. A convenience sampling method was adopted to select 215 individuals with heart failure who were hospitalized in the Department of Cardiology in two tertiary hospitals in Wuxi, China from June 2023 to May 2024. The questionnaire was handed out to eligible participants face to face. Eligible participants were: (1) patients with definite diagnosis of heart failure; (2) classified as New York Heart Association (NYHA) grade II to IV; (3) age 60 years or older; Participants with severe damage to liver and kidney function, advanced tumors, participating in other interventional studies, and those who were unable to communicate normally were excluded. This study has been approved by the Ethics Committee of Wuxi People’s Hospital (2023-KY23114). Informed consent was obtained from all individual participants included in the study. 2.2 Data collection i) Sociodemographic and clinical data Socio-demographic and clinical information was gathered through patient interviews and review of medical records. Collected data included age, body mass index (BMI), gender, marital status, education level, monthly income, living arrangements, medical expense coverage, New York Heart Association (NYHA) functional classification, current smoking status, current drinking status, and history of chronic diseases. ii) Intrinsic Capacity Assessment Based on the WHO's conceptual framework for intrinsic capacity [ 12 ] , five domains-cognition, locomotion, vitality, psychological well-being, and sensory function-were assessed and combined into a composite score. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Cognitive decline was defined according to education level-specific cutoffs: ≤13 points for illiterate participants, ≤ 19 points for primary school education, and ≤ 24 points for those with junior high school or higher education levels [ 25 ] . Locomotion was evaluated using the Short Physical Performance Battery (SPPB), with a total score ≤ 8 indicating a decline in locomotion [ 26 ] . Vitality was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), with scores ≤ 11 indicating a decline in vitality [ 27 ] . Psychological well-being was assessed using the Geriatric Depression Scale-15 (GDS-15), where a score ≥ 8 was considered indicative of psychological decline [ 28 ] . Sensory function was determined based on self-reported visual or hearing impairments affecting daily life. No impairment was scored as 0, while the presence of visual or hearing loss was scored as 1 point in the IC composite score. A decline in each domain contributed 1 point to the total IC composite score, which ranged from 0 to 5, with higher scores indicating greater declines in intrinsic capacity. iii) Self-care ability The self-care ability was assessed using the 22-item Self-Care Heart Failure Index (SCHFI), which measures the self-care abilities across three subscales: self-care maintenance (10 items), self-care management (6 items), and self-care confidence (6 items). Scores of each subscale were standardized to a scale of 0 to 100, with a score of 70 or higher indicating adequate self-care [ 29 ] . The Chinese version of the SCHFI has demonstrated satisfactory psychometric properties, with a Cronbach’s α of 0.853 for internal consistency and a test-retest reliability of 0.861 [ 30 ] . 2.3 Data analysis Statistical analyses were performed using SPSS version 20.0 software. Continuous variables were expressed as mean ± standard deviation (SD) for normally distributed data, or as median and interquartile range (IQR) for non-normally distributed data. Categorical variables were presented as frequencies (N) and percentages (%). Differences in intrinsic capacity across various sociodemographic and clinical characteristics were assessed using independent-sample t-tests, one-way ANOVA, or the Kruskal-Wallis test, as appropriate based on the data distribution. Spearman’s correlation coefficient was used to evaluate the associations between self-care and intrinsic capacity composite scores. Multiple linear regression analysis was conducted to identify the independent effects of selected variables on intrinsic capacity. Variables with p < 0.05 in bivariate analyses, as well as clinically relevant variables reported in the literature, were included in the multivariable regression model. p < 0.05 was considered statistically significant for all analyses. 3. Results 3.1 Demographic and clinical characteristics of the participants The study included 215 older adults with heart failure. The mean age of participants was 74.13 years (SD = 7.07), ranging from 60 to 92 years old. More than half of the participants were female (56.7%). In terms of educational level, 42.8% had completed elementary school or lower levels of education. The majority were married (74.9%) and nearly all (93.0%) had medical insurance coverage. Most participants were classified as NYHA Class II or III (88.1%) and were not living alone (87.4%). The majority (69.8%) reported a monthly income exceeding 2000 RMB. Regarding chronic conditions, 70.6% of participants had concurrent hypertension, 61.4% had a history of coronary artery disease, and 38.6% had diabetes (see Table 1 ). Table 1 Characteristics of study participants (N = 215). Variables mean ± SD/ n (%) Age (years) 74.13 ± 7.07 BMI (Kg/m 2 ) 23.91 ± 3.80 Gender Male 122 (56.7) Female 93 (43.3) Education level Primary school or lower 92 (42.8) Junior high school 77 (35.8) High school (including vocational) 26 (12.1) College or above 20 (9.3) Marital status Married 161 (74.9) Divorced or widowed 54 (25.1) Medical expense coverage Medical insurance 200 (93.0) Self-funded 15 (7.0) NYHA class Class II 88 (40.9) Class III 80 (37.2) Class IV 47 (21.9) Living arrangement Living alone 27 (12.6) Living with family/others 188 (87.4) Monthly income (RBM) 2000 150 (69.8) Current smoking status 70 (32.6) Current drinking status 12 (5.6) History of chronic disease Hypertension 152 (70.6) Diabetes 83 (38.6) Coronary artery disease 132 (61.4) Stroke 28 (13.0) COPD 8 (3.7) Tumor 3 (1.4) 3.2 Intrinsic capacity of the participants The average composite intrinsic capacity score for older adults with heart failure was 2.58 (SD = 1.17). Nearly all participants (98.1%) experienced a decline in at least one domain of intrinsic capacity. The most affected domains were vitality (87.9%), cognition (60.9%), and sensory function (49.3%). Locomotor decline was observed in 49.3% of participants, while 10.2% experienced psychological decline. The distribution of participants experiencing declines in one to five domains was 17.2%, 30.2%, 28.4%, 16.7% and 5.6% respectively. The median scores were 21 (IQR = 6) for MoCA, 3 (IQR = 4) for GDS-15, and 9 (IQR = 3) for both SPPB and MNASF. 3.3 Self-care of participants The median overall score for self-care was 110.58 (IQR = 61.12). For the subscales, the median score for self-care maintenance was 43.33 (IQR = 23.33), self-care management was 35 (IQR = 30), and self-care confidence was 33.36 (IQR = 27.80). These findings suggest that the self-care abilities among older adults with heart failure were suboptimal across all dimensions. 3.4 Analysis of sociodemographic and clinical characteristics on intrinsic capacity The results showed that intrinsic capacity was significantly influenced by age (F = 6.882, P = 0.001), with older participants having higher scores and poorer intrinsic capacity. Marital status (t = 2.282, P = 0.023), NYHA class ( P < 0.001), and monthly income (H = 6.729, P = 0.035) were also significantly associated with intrinsic capacity. Participants who were married, had better cardiac function, or reported higher income demonstrated greater intrinsic capacity. However, no significant differences in intrinsic capacity were observed based on gender, BMI, education level, smoking or drinking status, medical insurance coverage, number of comorbidities, or living alone status (Fig. 1 ). 3.5 Correlation analysis of self-care and intrinsic capacity among older adults with heart failure The correlation analysis demonstrated a significant negative relationship between the intrinsic capacity composite score and overall self-care (r = -0.238, p < 0.01). In addition, intrinsic capacity score was significantly negatively correlated with self-care maintenance (r = -0.232, p < 0.01), self-care management (r = -0.153, p < 0.05), and self-care confidence (r = -0.216, p < 0.01). These findings indicated that a decline in intrinsic capacity is strongly associated with poorer performance in self-care maintenance, management, and confidence among older adults with heart failure (Table 2 ). Table 2 Correlation analysis of intrinsic capacity and self-care among older adults with heart failure (N = 215). Variables 1 2 3 4 5 1 IC composite score 1 2 Self-care overall -0.238 ** 1 3 Self-care maintenance -0.232 ** 0.755 ** 1 4 Self-care management -0.153 * 0.834 ** 0.478 ** 1 5 Self-care confidence -0.216 ** 0.810 ** 0.419 ** 0.565 ** 1 * p < 0.05, ** p < 0.01 3.6 Effect of sociodemographic and clinical variables, and self-care on intrinsic capacity The regression analysis revealed that age, marital status, monthly income, NYHA class, and self-care explained 29% of the variation in intrinsic capacity among older adults with heart failure ( F = 18.499, p < 0.001). Among these factors, NYHA class was the strongest predictor of intrinsic capacity (β = 0.466, t = 8.032, p < 0.001), indicating that participants with more severe heart failure symptoms had significantly worse intrinsic capacity. Age (β = 0.138, t = 2.163, p = 0.032) and self-care abilities (β = -0.133, t = -2.140, p = 0.033) were also significant predictors, suggesting that older age is associated with worse intrinsic capacity, whereas better self-care practices are linked to improved intrinsic capacity. In contrast, marital status (β = -0.043, t = -0.710, p = 0.479) and monthly income (β = -0.090, t = -1.541, p = 0.125) did not show a significant effect on intrinsic capacity in this population (Table 3 ). Table 3 Regression Analysis of Sociodemographic and Clinical Characteristics, and Self-Care on Intrinsic Capacity Among Older Adults with Heart Failure (N = 215). Variable B SE β t p Adj.R2 F Age 0.248 0.115 0.138 * 2.163 0.032 0.290 *** 18.499 *** Marital status -0.116 0.164 -0.043 -0.710 0.479 Monthly income -0.137 0.089 -0.090 -1.541 0.125 NYHA class 0.710 0.088 0.466 *** 8.032 < 0.001 Self-care -0.004 0.002 -0.133 * -2.140 0.033 * p < 0.05, *** p < 0.001 4. Discussion This study found that intrinsic capacity decline was prevalent among older adults with heart failure, with 98.1% experiencing a decline in at least one domain. This is consistent with previous research, which reported that 92.6% of older adults showed decline in at least one area of intrinsic capacity [ 31 ] . Notably, vitality and cognitive function were the most affected domains, with over 60% of participants showing declines. These higher rates, compared to those observed among community-dwelling older adults [ 32 ] , may be attributed to advanced disease progression, multifaceted symptom burden, and complex comorbidities. In particular, vitality was the most severely impacted domain, with 87.9% of participants affected. Heart failure patients are at a high risk of undernutrition due to an imbalance between protein catabolism and anabolism [ 33 ] . International guidelines recommend nutritional supplements as a critical component of cardiac rehabilitation for heart failure patients [ 18 ] . Furthermore, 60.9% of heart failure patients experienced a decline in the cognitive domain. Maintaining normal cognitive function is crucial for heart failure management; however, cognitive decline has been reported to affect 20–80% of heart failure patients [ 34 ] . Reduced cardiac output, vascular dysfunction, and imbalances in the autonomic nervous system may contribute to decreased cerebral function, leading to cognitive decline [ 35 ] . The most affected cognitive domains include learning and memory, executive function, and complex attention [ 36 ] . Overall, the high prevalence of intrinsic capacity decline underscores the vulnerability of older adults with heart failure, particularly in the domains of vitality and cognitive function. The intrinsic capacity deficit score is a powerful predictor of functional trajectories and individual vulnerabilities related to cardiovascular incidents and premature death, with monitoring providing an early-warning system for initiating preventive efforts [ 37 ] . It is imperative to assess intrinsic capacity decline among older adults with heart failure at an early stage and explore effective intervention strategies to address these issues. To enhance the intrinsic capacity of older adults, WHO has proposed the 'Integrated Care for Older People' (ICOPE) program, which emphasizes a community-based, age-centered, interdisciplinary, and integrated care model [ 38 ] . Collaboration among healthcare professionals is essential; once impairments are identified, an interdisciplinary team should implement interventions to slow progression [ 22 ] . Furthermore, interventions targeting multiple domains of intrinsic capacity should be well-integrated. A previous study demonstrated the efficacy of a 24-week multi-component intervention-comprising exercise, nutrition, cognitive training, and pre-rehabilitation-in delaying or reversing intrinsic capacity decline [ 39 ] . The effectiveness of the ICOPE program in enhancing cognitive function and physiological domains has been substantiated by a recent systematic review [ 40 ] . However, the potential benefits of these interventions for improving the intrinsic capacity of heart failure patients require further investigation. Addressing these gaps could significantly advance our understanding and management of intrinsic capacity decline in this vulnerable population. As individuals age, their intrinsic capacity declines from a high and stable state to a compromised one, posing risks such as cognitive decline, depression, sensory dysfunction, impaired mobility, and increased rates of recurrent hospitalization and morbidity [ 40 ] . Our study was consistent with previous findings that older age is associated with worse intrinsic capacity [ 41 ] . Further research on the trajectories of intrinsic capacity in older adults has demonstrated a gradual decline with advancing age [ 41 ] . This decline is due to the buildup of molecular and cellular damage over time, which weakens physical abilities and increases vulnerability to illness, ultimately resulting in a decrease in overall intrinsic capacity [ 20 ] . Specifically, cardiovascular aging can lead to progressive structural and functional decline [ 42 ] . Therefore, it is crucial to monitor and address the intrinsic capacity of older adults, particularly those with heart failure. The New York Heart Association (NYHA) classification system categorizes heart failure patients based on the severity of their symptoms, with higher classes indicating greater severity [ 43 ] . Our findings revealed a significant association between NYHA class and intrinsic capacity, suggesting that more severe cardiac dysfunction correlates with poorer intrinsic capacity. Previous studies have also indicated that the prevalence of cognitive impairment rises with the severity of heart failure and is higher in those classified as NYHA class IV compared to class II [ 44 ] . Patients with worsening heart failure symptoms often experience increased confusion, difficulty with attention, solving problems, concentration, slower reaction times, and forgetfulness [ 45 ] . These findings highlight the need for targeted attention to individuals with more severe cardiac dysfunction. Self-care is essential for managing heart failure, and consistent self-care practices could prevent 30% of hospital admissions and over half of readmissions [ 46 ] . Our study found a significant association between self-care and intrinsic capacity among older adults with heart failure. This finding was supported by a secondary analysis of the China Health and Retirement Longitudinal Study (CHARLS) dataset, which showed a significant negative relationship between intrinsic capacity and self-care in daily activities and instrumental activities [ 47 ] . Previous research corroborates our findings, indicating that cognitive decline in heart failure often leads to deficits in attention, memory, executive function, and processing speed, which can impair patients' ability to manage their self-care [ 48 , 49 ] . Despite the recognized importance of self-care, our findings indicated that self-care abilities among older adults with heart failure were suboptimal, with a median overall score of 110.58 and lower scores in the sub-scales(43.33, 35, and 33.36). This aligns with previous research showing that 73.8% of older adults demonstrated poor overall self-care behavior [ 50 ] . Thus, strategies to enhance self-care in heart failure should be prioritized, and their effectiveness in improving intrinsic capacity needs to be demonstrated. In summary, this study highlights significant associations of age, NYHA class, and self-care with intrinsic capacity among older adults with heart failure. Our findings offer valuable insights for detecting declines in intrinsic capacity and suggest new directions for developing strategies to enhance it. However, our study has several limitations. First, we used a convenience sampling method and selected participants from two hospitals in Wuxi city, China, which may limit the generalizability of the results. Further multi-center, larger-scale studies are needed to verify our findings. Additionally, the intrinsic capacity and its sub-domains in our study were measured using subjective scales, which may introduce bias. Finally, this was a cross-sectional study. Given that intrinsic capacity is a dynamic ability, longitudinal studies are necessary to further explore its relationship with the factors examined in this study. 5. Conclusion This study examined 215 older adults with heart failure to explore the relationships between sociodemographic and clinical characteristics, self-care, and intrinsic capacity. The findings indicate that older age and poorer cardiac function are associated with diminished intrinsic capacity. Additionally, a significant link between self-care and intrinsic capacity was identified. Our findings suggest that medical professionals should prioritize evaluating and managing intrinsic capacity in older adults with heart failure, especially in elderly patients and those with complex health conditions. It is also crucial to tailor self-care strategies to enhance intrinsic capacity. These insights can aid in developing more effective interventions to improve the overall well-being of older adults with heart failure. Declarations Funding Declaration This study was supported by Wuxi Municipal Science and Technology Commission Project (Y20212023), Wuxi Medical Center Nanjing Medical University Project (WMCHL202301), the Science and Technology Development Fund of Nanjing Medical University (NMUB20230234), and the Major Project of Wuxi Nursing Association (Z202301), and Chinese Medical Association Nursing Project (CMAPH-NRD2022035). Clinical Trial Registration Clinical trial number: not applicable Author Contribution PENG Ronggang: Investigation, Writing – review & editing, Writing – original draft, Software, Methodology, Conceptualization. YANG Fang: Project administration, Methodology, Formal analysis, Conceptualization. WAN Xia: Project administration, Formal analysis, Conceptualization. XU Yanhua: Investigation, Methodology, Formal analysis. ZHAO Qing: Investigation, Funding acquisition, Writing – review & editing, Supervision. Acknowledgement We would like to acknowledge Wuxi Municipal Science and Technology Commission, Wuxi Medical Center Nanjing Medical University, Wuxi Nursing Association, and Chinese Medical Association for their financial support in this research. However, the sponsors had no role in the design of the study, data collection, analysis, interpretation of the data, or writing of the manuscript. Data Availability Data is provided within the manuscript or supplementary information files. The original data can be obtained from the corresponding author upon a reasonable request. References McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. Wang H, Chai K, Du MH, Wang SF, Cai JP, Li YY, et al. Prevalence and Incidence of Heart Failure Among Urban Patients in China A National Population-Based Analysis. Circ-Heart Fail. 2021;14(10):1127–35. 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Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future. J Am Coll Cardiol. 2018;71(17):1921–36. Ramírez-Vélez R, Iriarte-Fernández M, Santafé G, Malanda A, Beard JR, Garcia-Hermoso A, et al. Association of intrinsic capacity with incidence and mortality of cardiovascular disease: Prospective study in UK Biobank. J Cachexia Sarcopenia Muscle. 2023;14(5):2054–63. WHO. Integrated Care for Older People: Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity. Geneva, Switzerland: WHO.; 2017. Moon SY, Hong CH, Jeong JH, Park YK, Na HR, Song HS, et al. Facility-based and home-based multidomain interventions including cognitive training, exercise, diet, vascular risk management, and motivation for older adults: a randomized controlled feasibility trial. Aging-Us. 2021;13(12):15898–. Liu W, Qin R, Zhang X, Li G, Qiu Y, Zhang G et al. Effectiveness of Integrated Care for Older Pepole (ICOPE) in Improving Intrinsic Capacity in Older Adults: A Systematic Review and Meta-Analysis. J Clin Nurs. 2024. Yu R, Lai D, Leung G, Woo J. Trajectories of Intrinsic Capacity: Determinants and Associations with Disability. J Nutr Health Aging. 2023;27(3):174–81. Triposkiadis F, Xanthopoulos A, Butler J. Cardiovascular Aging and Heart Failure Review Topic of the Week. J Am Coll Cardiol. 2019;74(6):804–13. Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, et al. Clinical Implications of the New York Heart Association Classification. J Am Heart Assoc. 2019;8(23):e014240. van Nieuwkerk AC, Delewi R, Wolters FJ, Muller M, Daemen M, Biessels GJ, et al. Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice. Stroke. 2023;54(8):2181–91. Sargent L, Flattery M, Shah K, Price ET, Tirado C, Oliveira T, et al. Influence of physiological and psychological factors on cognitive dysfunction in heart failure patients. Appl Nurs Res. 2020;56:151375. Jiang Y, Wang W. Improve self-care in heart failure. Int J Nurs Sci. 2021;8(2):243–4. Beard JR, Si YF, Liu ZX, Chenoweth L, Hanewald K. Intrinsic Capacity: Validation of a New WHO Concept for Healthy Aging in a Longitudinal Chinese Study. J Gerontol a-Biol. 2022;77(1):94–100. Ye S, Huynh Q, Potter EL. Cognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management. Curr Heart Fail Rep. 2022;19(5):303–15. Vellone E, Chialà O, Boyne J, Klompstra L, Evangelista LS, Back M, et al. Cognitive impairment in patients with heart failure: an international study. Esc Heart Fail. 2020;7(1):47–54. Niriayo YL, Yemane B, Asgedom SW, Teklay G, Gidey K. Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure. Sci Rep. 2024;14(1):1984. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5476128","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380966480,"identity":"7465a889-7cac-4588-9e93-95e5f5f2cc98","order_by":0,"name":"Ronggang PENG","email":"","orcid":"","institution":"Affiliated Hospital of Jiangnan University","correspondingAuthor":false,"prefix":"","firstName":"Ronggang","middleName":"","lastName":"PENG","suffix":""},{"id":380966482,"identity":"91edadfd-228e-49f4-906f-3e8eedfe7001","order_by":1,"name":"Fang YANG","email":"","orcid":"","institution":"The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"YANG","suffix":""},{"id":380966484,"identity":"63cbec2e-beb3-4ef1-a694-0252158078be","order_by":2,"name":"Xia WAN","email":"","orcid":"","institution":"The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"WAN","suffix":""},{"id":380966486,"identity":"66c06fe3-7286-4005-805b-1a7b02632a63","order_by":3,"name":"Yanhua XU","email":"","orcid":"","institution":"The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanhua","middleName":"","lastName":"XU","suffix":""},{"id":380966487,"identity":"2e91c878-83bb-465a-9823-21d7eac3bf70","order_by":4,"name":"Qing ZHAO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYDACZhBhwCDHxt58gDQtxnw8xxJIsyxxnkSOAnFK+Y7zHn75o+BwehtDDgPDj4pthLVIHuZLs5AwOJzbxnD2AGPPmduEtRgc5jEzMABpYexLYGZsI1ZLgsHhdDZmHgOitRg/OGBwOIGNjVgtkkBbGBsM0g3beNgSDhLlF77zZ4w//vhjLS8///HBBz8qiNDCcICBTQLBJgocYGD+QJzKUTAKRsEoGLEAAGFVOSBL9O2+AAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Qing","middleName":"","lastName":"ZHAO","suffix":""}],"badges":[],"createdAt":"2024-11-18 12:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5476128/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5476128/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71890117,"identity":"2d096a54-151e-4847-b50e-139ce15c0312","added_by":"auto","created_at":"2024-12-19 12:55:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120613,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Intrinsic Capacity Scores Across Various Sociodemographic and Clinical Subgroups.\u003c/strong\u003e The subgroups include: (A) Age, (B) Gender, (C) Body Mass Index (BMI), (D) Marital Status, (E) Education Level, (F) Smoking Status, (G) Alcohol Consumption, (H) New York Heart Association (NYHA) Class, (I) Medical Insurance Status, (J) Monthly Income, (K) Number of Comorbidities, and (L) Living Alone Status.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5476128/v1/af41a176c308aaea1a55ea00.png"},{"id":99310733,"identity":"6276ed17-19cb-4c88-a6fe-8378e146251d","added_by":"auto","created_at":"2025-12-31 16:13:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1025806,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5476128/v1/15a4cec8-3728-4c9b-98b3-fd79a9fe3315.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Sociodemographic, Clinical factors, and Self-Care with Intrinsic Capacity in Older Adults with Heart Failure","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHeart failure is a progressive cardiovascular disease characterized by the heart's inability to pump blood efficiently to meet the body's needs \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Approximately 1%-2% of adults globally and an estimated 12.1\u0026nbsp;million individuals in China are affected with heart failure \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The prevalence of heart failure rises significantly with age, reaching nearly 10% in people aged 70 and older \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Despite advances in treatment, the five-year survival rate remains around 50% once diagnosed \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Patients with heart failure experience a considerable burden of symptoms, including physical debilitation, psychological distress, and a diminished quality of life \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This underscores the critical need for effective management strategies for these individuals.\u003c/p\u003e \u003cp\u003eSelf-care behaviors, which encompass complex actions to maintain physiological stability and manage symptoms, are considered the cornerstone of effective management \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. These behaviors include medication adherence, symptom monitoring, attending medical appointments, and seeking timely care when symptoms worsen \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Effective self-care has been shown to improve quality of life, reduce hospital readmissions, and lower mortality rates in patients with heart failure \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. However, despite the positive impact of self-care on health outcomes, many patients with heart failure struggle to engage in adequate self-care, which remains a significant barrier to optimal outcomes \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIntrinsic capacity, a concept introduced by the World Health Organization, refers to the comprehensive capacity of all physical and mental capacities that an individual could draw on \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. It consists of multiple domains, including locomotion, vitality, cognition, psychological well-being, and sensory function \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Maintaining optimal intrinsic capacity is of great significance for promoting healthy aging and preserving functional independence in older adults \u003csup\u003e[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Declines in intrinsic capacity have been linked to worsened clinical outcomes, reduced physiological function and quality of life, and higher risks of mortality and hospital utilization \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In heart failure management, international guidelines recommend cardiac rehabilitation, particularly emphasizing exercise and nutritional counselling as key intervention strategies \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. These interventions align with key domains of intrinsic capacity, particularly locomotion and nutrition, which are critical to maintaining functional independence in heart failure patients. As the WHO emphasizes the importance of functional performance for healthy aging \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, understanding and optimizing intrinsic capacity in older adults with heart failure is essential for developing interventions that improve quality of life and maintain independence.\u003c/p\u003e \u003cp\u003eSociodemographic factors, such as age, gender, and educational level, as well as clinical characteristics like comorbidities and disease severity, have been shown to influence intrinsic capacity in older adults \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Additionally, intrinsic capacity has been associated with self-care abilities, particularly in performing activities of daily living \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. For patients with heart failure, intrinsic capacity may act as a mediating factor between heart failure symptoms and functional ability \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Cognitive function, a key domain of intrinsic capacity, is especially relevant, as it can significantly impact self-care behaviours in older adults with heart failure \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite these insights, research exploring the relationships among sociodemographic factors, clinical characteristics, self-care, and intrinsic capacity in older adults with heart failure remains limited. This gap limits the development of individualized care plans that address the complex needs of older adults with heart failure. Therefore, the current study aims to fill this gap by examining the association between sociodemographic and clinical characteristics, self-care, and intrinsic capacity in older adults with heart failure, so as to provide valuable insights for early identification of those at risk for diminished intrinsic capacity and for designing effective self-care interventions.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study. A convenience sampling method was adopted to select 215 individuals with heart failure who were hospitalized in the Department of Cardiology in two tertiary hospitals in Wuxi, China from June 2023 to May 2024. The questionnaire was handed out to eligible participants face to face. Eligible participants were: (1) patients with definite diagnosis of heart failure; (2) classified as New York Heart Association (NYHA) grade II to IV; (3) age 60 years or older; Participants with severe damage to liver and kidney function, advanced tumors, participating in other interventional studies, and those who were unable to communicate normally were excluded. This study has been approved by the Ethics Committee of Wuxi People\u0026rsquo;s Hospital (2023-KY23114). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data collection\u003c/h2\u003e \u003cp\u003e \u003cb\u003ei) Sociodemographic and clinical data\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSocio-demographic and clinical information was gathered through patient interviews and review of medical records. Collected data included age, body mass index (BMI), gender, marital status, education level, monthly income, living arrangements, medical expense coverage, New York Heart Association (NYHA) functional classification, current smoking status, current drinking status, and history of chronic diseases.\u003c/p\u003e \u003cp\u003e \u003cb\u003eii) Intrinsic Capacity Assessment\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on the WHO's conceptual framework for intrinsic capacity \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, five domains-cognition, locomotion, vitality, psychological well-being, and sensory function-were assessed and combined into a composite score. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Cognitive decline was defined according to education level-specific cutoffs: \u0026le;13 points for illiterate participants, \u0026le;\u0026thinsp;19 points for primary school education, and \u0026le;\u0026thinsp;24 points for those with junior high school or higher education levels \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Locomotion was evaluated using the Short Physical Performance Battery (SPPB), with a total score\u0026thinsp;\u0026le;\u0026thinsp;8 indicating a decline in locomotion \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Vitality was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), with scores\u0026thinsp;\u0026le;\u0026thinsp;11 indicating a decline in vitality \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Psychological well-being was assessed using the Geriatric Depression Scale-15 (GDS-15), where a score\u0026thinsp;\u0026ge;\u0026thinsp;8 was considered indicative of psychological decline \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Sensory function was determined based on self-reported visual or hearing impairments affecting daily life. No impairment was scored as 0, while the presence of visual or hearing loss was scored as 1 point in the IC composite score. A decline in each domain contributed 1 point to the total IC composite score, which ranged from 0 to 5, with higher scores indicating greater declines in intrinsic capacity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eiii) Self-care ability\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe self-care ability was assessed using the 22-item Self-Care Heart Failure Index (SCHFI), which measures the self-care abilities across three subscales: self-care maintenance (10 items), self-care management (6 items), and self-care confidence (6 items). Scores of each subscale were standardized to a scale of 0 to 100, with a score of 70 or higher indicating adequate self-care \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The Chinese version of the SCHFI has demonstrated satisfactory psychometric properties, with a Cronbach\u0026rsquo;s α of 0.853 for internal consistency and a test-retest reliability of 0.861 \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 20.0 software. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for normally distributed data, or as median and interquartile range (IQR) for non-normally distributed data. Categorical variables were presented as frequencies (N) and percentages (%). Differences in intrinsic capacity across various sociodemographic and clinical characteristics were assessed using independent-sample t-tests, one-way ANOVA, or the Kruskal-Wallis test, as appropriate based on the data distribution. Spearman\u0026rsquo;s correlation coefficient was used to evaluate the associations between self-care and intrinsic capacity composite scores. Multiple linear regression analysis was conducted to identify the independent effects of selected variables on intrinsic capacity. Variables with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in bivariate analyses, as well as clinically relevant variables reported in the literature, were included in the multivariable regression model. \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic and clinical characteristics of the participants\u003c/h2\u003e \u003cp\u003eThe study included 215 older adults with heart failure. The mean age of participants was 74.13 years (SD\u0026thinsp;=\u0026thinsp;7.07), ranging from 60 to 92 years old. More than half of the participants were female (56.7%). In terms of educational level, 42.8% had completed elementary school or lower levels of education. The majority were married (74.9%) and nearly all (93.0%) had medical insurance coverage. Most participants were classified as NYHA Class II or III (88.1%) and were not living alone (87.4%). The majority (69.8%) reported a monthly income exceeding 2000 RMB. Regarding chronic conditions, 70.6% of participants had concurrent hypertension, 61.4% had a history of coronary artery disease, and 38.6% had diabetes (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of study participants (N\u0026thinsp;=\u0026thinsp;215).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD/ n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (43.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (42.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (35.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school (including vocational)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161 (74.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced or widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical expense coverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (93.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-funded\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (40.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (37.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving arrangement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (12.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with family/others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188 (87.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly income (RBM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e500\u0026ndash;2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (69.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (32.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent drinking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of chronic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (70.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (38.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (61.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Intrinsic capacity of the participants\u003c/h2\u003e \u003cp\u003eThe average composite intrinsic capacity score for older adults with heart failure was 2.58 (SD\u0026thinsp;=\u0026thinsp;1.17). Nearly all participants (98.1%) experienced a decline in at least one domain of intrinsic capacity. The most affected domains were vitality (87.9%), cognition (60.9%), and sensory function (49.3%). Locomotor decline was observed in 49.3% of participants, while 10.2% experienced psychological decline. The distribution of participants experiencing declines in one to five domains was 17.2%, 30.2%, 28.4%, 16.7% and 5.6% respectively. The median scores were 21 (IQR\u0026thinsp;=\u0026thinsp;6) for MoCA, 3 (IQR\u0026thinsp;=\u0026thinsp;4) for GDS-15, and 9 (IQR\u0026thinsp;=\u0026thinsp;3) for both SPPB and MNASF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Self-care of participants\u003c/h2\u003e \u003cp\u003eThe median overall score for self-care was 110.58 (IQR\u0026thinsp;=\u0026thinsp;61.12). For the subscales, the median score for self-care maintenance was 43.33 (IQR\u0026thinsp;=\u0026thinsp;23.33), self-care management was 35 (IQR\u0026thinsp;=\u0026thinsp;30), and self-care confidence was 33.36 (IQR\u0026thinsp;=\u0026thinsp;27.80). These findings suggest that the self-care abilities among older adults with heart failure were suboptimal across all dimensions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Analysis of sociodemographic and clinical characteristics on intrinsic capacity\u003c/h2\u003e \u003cp\u003eThe results showed that intrinsic capacity was significantly influenced by age (F\u0026thinsp;=\u0026thinsp;6.882, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), with older participants having higher scores and poorer intrinsic capacity. Marital status (t\u0026thinsp;=\u0026thinsp;2.282, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023), NYHA class (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and monthly income (H\u0026thinsp;=\u0026thinsp;6.729, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) were also significantly associated with intrinsic capacity. Participants who were married, had better cardiac function, or reported higher income demonstrated greater intrinsic capacity. However, no significant differences in intrinsic capacity were observed based on gender, BMI, education level, smoking or drinking status, medical insurance coverage, number of comorbidities, or living alone status (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Correlation analysis of self-care and intrinsic capacity among older adults with heart failure\u003c/h2\u003e \u003cp\u003eThe correlation analysis demonstrated a significant negative relationship between the intrinsic capacity composite score and overall self-care (r = -0.238, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In addition, intrinsic capacity score was significantly negatively correlated with self-care maintenance (r = -0.232, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), self-care management (r = -0.153, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and self-care confidence (r = -0.216, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). These findings indicated that a decline in intrinsic capacity is strongly associated with poorer performance in self-care maintenance, management, and confidence among older adults with heart failure (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation analysis of intrinsic capacity and self-care among older adults with heart failure (N\u0026thinsp;=\u0026thinsp;215).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 IC composite score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 Self-care overall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.238\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 Self-care maintenance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.232\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.755\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 Self-care management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.153\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.834\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.478\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 Self-care confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.216\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.810\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.419\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.565\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Effect of sociodemographic and clinical variables, and self-care on intrinsic capacity\u003c/h2\u003e \u003cp\u003eThe regression analysis revealed that age, marital status, monthly income, NYHA class, and self-care explained 29% of the variation in intrinsic capacity among older adults with heart failure (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.499, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among these factors, NYHA class was the strongest predictor of intrinsic capacity (β\u0026thinsp;=\u0026thinsp;0.466, \u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.032, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that participants with more severe heart failure symptoms had significantly worse intrinsic capacity. Age (β\u0026thinsp;=\u0026thinsp;0.138, t\u0026thinsp;=\u0026thinsp;2.163, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032) and self-care abilities (β = -0.133, t = -2.140, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033) were also significant predictors, suggesting that older age is associated with worse intrinsic capacity, whereas better self-care practices are linked to improved intrinsic capacity. In contrast, marital status (β = -0.043, \u003cem\u003et\u003c/em\u003e = -0.710, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.479) and monthly income (β = -0.090, \u003cem\u003et\u003c/em\u003e = -1.541, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.125) did not show a significant effect on intrinsic capacity in this population (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression Analysis of Sociodemographic and Clinical Characteristics, and Self-Care on Intrinsic Capacity Among Older Adults with Heart Failure (N\u0026thinsp;=\u0026thinsp;215).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdj.R2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.290\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e18.499\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.466\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.133\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study found that intrinsic capacity decline was prevalent among older adults with heart failure, with 98.1% experiencing a decline in at least one domain. This is consistent with previous research, which reported that 92.6% of older adults showed decline in at least one area of intrinsic capacity \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Notably, vitality and cognitive function were the most affected domains, with over 60% of participants showing declines. These higher rates, compared to those observed among community-dwelling older adults \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, may be attributed to advanced disease progression, multifaceted symptom burden, and complex comorbidities. In particular, vitality was the most severely impacted domain, with 87.9% of participants affected. Heart failure patients are at a high risk of undernutrition due to an imbalance between protein catabolism and anabolism \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. International guidelines recommend nutritional supplements as a critical component of cardiac rehabilitation for heart failure patients \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Furthermore, 60.9% of heart failure patients experienced a decline in the cognitive domain. Maintaining normal cognitive function is crucial for heart failure management; however, cognitive decline has been reported to affect 20\u0026ndash;80% of heart failure patients \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Reduced cardiac output, vascular dysfunction, and imbalances in the autonomic nervous system may contribute to decreased cerebral function, leading to cognitive decline \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. The most affected cognitive domains include learning and memory, executive function, and complex attention \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Overall, the high prevalence of intrinsic capacity decline underscores the vulnerability of older adults with heart failure, particularly in the domains of vitality and cognitive function.\u003c/p\u003e \u003cp\u003eThe intrinsic capacity deficit score is a powerful predictor of functional trajectories and individual vulnerabilities related to cardiovascular incidents and premature death, with monitoring providing an early-warning system for initiating preventive efforts \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. It is imperative to assess intrinsic capacity decline among older adults with heart failure at an early stage and explore effective intervention strategies to address these issues. To enhance the intrinsic capacity of older adults, WHO has proposed the 'Integrated Care for Older People' (ICOPE) program, which emphasizes a community-based, age-centered, interdisciplinary, and integrated care model \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Collaboration among healthcare professionals is essential; once impairments are identified, an interdisciplinary team should implement interventions to slow progression \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Furthermore, interventions targeting multiple domains of intrinsic capacity should be well-integrated. A previous study demonstrated the efficacy of a 24-week multi-component intervention-comprising exercise, nutrition, cognitive training, and pre-rehabilitation-in delaying or reversing intrinsic capacity decline \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. The effectiveness of the ICOPE program in enhancing cognitive function and physiological domains has been substantiated by a recent systematic review \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. However, the potential benefits of these interventions for improving the intrinsic capacity of heart failure patients require further investigation. Addressing these gaps could significantly advance our understanding and management of intrinsic capacity decline in this vulnerable population.\u003c/p\u003e \u003cp\u003eAs individuals age, their intrinsic capacity declines from a high and stable state to a compromised one, posing risks such as cognitive decline, depression, sensory dysfunction, impaired mobility, and increased rates of recurrent hospitalization and morbidity \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Our study was consistent with previous findings that older age is associated with worse intrinsic capacity \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Further research on the trajectories of intrinsic capacity in older adults has demonstrated a gradual decline with advancing age \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. This decline is due to the buildup of molecular and cellular damage over time, which weakens physical abilities and increases vulnerability to illness, ultimately resulting in a decrease in overall intrinsic capacity \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Specifically, cardiovascular aging can lead to progressive structural and functional decline \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Therefore, it is crucial to monitor and address the intrinsic capacity of older adults, particularly those with heart failure.\u003c/p\u003e \u003cp\u003eThe New York Heart Association (NYHA) classification system categorizes heart failure patients based on the severity of their symptoms, with higher classes indicating greater severity \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. Our findings revealed a significant association between NYHA class and intrinsic capacity, suggesting that more severe cardiac dysfunction correlates with poorer intrinsic capacity. Previous studies have also indicated that the prevalence of cognitive impairment rises with the severity of heart failure and is higher in those classified as NYHA class IV compared to class II \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Patients with worsening heart failure symptoms often experience increased confusion, difficulty with attention, solving problems, concentration, slower reaction times, and forgetfulness \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. These findings highlight the need for targeted attention to individuals with more severe cardiac dysfunction.\u003c/p\u003e \u003cp\u003eSelf-care is essential for managing heart failure, and consistent self-care practices could prevent 30% of hospital admissions and over half of readmissions \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. Our study found a significant association between self-care and intrinsic capacity among older adults with heart failure. This finding was supported by a secondary analysis of the China Health and Retirement Longitudinal Study (CHARLS) dataset, which showed a significant negative relationship between intrinsic capacity and self-care in daily activities and instrumental activities \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e. Previous research corroborates our findings, indicating that cognitive decline in heart failure often leads to deficits in attention, memory, executive function, and processing speed, which can impair patients' ability to manage their self-care \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e. Despite the recognized importance of self-care, our findings indicated that self-care abilities among older adults with heart failure were suboptimal, with a median overall score of 110.58 and lower scores in the sub-scales(43.33, 35, and 33.36). This aligns with previous research showing that 73.8% of older adults demonstrated poor overall self-care behavior \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. Thus, strategies to enhance self-care in heart failure should be prioritized, and their effectiveness in improving intrinsic capacity needs to be demonstrated.\u003c/p\u003e \u003cp\u003eIn summary, this study highlights significant associations of age, NYHA class, and self-care with intrinsic capacity among older adults with heart failure. Our findings offer valuable insights for detecting declines in intrinsic capacity and suggest new directions for developing strategies to enhance it. However, our study has several limitations. First, we used a convenience sampling method and selected participants from two hospitals in Wuxi city, China, which may limit the generalizability of the results. Further multi-center, larger-scale studies are needed to verify our findings. Additionally, the intrinsic capacity and its sub-domains in our study were measured using subjective scales, which may introduce bias. Finally, this was a cross-sectional study. Given that intrinsic capacity is a dynamic ability, longitudinal studies are necessary to further explore its relationship with the factors examined in this study.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study examined 215 older adults with heart failure to explore the relationships between sociodemographic and clinical characteristics, self-care, and intrinsic capacity. The findings indicate that older age and poorer cardiac function are associated with diminished intrinsic capacity. Additionally, a significant link between self-care and intrinsic capacity was identified. Our findings suggest that medical professionals should prioritize evaluating and managing intrinsic capacity in older adults with heart failure, especially in elderly patients and those with complex health conditions. It is also crucial to tailor self-care strategies to enhance intrinsic capacity. These insights can aid in developing more effective interventions to improve the overall well-being of older adults with heart failure.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eFunding Declaration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study was supported by Wuxi Municipal Science and Technology Commission Project (Y20212023), Wuxi Medical Center Nanjing Medical University Project (WMCHL202301), the Science and Technology Development Fund of Nanjing Medical University (NMUB20230234), and the Major Project of Wuxi Nursing Association (Z202301), and Chinese Medical Association Nursing Project (CMAPH-NRD2022035).\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical Trial Registration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePENG Ronggang: Investigation, Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Software, Methodology, Conceptualization. YANG Fang: Project administration, Methodology, Formal analysis, Conceptualization. WAN Xia: Project administration, Formal analysis, Conceptualization. XU Yanhua: Investigation, Methodology, Formal analysis. ZHAO Qing: Investigation, Funding acquisition, Writing \u0026ndash; review \u0026amp; editing, Supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to acknowledge Wuxi Municipal Science and Technology Commission, Wuxi Medical Center Nanjing Medical University, Wuxi Nursing Association, and Chinese Medical Association for their financial support in this research. However, the sponsors had no role in the design of the study, data collection, analysis, interpretation of the data, or writing of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files. The original data can be obtained from the corresponding author upon a reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599\u0026ndash;726.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, Chai K, Du MH, Wang SF, Cai JP, Li YY, et al. Prevalence and Incidence of Heart Failure Among Urban Patients in China A National Population-Based Analysis. Circ-Heart Fail. 2021;14(10):1127\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark MS, Kim EJ. A Correlative Relationship Between Heart Failure and Cognitive Impairment: A Narrative Review. J Korean Med Sci. 2023;38(39).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones NR, Roalfe AK, Adoki I, Hobbs FDR, Taylor CJ. 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Curr Heart Fail Rep. 2022;19(5):303\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVellone E, Chial\u0026agrave; O, Boyne J, Klompstra L, Evangelista LS, Back M, et al. Cognitive impairment in patients with heart failure: an international study. Esc Heart Fail. 2020;7(1):47\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiriayo YL, Yemane B, Asgedom SW, Teklay G, Gidey K. Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure. Sci Rep. 2024;14(1):1984.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"heart failure, intrinsic capacity, self-care, older adults","lastPublishedDoi":"10.21203/rs.3.rs-5476128/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5476128/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to examine the association between sociodemographic and clinical characteristics, self-care practices, and intrinsic capacity in older adults with heart failure.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 215 heart failure patients aged 60 years or older were recruited from two tertiary hospitals in Wuxi, China. The intrinsic capacity composite score was derived from scores on the Montreal Cognitive Assessment (MoCA), Short Physical Performance Battery (SPPB), Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Depression Scale-15 (GDS-15), and self-reported visual or hearing impairments. Self-care was assessed using the Self-Care Heart Failure Index (SCHFI). Sociodemographic and clinical data were collected via a self-designed questionnaire. The associations between sociodemographic and clinical characteristics, self-care, and intrinsic capacity were explored using binary analysis, Spearman\u0026rsquo;s correlation coefficient analysis, and multiple linear regression analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e98.1% of participants experienced a decline in at least one domain of intrinsic capacity. The most affected domains were vitality (87.9%) and cognition (60.95%). Reduced intrinsic capacity composite scores were associated with older age (β\u0026thinsp;=\u0026thinsp;0.138, t\u0026thinsp;=\u0026thinsp;2.163, p\u0026thinsp;=\u0026thinsp;0.032), higher NYHA class grade (β\u0026thinsp;=\u0026thinsp;0.466, t\u0026thinsp;=\u0026thinsp;8.032, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and poorer self-care (β = -0.133, t = -2.140, p\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIntrinsic capacity in older adults with heart failure was found to be related to age, NYHA class grade, and self-care practices. Healthcare professionals should focus on these factors and implement targeted interventions to support this population.\u003c/p\u003e","manuscriptTitle":"Association of Sociodemographic, Clinical factors, and Self-Care with Intrinsic Capacity in Older Adults with Heart Failure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 12:54:09","doi":"10.21203/rs.3.rs-5476128/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5dbab3b2-207e-4ecb-8ead-5d7895e684d1","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-24T11:54:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-19 12:54:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5476128","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5476128","identity":"rs-5476128","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}