Intrinsic capacity trajectories and health outcomes in home care settings: a Canadian population-based cohort study

Intrinsic capacity (IC), defined as the composite of physical and mental capacities, is a dynamic indicator of healthy ageing. Understanding its longitudinal patterns may improve risk stratification and inform care planning among home care recipients.

This population-based retrospective cohort study used routinely collected interRAI Home Care data in Canada. IC was derived across five domains and modelled using group-based trajectory modelling to identify distinct patterns over time. Associations between trajectory membership and key outcomes, including mortality and long-term care (LTC) admission, were examined.

The study included 302 467 home care recipients; 62.2% were female, with a median age of 81 years (IQR 14). Five distinct IC trajectories were identified, demonstrating substantial heterogeneity in functional ageing. Most individuals followed declining trajectories, while smaller groups remained stable or showed improvement. Cognitive impairment was strongly associated with adverse trajectories, whereas gains were most evident in locomotion and psychological domains. Importantly, baseline IC level alone did not fully capture subsequent outcome heterogeneity. For example, individuals with moderate baseline IC had higher LTC admission than those with low IC who improved (48.4% vs 38.1%), underscoring the importance of longitudinal assessment.

IC trajectories capture clinically meaningful differences in ageing pathways that are not apparent from single assessments. These findings support the use of routinely collected interRAI data to enable scalable, trajectory-informed care, with implications for earlier intervention, targeted service allocation and improved planning across the continuum of care. Further work is required to translate these findings into practical clinical tools to support early risk stratification at admission and guide future care planning.