The World Health Organization has proposed a model of healthy aging built around the concept of functional ability, comprising an individual’s intrinsic capacity, the physical and social environment they occupy, and interactions between the two. However, these constructs have been poorly defined. We examined the structure of intrinsic capacity in a representative sample of the Chinese population aged 60 years and older and assessed its value in predicting declining performance in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) using similar methods to a construct validation previously undertaken in an English cohort. Deidentified data were accessed on 7 643 participants of the China Health and Retirement Longitudinal Study 2011 and 2013 waves. Incrementally related structural equation modeling was applied, including exploratory and confirmatory factor analysis, and path analysis. Multiple linear regression tested construct validity, and simple and serial mediation models assessed predictive validity. Factor loadings for the models showed a clear structure for intrinsic capacity: 1 general factor with 5 subfactors—locomotor, cognitive, psychological and sensory capacities, and vitality (reflecting underlying physiologic changes). Intrinsic capacity predicted declining performance in both IADLs (standardized coefficient (SE) −0.324 (0.02), p < .001) and ADLs (−0.227 (0.03), p < .001), after accounting for age, sex, education, wealth, and number of chronic diseases. Each characteristic was associated with intrinsic capacity, providing strong construct validity. Assessment of intrinsic capacity provides valuable information on an individual’s subsequent functioning beyond that afforded by age, other personal factors, and multimorbidity.

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study of Ageing and the China Health and Retirement Longitudinal Study. Applying multilevel growth curve models, we found that more recent cohorts entered older ages with higher levels of capacity, while subsequent age-related declines were somewhat compressed compared to earlier cohorts. Trends were most evident for the cognitive, locomotor and vitality capacities. Improvements were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old participant of the English Longitudinal Study of Ageing born in 1950 had higher capacity than a 62-year-old born 10 years earlier. Trends were similar for men and women and were generally consistent across English and Chinese cohorts. Possible causes include broad societal influences and improvements in medical care.

Importance: Intrinsic capacity (IC) is a core component of the World Health Organization’s healthy aging framework. Yet, despite multiple validations of IC across various settings, there is still a lack of longitudinal cross-national analysis.Objective: To validate the IC construct, describe variance between key demographic groups, and create population centile curves across 15 countries using data from the Survey of Health, Aging, and Retirement in Europe (SHARE).Design, Setting, and Participants: In this population-based multicenter cohort study, data from SHARE wave 5 (January to November 30, 2013) were analyzed, and subsequent care dependence in wave 6 (January to November 30, 2015) was determined. Adults 50 years and older from SHARE wave 5 with at least 1 available measure and follow-up data in SHARE wave 6 were included. Data analyses were conducted between December 11, 2022, and June 7, 2024.Exposure: SHARE waves 5 and 6.Main Outcomes and Measures: Changes in activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods included structural equation modeling, bifactor analysis, and path analysis. Construct validity was tested through multiple linear regression and validity of estimates through mediation analysis. Centile curves were established using the generalized additive models for location, scale, and shape.Results: The sample included 64 872 eligible participants aged 50 to 104 years, with a mean (SD) age of 67.24 (10.01) years, of whom 35 976 (55.46%) were women. The bifactor confirmatory factor analysis model achieved good fit (comparative fit index, 0.986; Tucker-Lewis index, 0.981), suggesting an IC structure consisting of 1 general factor and 5 subdomains. Mediation analysis indicated that IC was associated with subsequent declining performance in ADL (standard coefficient [SD], −0.213 [0.002]; P < .001) and IADL (standard coefficient [SD], −0.209 [0.002]; P < .001) after adjusting for age, gender, educational attainment, socioeconomic status, and country. Socioeconomic status was associated with IC both within and between countries. Centile curves for IC by gender and country (5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles) were constructed.Conclusions and Relevance: Results of this cohort study of older adults suggest that IC was a valid and reliable measure that effectively captured individual-level aspects of functional ability. The centile curves developed during the study suggest that IC has the potential to serve as a benchmark for health status in older populations.

The life annuity business is heavily exposed to longevity risk. Risk transfer solutions are not yet fully developed, and when available they are expensive. A significant part of the risk must therefore be retained by the life insurer. So far, most of the research work on longevity risk has been mainly concerned with capital requirements and specific risk transfer solutions. However, the impact of longevity risk on shareholder value also deserves attention. While it is commonly accepted that a market-consistent valuation should be performed in this respect, the definition of a fair shareholder value for a life insurance business is not trivial. In this paper, we develop a multi-period market-consistent shareholder value model for a life annuity business. The model allows for systematic and idiosyncratic longevity risk and includes the most significant variables affecting shareholder value: the cost of capital (which in a market-consistent setting must be quantified in terms of frictional and agency costs, net of the value of the limited liability put option), policyholder demand elasticity and the cost of alternative longevity risk management solutions, namely indemnity-based and index-based solutions. We show how the model can be used for assessing the impact of different longevity risk management strategies on life insurer shareholder value and solvency.