According to the World Health Statistics 2022 raised by the World Health Organization (WHO),1 from 2000 to 2019, healthy life expectancy (HALE) and life expectancy at birth increased from 63.7 to 68.5 and 71.6 to 77.4 years in China, respectively. Increasing HALE, reducing disability, and the burden of care are current strategies for coping with global aging. Survival with chronic diseases is common in older adults. In China, 76.3% of adults aged ≥60 years have one or more diseases2, and a disease-centered care model approach among older adults has been used for a long time. Comorbidity increases the risk of hospitalization, disability, and death among older adults.3 However, with an increased life expectancy, the disease-centered fragmented medical care model can no longer keep pace with a global aging trend. The integrated care model, with the core of intrinsic capacity (IC) proposed by the WHO, may improve the quality of life in older age4.

In 2015, the WHO4 proposed a definition for "healthy aging”, indicating that healthy aging does not imply living a disease-free life, but maintaining functional abilities that enable well-being in later life, which is determined by IC, relevant environmental characteristics, and the interactions between them. In 2019, the WHO published “guidance on person-centered assessment and Integrated Care for Older People (ICOPE) pathways in primary care”,5 which proposed the assessment methods to evaluate IC, in order to provide individualized intervention care for those with IC decline. In recent years, studies in both hospitalized6 and community-dwelling7, 8 older adults have demonstrated the effect of IC decline on adverse health outcomes in China. However, only one study6 in the hospitalized older population found that a better IC status was associated with reduced 1-year mortality. There are few studies on the predictive value of IC for mortality among the community-dwelling older adults in China. Moreover, the assessment methods for each IC dimension differed among those studies. Few studies used the standard IC assessment methods proposed by the WHO. In terms of the care model of older adults, the community health service in China has always focused on community doctors' management of diseases, rather than care managers' maintenance of functional status in older adults. Zhao et al9 found that the impairment in IC domains had higher odds of disability than comorbidity. Whether IC would be better than comorbidity in predicting all-cause mortality and falls among the community-dwelling older adults in China remains to be confirmed. This will provide foundation for the transformation of the care model of community-dwelling older adults.

Functional abilities can also be greatly influenced by support systems, including families, communities, and health care. In community-dwelling older adults with stable chronic diseases, which should one be more concerned about in terms of health care goals, functional status, or diseases? This study, conducted in an age-friendly community with a relatively uniform external environment, aimed to compare the predictive value of comorbidity and IC on adverse health outcomes including all-cause mortality and falls in older adults based on the standard IC assessment proposed by the WHO. We hypothesized that IC may have better predictive value for adverse health outcomes than comorbidity.