{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:57:02Z","timestamp":1790657822784,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older adults in real\u2010world Chinese integrative\u2010care settings often present with uneven patterns of functional limitation, cognitive impairment, and clinical vulnerability. Whether routinely collected geriatric and Traditional Chinese Medicine (TCM) constitution records can be organized into clinically interpretable profiles remains insufficiently described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional analysis of 402 adults aged 60\u2009years or older assessed during 2024\u20132025 in three Shanghai institutions: a hospital TCM department, a nursing home, and an elderly care center. Of 435 screened records, 33 (7.6%) were excluded due to missing data. Four routine continuous variables were analyzed: Barthel Index, education\u2010adjusted Montreal Cognitive Assessment (MoCA), a study\u2010specific tumor risk score, and a study\u2010specific infection risk score. Standardized variables were summarized by principal component analysis (PCA; PC1 and PC2, cumulative variance 70.8%) and K\u2010means clustering. TCM constitution and concurrent care disposition were examined as external descriptive variables and were not used to derive clusters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants had a mean age of 78.0\u2009\u00b1\u20099.6\u2009years; 206 (51.2%) were women. Among candidate solutions (\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20092\u20136), the gap statistic and silhouette coefficient both favored\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20092 (gap\u2009=\u20090.152, SE\u2009=\u20090.016; silhouette\u2009=\u20090.287), but a three\u2010profile solution (silhouette\u2009=\u20090.252; gap\u2009=\u20090.118, SE\u2009=\u20090.019) was retained as an exploratory descriptive summary based on prespecified clinical interpretability criteria. The three profiles were:\n                      <jats:italic>Functionally Preserved Profile<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009149, 37.1%; Barthel 76.9\u2009\u00b1\u200914.8, MoCA 18.2\u2009\u00b1\u20093.9, tumor risk 9.6\u2009\u00b1\u20094.5, infection risk 25.0\u2009\u00b1\u200911.8),\n                      <jats:italic>Cognitive\u2010Functional Vulnerability with Low Tumor\u2010Risk Profile<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009101, 25.1%; Barthel 47.0\u2009\u00b1\u200918.2, MoCA 12.0\u2009\u00b1\u20094.6, tumor risk 4.9\u2009\u00b1\u20093.1, infection risk 34.3\u2009\u00b1\u200913.5), and\n                      <jats:italic>Multidomain High\u2010Risk Profile<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009152, 37.8%; Barthel 37.8\u2009\u00b1\u200919.8, MoCA 12.0\u2009\u00b1\u20095.1, tumor risk 15.2\u2009\u00b1\u20095.6, infection risk 46.8\u2009\u00b1\u200915.2). The Cognitive\u2010Functional Vulnerability profile had the lowest tumor risk score among the three profiles while its MoCA score was identical to that of the Multidomain High\u2010Risk Profile, confirming that the profiles represent distinct combinations of domain\u2010specific vulnerabilities rather than a single ordinal gradient. A preserved\u2010function\/impaired\u2010cognition subgroup was identified in 73 participants (18.2%). Among nine TCM constitution labels, Yang deficiency differed across profiles after Bonferroni correction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Routine multidimensional assessment data can describe clinically recognizable vulnerability profiles among older adults in Chinese integrative\u2010care settings. The three\u2010profile solution represents an exploratory descriptive summary rather than a statistically optimal classification (silhouette coefficient\u2009=\u20090.252, indicating weak cluster separation; gap statistic favored\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u20092). The most actionable observation was the functional\u2010cognitive dissociation subgroup, which may be missed if function alone is assessed. TCM constitution contributed descriptive context but did not independently define the profiles. These findings require external, prospective validation before clinical deployment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70856","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:21:19Z","timestamp":1790655679000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional Vulnerability Profiles Among Older Adults in Chinese Integrative\u2010Care Settings: A Cross\u2010Sectional Assessment of Function, Cognition, Clinical Risk, and\n                    <scp>TCM<\/scp>\n                    Constitution"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2299-4400","authenticated-orcid":false,"given":"Yizhou","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Traditional Chinese Medicine Shanghai Jiangong Hospital  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Shanghai Jiangong Hospital  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4521-8416","authenticated-orcid":false,"given":"Yiming","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Shanghai Jiangong Hospital  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization \u201cAgeing and Health \u201d updated October 1 2025 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/ageing\u2010and\u2010health."},{"key":"e_1_2_11_3_1","unstructured":"National Bureau of Statistics of China \u201cStatistical Communique of the People's Republic of China on the 2025 National Economic and Social Development \u201d 2026 https:\/\/www.stats.gov.cn\/zwfwck\/sjfb\/202602\/t20260228_1962662.html."},{"issue":"9836","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of Multimorbidity and Implications for Health Care, Research, and Medical Education: A Cross\u2010Sectional Study","volume":"380","author":"Barnett K.","year":"2012","journal-title":"Lancet"},{"issue":"5","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1111\/j.1532-5415.2007.01156.x","article-title":"Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept","volume":"55","author":"Inouye S. 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