以高齡者為中心的整合照護模式

Integrated Care for Older People, ICOPE

我國即將於2025年邁入超高齡社會，對健康照護產業造成極大的挑戰，台灣民眾雖然長壽，但晚年時需歷經約8年以上的失能與依賴，主因為目前以疾病為導向的醫療服務，無法符合高齡者需以功能最佳化維持獨立之需求。因此世界衛生組織2015年起提出健康老化的概念，而後具體以維持高齡者內在能力與功能性能力的整合照護模式，作為面對世界人口快速高齡化，公共衛生促進健康老化之行動架構。衛生福利部國民健康署則在2020年10月起推出「預防及延緩失能之長者功能評估服務試辦計畫」，設計「長者健康整合式功能評估量表」，針對高齡者認知功能、行動力、營養、聽力、視力、憂鬱情形等內在能力進行篩檢，2022年更推出長者功能自評量表，並完善後續的衛教與轉介服務，以幫助高齡者維持內在能力。未來仍需持續努力，由整合醫療服務系統、建置長期照護服務，以及建構支持性環境，幫助內在能力下降之高齡者能維持功能性能力，才能達到高齡者健康老化的目標。

The percentage of people aged 65 years and older is estimated to exceed 20% of the total population in Taiwan in 2025, making Taiwan a ''super-aged'' society with unique healthcare challenges. Older people in Taiwan have increased life expectancy but tend to be disabled and dependent in the last eight years of their life. This is likely because our healthcare services are designed to cure acute diseases, which detracts from helping older people receive the help they need to improve their functioning irrespective of the multitude of health disorders they might have. In framing a public health response to population ageing, the World Health Organization (WHO) released the first World report on ageing and health. The report is built around a redefinition of healthy ageing that focuses on the concepts of intrinsic capacity and functional ability. WHO also issued guidelines on Integrated Care for Older People (ICOPE) to provide recommendations for community-level interventions. Using a questionnaire revised from the WHO ICOPE screening tool, the Health Promotion Administration (HPA) of Taiwan’s Ministry of Health and Welfare launched a pilot program in October, 2020, to screen for cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms among older adults. In 2022, the HPA launched a self-assessment scale for older adults to improve their follow-up education and referral services and help maintain intrinsic capacity. To achieve the goal of healthy ageing, health systems should be aligned to the needs of older populations, ensure long-term care services, and provide individuals with the opportunity to grow old in an age-friendly environment in the future.