Intrinsic capacity subtypes in healthy Chinese older adults: links to possible sarcopenia and fall risk

BACKGROUND: Intrinsic capacity (IC) reflects physiological reserve in older adults. However, most studies have focused on hospital-based populations or summed IC scores. Evidence on IC impairment patterns and their associations with possible sarcopenia and falls among community-dwelling healthy older adults remains limited. OBJECTIVE: To characterize domain-specific and clustered patterns of IC impairment among community-dwelling healthy older adults and evaluate their associations with falls and possible sarcopenia, with the aim of improving precision screening and risk stratification. METHODS: This cross-sectional study enrolled 1,607 community-dwelling adults aged ≥60 years who broadly met the Standard for Healthy Chinese Older Adults (2022), with generally good health, functional independence, and adequate cognitive and communication abilities. IC was assessed using the Integrated Care for Older People (ICOPE) screening tool across five domains: cognition, locomotion, vitality, sensory function, and psychology. Fall risk and possible sarcopenia were evaluated according to the World Guidelines by The World Falls Task Force and the Asian Working Group for Sarcopenia (AWGS) 2025 Updated Consensus, respectively. K-means clustering was used to identify IC impairment subtypes. Multivariate logistic regression, extreme gradient boosting (XGBoost) models, and structural equation modeling (SEM) were applied to examine associations of individual IC domains and clustered subtypes with fall risk and possible sarcopenia. RESULTS: Over 92% of participants exhibited impairment in ≥1 IC domain, with sensory impairment being most prevalent (80.9%) and locomotion least common (5.8%). Four distinct IC subtypes were identified: isolated cognitive impairment (17.4%), predominant sensory impairment (49.7%), sensory-psychological-vitality impairment (27.1%), and multi-domain impairment (5.8%). Overall, each additional impaired IC domain increased fall risk by 37% and possible sarcopenia risk by 41%, respectively. Locomotion impairment demonstrated a strong association with fall risk (OR = 4.78, 95% CI: 2.21-7.62), whereas cognitive impairment showed a strong association with possible sarcopenia (OR = 3.40, 95% CI: 2.18-5.32). Only multi-domain impairment exhibited significant associations with both outcomes (OR = 4.10, 95% CI: 2.21-7.62 for falls; OR = 2.78, 95% CI: 1.65-4.67 for possible sarcopenia). The five-domain IC XGBoost model showed higher AUCs than the age-sex model for fall risk (0.742 vs. 0.677) and possible sarcopenia (0.726 vs. 0.679). SEM identified significant paths linking age, cognition, locomotion, possible sarcopenia, and falls (β = 0.05-0.27), as well as an inter-domain sensory-psychological-vitality pathway (β = 0.16-0.59; all P < 0.001). CONCLUSION: IC impairment was common even among healthy community-dwelling older adults. Sensory impairment may be an early marker of IC decline, whereas multidomain impairment was linked to higher fall risk and possible sarcopenia. Community prevention should prioritize ICOPE-based sensory screening, timely vision/hearing management, and targeted muscle strength, gait, and fall-risk assessment for high-risk IC subtypes.