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The structure and predictive value of intrinsic capacity in a longitudinal study of ageing
  1. John R Beard1,2,
  2. A T Jotheeswaran1,
  3. Matteo Cesari3,
  4. Islene Araujo de Carvalho1
  1. 1 Department of Ageing and Life Course, World Health Organization, Geneve, Switzerland
  2. 2 University of New South Wales, Sydney, Australia
  3. 3 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy
  1. Correspondence to Dr. Islene Araujo de Carvalho; araujodecarvalho{at}


Objectives To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.

Design Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.

Settings Community, United Kingdom.

Participants 2560 eligible participants aged over 60 years.

Main outcome measures Activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.

Conclusions The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.

  • epidemiology
  • geriatric medicine
  • public health
  • primary care
  • general medicine (see internal medicine)

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  • Contributors JRB conceived of the research, oversaw analysis and was responsible for final drafting of the paper. ATJ undertook all analyses, reviews of related literature, and contributed to drafting of the paper. MC contributed to conceptualisation, reviews of related literature and drafting of the paper. IAC contributed to conceptualisation, reviews of related literature and drafting of the paper. All authors reviewed and approved the final manuscript submitted for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval for ELSA was obtained from NHS Research Ethics Committees under the National Research and Ethics Service (NRES), and participants gave full informed written consent for participation. More information on ELSA can be found at

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available. However, ELSA dataset and information on all currently archived can be freely accessed through the UK Data Archive (

  • Patient consent for publication Not required.

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