埔里地區社區老年人內在能力受損的分群分析

Profiling Intrinsic Capacity Decline in Community-Dwelling Older Adults: A Cluster Analysis in Puli, Taiwan

研究背景：高齡化社會下，維持老年人功能是重要課題。世界衛生組織(World Health Organization, WHO)提出「健康老化」理念，強調內在能力(Intrinsic Capacity, IC)的重要性。本研究採用WHO整合性照護老年人模式(Integrated Care for Older People, ICOPE)，分析臺灣南投縣埔里地區社區長者內在能力受損分群特徵，作為精準照護基礎。

方法：本研究為橫斷性研究，2023至2024年間在埔里招募1,367位65歲以上長者，進行ICOPE六大內在能力篩檢，對篩檢異常者進行綜合評估並收集人口與共病資料。採K-均值結合階層式分群分析，探討不同能力受損組合，並以卡方檢定比較各群組特徵。

結果：研究共辨識出8種分群類型：功能完整型(n=232, 17.0%)、視力型－代謝共病(n=202, 14.8%)、多重受損型A (n=216, 15.8%)、多重受損型B (n=180, 13.2%)、認知型－心血管共病(n=174, 12.7%)、感官型－多病共存(n=159, 11.6%)、高度虛弱型(n=109, 8.0%)、極重度虛弱型(n=95, 6.9%)。第1群功能正常，慢病比例最低。第2群以視力受損為主，糖尿病與高血壓比例較高。第3、4群屬多重受損型，常見行動力下降、營養不良與憂鬱，第4群另有視力缺損與認知退化。第5群以認知衰退為主，常伴心血管疾病。第6群視聽障礙與多病共存明顯。第7、8群功能衰退最嚴重，屬高度虛弱族群。結果呈現年齡與健康狀態梯度，第1、5群年齡較低，第3、4群年齡較高且多重受損，第7、8群最年長且衰弱最顯著，多重受損群慢病比例偏高。

結論：本研究辨識出8種內在能力受損模式，顯示社區長者功能與健康狀態具異質性。依分群特徵提供客製化照護，有助落實以人為本整合照護。單一缺損者應強化預防，多重缺損與高度虛弱者則需密集跨專業介入，以延緩衰退、促進健康老化。

Background: Amid global population aging, maintaining functional ability in older adults is a key public health challenge. The World Health Organization (WHO) emphasizes “healthy aging” and the role of intrinsic capacity (IC)—including cognition, mobility, vitality, vision, hearing, and mood—in supporting quality of life with declines in IC linked to frailty and disability. This study applies the WHO Integrated Care for Older People (ICOPE) framework to analyze IC impairment clusters among community-dwelling older adults in Puli, Taiwan.

Methods: This cross-sectional study recruited 1,367 adults aged ≥65 years in Puli between 2023 and 2024. IC was screened using the ICOPE tool. Participants with IC impairments underwent comprehensive assessments, and demographic and comorbidity data were collected. K-means and hierarchical clustering were used to identify IC impairment patterns, and chi-square tests were used to examine differences across clusters.

Results: Eight IC impairment profiles were identified. Group 1 (robust) had minimal impairments and the lowest chronic disease burden. Group 2 had visual impairments with a higher prevalence of diabetes and hypertension. Groups 3 and 4 showed multiple impairments, with Group 4 also exhibiting cognitive decline. Group 5 showed cognitive decline alongside cardiometabolic disease. Group 6 had sensory impairments and multimorbidity. Groups 7 and 8 were the most frail, with impairments across all domains and the highest ages. Multimorbidity burden increased with the number of IC impairments.

Conclusion: Eight distinct IC profiles highlight heterogeneity among older adults. Group-specific strategies are needed—ranging from preventive care for single impairments to multidisciplinary approaches for the frailest—to promote healthy aging.