A decade of difference: cross-continental patterns of functional performance in Brazil and Europe within the WHO ICOPE framework

Introduction: Global aging patterns are highly heterogeneous, especially in diverse socioeconomic contexts. Objective: We aimed to analyze the determinants of functional performance within the WHO’s Integrated Care for Older People (ICOPE) framework. Methods: Functional performance was evaluated using basic and instrumental activities of daily living (BADL/IADL) from ELSI-Brasil and SHARE cohorts. Sociodemographic characteristics and the clinical domains of intrinsic capacity (mobility, vitality, cognition, psychological, and sensory functions) were also assessed. Results: The final sample consisted of 4,825 participants from ELSI-Brasil and 25,978 from SHARE. Functional risks diverged significantly based on intrinsic capacity domains: i) mobility: handgrip strength was a stronger protective factor in Europe, while the walking speed was a unique BADL risk factor in Brazil (OR 1.16); ii) vitality: weight loss showed a significant BADL risk for Europeans (OR 1.18); iii) cognition: low self-perceived memory showed similar risk for IADL across both cohorts (SHARE OR 1.23 vs. ELSI-Brasil OR 1.22); iv) psychological: depression posed a higher independent risk in Europe (OR 1.67–1.71) than in Brazil (OR 1.26–1.53), while poor self-rated health reflected higher risk in the Brazilian context (BADL OR 2.72 vs. 2.07 in Europe); v) sensory function: hearing impairment was a stronger IADL risk in Brazil (OR 1.27), while vision was significant only in Europe (OR 1.32). Conclusions: Functional decline begins a decade earlier in Brazil than in Europe, reflecting socioeconomic disparities across intrinsic capacity domains. ICOPE strategies should be tailored to each societal context to promote equitable healthy aging.