Preserving intrinsic capacity in midlife women: A mixed-methods study of a personalized multicomponent intervention aligned with the WHO ICOPE framework

BACKGROUND: Intrinsic capacity (IC) preservation during midlife represents a critical yet overlooked opportunity for preventing age-related functional decline. We developed WomenWellness, a 12-week personalized multicomponent intervention aligned with the WHO Integrated Care for Older People (ICOPE) framework, and evaluated its effectiveness and scalability potential. METHODS: In a multicentre randomized controlled trial conducted in Hong Kong, we enrolled 176 women with ≥1 IC domain impairment, randomizing them to WomenWellness (n = 117) or to a control group that received a health kit containing educational materials and lifestyle tips (n = 59). The intervention integrated personalized care, multimodal exercise, and cognitive-psychosocial activities. Outcomes included IC composite scores (range 0-6, higher = worse), domain-specific impairments, anthropometrics, physical and cognitive performance, urinary incontinence prevalence, and pain severity, analysed using generalized linear mixed models adjusted for age, education, and medication use. A parallel qualitative evaluation involved 14 focus groups (8 participant groups, 6 service provider groups) exploring intervention acceptability, feasibility, and scalability through thematic analysis. RESULTS: Participants (mean age 61.5 ± 3.6 years) receiving WomenWellness showed significantly greater reductions in IC composite scores than controls (β = 0.39, 95 % CI = 0.03-0.75, p = .032), with domain-specific benefits including reduced chair stand times (β = 1.57, 95 % CI = 0.51-2.63, p = .004), ASMI preservation (β = -0.32, 95 % CI = -0.60--0.04, p = .027), cardiorespiratory fitness gains (β = -11.47, 95 % CI = -16.89--6.04, p < .001), lower malnutrition risk (OR = 0.26, 95 % CI = 0.08-0.84, p = .025), and reduced visual impairment (OR = 0.28, 95 % CI = 0.12-0.65, p = .003). Qualitative findings revealed high acceptability, with participants valuing the integrated approach and service providers emphasizing its adaptability to community settings. CONCLUSION: WomenWellness effectively enhanced IC in midlife women, demonstrating high acceptability, feasibility, and adaptive fidelity, thereby supporting the integration of such programs into routine midlife healthcare services.