Associations of Healthy Lifestyle With All-Cause and Cardiovascular Disease Mortality in Individuals With Cardiovascular-Kidney-Metabolic Syndrome: Two Prospective Cohort Studies.

As life expectancy increases across the globe, the priority for public health initiatives has shifted from merely extending lifespan to optimizing the quality of life [,]. Activities of daily living (ADL) are the most common tool to assess functional abilities, being stratified according to complexity level as basic, instrumental, and advanced []. The basic activities of daily living (BADL) encompass fundamental self-care tasks such as bathing, dressing, and eating. The instrumental activities of daily living (IADL) involve tasks necessary for community dwelling including managing finances, cooking, and using transportation. The advanced ADL represent the highest level of functioning and reflect the ability of an individual to fulfill self-actualization and social roles, including care taking, legal planning, or online shopping []. The maintenance of high ADL levels is closely linked to an older person’s intrinsic capacity []. In response to the global need for person-centered health strategies, the World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) framework []. The ICOPE strategy focuses on the early identification of declines in intrinsic capacity domains, while crucially maintaining the functional performance (BADL and IADL) through individualized and coordinated care []. Complementing this perspective, the Fundamental Cause Theory posits that socioeconomic position and social support serve as primary drivers of health disparities because individuals with greater access to “flexible resources”, such as knowledge, financial means, and social networks, are better positioned to avoid risks and mitigate the consequences of disease []. Consequently, the relationship between intrinsic capacity and functional outcomes is shaped by environmental and structural conditions, which vary distinctively across populations as a result of socioeconomic inequalities, access to healthcare, and disparities in community resources []. Altogether, understanding how functional status manifests in different geopolitical contexts permits adapting and implementing the ICOPE framework effectively and equitably [,]. Brazil and Europe represent compelling contexts for examining BADL and IADL limitations among older adults, underscoring the need for context-specific approaches to implementing the ICOPE framework in these two distinct regions. European countries, characterized by advanced population aging, generally have more established long-term care infrastructures and social protection systems that support functional performance in later life []. In contrast, Brazil is undergoing one of the fastest demographic transitions worldwide, marked by profound socioeconomic inequalities, heterogeneous regional health profiles, and an urgent demand for integrated geriatric care strategies capable of addressing these disparities []. This study aimed to analyze the independent associations of BADL and IADL limitations among older adults in Brazil and Europe within the WHO ICOPE framework.