WHO’s Intrinsic Capacity Framework Explained

What Is Intrinsic Capacity?

The WHO defines intrinsic capacity (IC) as the composite of all the physical and mental capacities that an individual can draw on at any point in time. Rather than focusing on diseases (e.g., arthritis, diabetes, heart disease), this framework focuses on what a person can actually do—functionally and cognitively—as they age (academic.oup.com).

This marks a fundamental shift from disease‑centered care to function‑centered care, recognizing that:

• Two people with the same diagnosis can function very differently
• Functional decline often begins before diagnosable disease
• Preserving capacity can delay disability, dependence, and institutional care

Intrinsic Capacity vs. Functional Ability (Critical Distinction)

WHO distinguishes two closely related concepts:

• Intrinsic Capacity: What your body and brain are capable of
• Functional Ability: What you are able to do in your real environment

Functional ability is shaped by:

• Intrinsic capacity
• The physical environment (housing, walkability, assistive devices)
• The social environment (support, access to care, community)

This interaction is central to WHO’s Healthy Ageing model and underpins global aging policy from 2021–2030 (academic.oup.com).

The Five Domains of Intrinsic Capacity

WHO operationalizes intrinsic capacity into five measurable domains, now widely used in research and clinical care.

1. Locomotor Capacity (Movement & Strength)

Includes:

• Muscle strength
• Balance
• Gait speed
• Ability to rise from a chair or climb stairs

Why it matters:
Declines in locomotor capacity are among the strongest predictors of falls, disability, hospitalization, and loss of independence (pubmed.ncbi.nlm.nih.gov).

2. Vitality (Energy & Physiologic Reserves)

Includes:

• Nutrition status
• Metabolic health
• Muscle mass
• Fatigue resistance

WHO and gerontology researchers increasingly emphasize nutrition as central to vitality—not a separate domain—because it underpins all other capacities (academic.oup.com).

3. Cognitive Capacity

Includes:

• Memory
• Attention
• Executive function (planning, decision‑making)

Cognitive decline can occur even in the absence of dementia and often predicts later functional impairment (bmcgeriatr.biomedcentral.com).

4. Psychological Capacity

Includes:

• Emotional regulation
• Mood stability
• Stress resilience

Depression and anxiety significantly accelerate decline across other IC domains, yet are often under‑recognized in older adults (bmcgeriatr.biomedcentral.com).

5. Sensory Capacity (Vision & Hearing)

Includes:

• Visual acuity
• Hearing function

Sensory loss is not benign—it is associated with cognitive decline, falls, social isolation, and increased mortality risk when untreated (bmcgeriatr.biomedcentral.com).

Why WHO Created the Intrinsic Capacity Framework

WHO introduced intrinsic capacity in its World Report on Ageing and Health to address major gaps in traditional healthcare:

Limitations of Traditional Models

• Over‑reliance on diagnoses
• Age‑based clinical decisions
• Fragmented specialty care
• Late intervention after disability emerges

Advantages of the IC Model

• Detects decline earlier
• Supports personalized care planning
• Aligns medical, social, and environmental interventions
• Reduces ageism by focusing on abilities, not age

This paradigm is now foundational to WHO’s Integrated Care for Older People (ICOPE) program used globally (who.int).

How Intrinsic Capacity Is Measured in Practice

WHO ICOPE Two‑Step Assessment

1. Brief Screening

   • Quick, low‑resource screening across all five domains
   • High sensitivity (≈95%) for detecting decline

2. Comprehensive Assessment

   • Detailed evaluation of impaired domains
   • Guides targeted interventions

Large community studies confirm that IC screening predicts:

• Activities of daily living (ADLs)
• Self‑care capacity
• Social engagement
• Future disability risk (pubmed.ncbi.nlm.nih.gov).

Why Intrinsic Capacity Matters for Patients

From a patient empowerment perspective, intrinsic capacity:

• Helps you track meaningful health changes
• Provides language to discuss function—not just diagnoses—with clinicians
• Supports shared decision‑making
• Encourages earlier, lower‑risk interventions (exercise, nutrition, vision correction, mental health support)

Importantly, research shows that each IC domain independently predicts adverse outcomes, meaning small, early declines are clinically meaningful (pubmed.ncbi.nlm.nih.gov).

Clinical and Policy Implications

Intrinsic capacity is now used to:

• Design age‑friendly communities
• Guide preventive care
• Prioritize non‑pharmacologic interventions
• Inform global aging policy

WHO emphasizes that improving IC across the lifespan—not just in old age—offers the greatest public health return (springerlink.fh-diploma.de).

How Intrinsic Capacity (IC) Maps to Exercise and Therapy Decisions

Big Picture: How Clinicians Use IC

Instead of asking “What disease do you have?”, IC reframes the question as:

“Which capacities are declining, and which interventions best restore or preserve them?”

This leads to:

• More personalized therapy plans
• Earlier, lower‑risk interventions
• Better functional outcomes than diagnosis‑only care

IC‑Driven Care Pathway (Simplified)

1. Screen IC domains (movement, vitality, cognition, psychological, sensory)
2. Identify weakest domain(s) — not just diagnoses
3. Match therapies to the impaired capacity
4. Progress therapy as capacity improves
5. Reassess regularly

Domain‑by‑Domain Mapping

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1. Locomotor Capacity → Exercise & Physical Therapy

What This Domain Measures

• Muscle strength
• Balance
• Gait speed
• Transfers (standing, stairs, rising from a chair)

Common Signs of Decline

• Slower walking
• Fear of falling
• Difficulty standing up
• Reduced endurance

Therapy Mapping

IC Finding	Best‑Matched Intervention
Reduced strength	Progressive resistance training
Poor balance	Balance & perturbation training
Slow gait speed	Task‑specific gait training
Functional difficulty	Functional strength (sit‑to‑stand, stair work)

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Why This Works

• Falls
• Hospitalizations
• Loss of independence

Patient Tip

2. Vitality → Nutrition + Exercise Synergy

What This Domain Measures

• Energy reserves
• Muscle mass
• Nutritional status
• Fatigue resistance

Common Signs of Decline

• Unintentional weight loss
• Fatigue
• Reduced exercise tolerance
• Sarcopenia (muscle loss)

Therapy Mapping

IC Finding	Best‑Matched Intervention
Low muscle mass	Resistance training + protein optimization
Poor endurance	Low‑intensity aerobic conditioning
Nutritional risk	Dietitian referral + strength training
Frailty	Multicomponent exercise (strength + balance + endurance)

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Why This Works

Patient Tip

3. Cognitive Capacity → Cognitive‑Physical Therapy

What This Domain Measures

• Attention
• Memory
• Executive function (planning, multitasking)

Common Signs of Decline

• Slower processing
• Difficulty multitasking
• Forgetfulness without dementia

Therapy Mapping

IC Finding	Best‑Matched Intervention
Mild cognitive decline	Dual‑task training
Executive dysfunction	Movement + cognitive challenges
Reaction time issues	Balance + cognitive load exercises

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Examples

• Walking while counting backwards
• Obstacle navigation with decision‑making
• Strength exercises paired with memory tasks

Why This Works

Physical movement stimulates:

• Neuroplasticity
• Blood flow
• Executive function networks

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Patient Tip

Ask: “Does this exercise challenge my brain as well as my body?”

4. Psychological Capacity → Mind‑Body & Behavioral Therapy

What This Domain Measures

• Mood
• Emotional regulation
• Stress resilience

Common Signs of Decline

• Low motivation
• Depression
• Anxiety
• Exercise avoidance

Therapy Mapping

IC Finding	Best‑Matched Intervention
Depression	Structured exercise + behavioral activation
Anxiety	Predictable routines + graded exposure
Low confidence	Supervised therapy with feedback
Fear of falling	Balance training + confidence‑building tasks

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Why This Works

• Mood directly affects:
• Exercise adherence
• Recovery speed
• Perceived pain

Psychological capacity often determines whether therapy works at all.

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Patient Tip

5. Sensory Capacity → Safety‑Driven Therapy Design

What This Domain Measures

• Vision
• Hearing

Common Signs of Decline

• Poor depth perception
• Missed instructions
• Increased fall risk

Therapy Mapping

IC Finding	Best‑Matched Intervention
Vision loss	Environmental modification + balance training
Hearing loss	Visual cues + written instructions
Combined sensory loss	Slower progression + supervised therapy

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Why This Works

Sensory impairments:

• Increase fall risk
• Reduce therapy effectiveness
• Accelerate cognitive decline

Correcting or accommodating sensory loss amplifies all other interventions.

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Patient Tip

Ask: “Are my vision or hearing affecting my safety or progress?”

Putting It All Together: IC‑Driven Therapy Planning

Traditional Model

• Diagnosis → generic therapy

IC‑Based Model

• Capacity decline → targeted intervention
• Multiple domains addressed simultaneously
• Faster functional gains with fewer complications

Example: Two Patients, Same Diagnosis

Both have knee osteoarthritis.

Patient A	Patient B
Strong, good balance	Weak, fearful of falling
High vitality	Low vitality
No cognitive issues	Mild executive decline

➡️ Same diagnosis, completely different therapy plans—because IC differs.

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Key Takeaways

• IC tells clinicians where to intervene, not just what you have
• Exercise is medicine—but only when matched to the right capacity
• Early IC‑guided therapy prevents downstream disability
• Patients who understand IC ask better questions and get better care

Bottom Line (Why This Matters to You)

The WHO’s intrinsic capacity framework reframes aging as a dynamic, modifiable process, not an inevitable decline. By focusing on strength, cognition, vitality, mood, and sensory health—before disability occurs—it empowers individuals and clinicians to act earlier, more precisely, and more humanely.

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