Profiling functional ability to predict primary health care needs among community-dwelling older adults: a latent class analysis

With rapid population ageing and increasing multimorbidity, understanding how functional ability shapes access to care has become a public health priority. This study aimed to identify functional ability profiles among community-dwelling older adults by integrating assessments of intrinsic capacity (IC) and adaptive capacity, and to examine their associations with perceived service needs and reported service availability of primary health care (PHC) services. A convenience sample of older adults was recruited from two districts in Shanghai between July and October 2023. Demographic characteristics, intrinsic capacity, adaptive capacity, perceived service needs, and reported PHC service availability were assessed. Latent class analysis was performed to identify functional ability profiles. Group differences were examined using chi-square tests and logistic regression models. Among 220 participants, two functional profiles were identified: Class 1 (42.7%), characterized by relatively preserved cognitive, vitality, and psychological function with higher adaptive capacity, and Class 2 (57.3%), characterized by greater cognitive, vitality, and psychological impairment with lower adaptive capacity. Functional ability profile was significantly associated with perceived service needs but not with reported service availability. After adjustment, higher educational attainment, professional occupation, widowhood, a history of myocardial infarction or dementia, and unhealthy lifestyle behaviors were associated with membership in Class 2. Integrating IC and adaptive capacity enabled the identification of distinct functional ability profiles and reveals discrepancies between perceived service needs and reported service availability in urban settings. Assessing adaptive capacity alongside intrinsic capacity may help identify older adults with differing functional vulnerabilities and inform further research on targeted community-based services, including proactive outreach for people with greater cognitive, vitality, and psychological impairment with lower adaptive capacity and education-sensitive care planning, thereby supporting equitable delivery of primary health care. Not applicable.