The relationship between intrinsic capacity and functional ability – identifying key environmental features to support healthy ageing

Background: Within the World Health Organization's (WHO) healthy ageing framework, older adult's functional ability (FA) is determined by the intrinsic capacity (IC), the living environment, and their interaction. This study aimed to identify candidate environmental factors in relation to FA, both directly and interactively with IC. Methods: Data from older adults (mean age = 69.4 years, SD = 7.5; 54.7% women) were obtained from the Longitudinal Aging Study Amsterdam (n = 1634). FA was assessed using a composite score of (Instrumental) Activities of Daily living ((I)ADLs). IC was measured using IC domain (vitality, locomotion, sensory, cognition, and psychology) scores (0−100). A total of 28 environmental factors was included. Random forest regression was used to model six-year FA, with IC domain scores and environmental factors as predictors. Results: Vitality, cognition and psychology IC domains showed the strongest direct associations with the predicted six-year FA score. Among environmental factors, perceived sufficiency of care, neighbourhood housing prices and airborne particulate matter (PM₁₀) concentration levels demonstrated the strongest direct associations with the predicted FA. The most important interactions were observed between the cognition, vitality and psychology IC domains with environmental factors regarding housing adaptations, household help, perceived sufficiency of care, and emotional support. Conclusion: In addition to the vitality, cognition and psychology IC domains, environmental factors including sufficiency of care, housing prices and PM₁₀ showed important direct associations with FA. Interactions between IC and the environment primarily involved social environmental factors. Further longitudinal research is needed to clarify the mechanisms underlying these direct and interactive associations.