Intrinsic capacity as a key determinant of cumulative nursing risk initiation and escalation: a cross-sectional study among hospitalized older adults.

OBJECTIVES: To identify determinants of cumulative nursing risk initiation and escalation among hospitalized older adults, focusing on the independent and interactive associations of intrinsic capacity (IC) domains. METHODS: A cross-sectional study was conducted among 470 inpatients aged ≥60 years from a tertiary hospital in China using convenience sampling. IC and five nursing risk conditions, including falls, pressure injuries, aspiration, deep vein thrombosis, and unplanned tube removal, were assessed. Binary logistic regression was used to identify factors associated with nursing risk initiation, and ordinal logistic regression was used to examine determinants of nursing risk escalation. RESULTS: A total of 459 older inpatients were included in the final analysis, of whom 73.2% had ≥1 nursing risk. Overall IC impairment was independently associated with both risk initiation (OR = 16.801, 95% CI: 5.710-49.436) and escalation (OR = 12.154, 95% CI: 5.906-25.012). Cognitive and mobility impairments showed the strongest domain-specific associations with escalation. The strongest interaction was observed for concurrent cognitive and mobility impairments (OR = 19.594, 95% CI: 8.207-46.783). CONCLUSION: IC impairment was associated with cumulative nursing risk among hospitalized older adults. Routine IC screening should be integrated into geriatric nursing assessment to support early identification of high-risk patients, while interventions targeting combined cognitive and mobility impairments, pain, and polypharmacy may help prevent cumulative nursing risk escalation.