Heterogeneity of intrinsic capacity and associations with adverse health outcomes in China: a large community-based cross-sectional study

WHO’s intrinsic capacity (I C) construct shifts ageing focus from diseases to functional ability. We aimed to identify IC latent profiles among Chinese community-dwelling older adults and examine associations with health outcomes. This cross-sectional study was conducted among community-dwelling adults aged 60 years and older in China. IC was operationalized across five domains: locomotion, cognition, psychological capacity, vitality, and sensory function. Latent profile analysis identified IC phenotypes. Multinomial logistic and regression models assessed sociodemographic correlates and associations with falls, ADL disability, and quality-of-life. Up to June 30, 2025, a total of 9,356 older adults were recruited, of whom 7,151 with complete intrinsic capacity data were included in the analysis. Four profiles were identified: Robust (20.7%), Discordant capacity (8.9%; physical impairment but preserved mental capacities), Intermediate capacity (47.4%), and Global Impairment (23.0%). Compared with the Robust group, the Global Impairment group exhibited the highest odds of ADL disability (OR = 26.53, 95% CI: 17.24–40.83). Notably, although the Discordant Capacity group had a substantially elevated odds of ADL disability (OR = 10.26, 95% CI: 6.37–16.53), it displayed significantly lower odds of reporting a fall during the previous 12 months compared with the Robust group (OR = 0.44, 95% CI: 0.30–0.63). This profile was also characterized by older age, higher education/income, and non-agricultural occupations. However, this fall-related association was substantially attenuated after physical activity was excluded from the vitality domain. IC decline is heterogeneous. The Discordant Capacity group had lower fall risk, possibly due to cognitive preservation or reduced exposure, warranting cautious interpretation. These findings support shifting from “one-size-fits-all” to precision, profile-based ICOPE implementation to optimize functional ageing in rapidly ageing populations.