內在能力對高齡者心理安適、社會參與、健康行為之影響

背景：全球人口老化趨勢加劇，65歲及以上人口比例預計將從2022年的10%上升至2050年的16%，帶來前所未有的社會經濟挑戰。而世界衛生組織提出之內在能力（Intrinsic Capacity，IC）概念為健康老化政策提供新的評估框架。目的： 本研究旨在探討台灣高齡者內在能力與心理安適、社會參與及健康行為之關聯性，並分析社會、經濟、疾病等人口學變項對此關聯之影響及調節作用。評估多項內在能力指標於整體老年心理健康、社會參與和健康促進的預測能力與影響。 方法：採用民國108年臺灣地區中老年身心社會生活狀況長期追蹤調查（2019 Taiwan Longitudinal Study on Aging Survey Report，TLSA）資料，排除不適用個案樣本資料，共納入4,922名50歲以上參與者。依據WHO框架，將內在能力分為行動能力、感官能力（視力、聽力）、生命力、認知能力及心理能力五大領域（六個面向）。依變項包括心理安適（幸福感、寂寞感）、社會參與（社會活動、宗教信仰）及健康行為（自我健康行為、自覺健康）。採用描述性統計、卡方檢定及多元邏輯斯回歸分析，並進行性別、年齡、婚姻狀況、教育程度、居住狀況、居住地、經濟狀況分層分析。結果：本研究發現內在能力與高齡者多重健康面向存在顯著關聯，且IC障礙顯著影響心理安適，IC障礙愈多，主觀幸福感越低，寂寞感及心理困擾發生率顯著上升。多元邏輯斯回歸分析顯示，相較於無IC障礙者，嚴重多重IC障礙者出現低幸福感的風險增加約13倍（OR=13.044，95% CI：9.15–18.60，p<0.001），且IC障礙愈多，感受到低幸福感的風險亦顯著上升。高寂寞感風險則增加約22倍（OR=22.032，95% CI：11.85–40.97，p<0.001）；中度寂寞感風險則增加約3.28倍（OR=3.281，95% CI：2.33-4.62，p<0.001）。不論高、中度寂寞感皆與內在能力顯著相關，且皆隨著IC障礙程度愈多，發生寂寞感風險皆亦顯著上升。內在能力同時影響社會參與程度，根據多元邏輯斯回歸分析顯示，相較於無IC障礙者，嚴重多重IC障礙者參與社會活動之可能性約僅剩40%（OR=0.409，95% CI：0.29-0.58，p<0.001），而宗教活動參與亦具相同顯著影響，顯現出良好的內在能力是維持社會參與的重要基礎。健康行為方面，相較於無任何IC障礙者，嚴重多重IC障礙者的吸菸風險高達兩倍（OR=2.044，95% CI：1.33-3.13，p=0.001），且隨著IC障礙的累積，吸菸行為的風險亦顯著上升；飲酒行為呈現有飲酒習慣的高齡者其IC障礙比例較低，且隨著IC障礙增加，高齡者的飲酒機率呈現下降趨勢；運動展現出最強的保護效果，規律運動者在所有內在能力面向的障礙比例明顯低於無運動習慣者，且相較於無任何IC障礙者，嚴重多重IC障礙者的運動機率下降至30%（OR=0.302，95% CI：0.22-0.41，p<0.001），顯示IC障礙會限制運動行為，且隨著IC障礙累積增加，養成運動習慣的可能性越低；自覺健康狀況則顯示相較於無任何IC障礙者，嚴重多重IC障礙者自覺健康不佳的風險約為19倍（OR=18.956，95% CI：12.76-28.16，p<0.001），自覺健康狀況視為最重要預測指標。結論：內在能力與台灣高齡者心理安適、社會參與和健康行為間存在複雜且密切的相互關聯。IC障礙顯著增加高齡者心理困擾風險，形成負向循環機制；而良好的內在能力則促進社會參與，進而對心理健康產生保護效果；而良好的健康行為與意識，是維持內在能力的重要策略。本研究結果為建構以內在能力為核心的健康老化政策提供重要實證基礎，發展多面向的整合介入策略，從早期預防到長期照護，全面提升台灣高齡者的健康與福祉。註：1.衛生福利部國民健康署委託辦理，報告內容不代表衛生福利部國民健康署意見。2.科技計畫編號：MOHW113-HPA-H-114404。

Background：The global trend of population aging is intensifying, with the proportion of people aged 65 and above expected to increase from 10% in 2022 to 16% by 2050. This shift poses unprecedented socio-economic challenges. The concept of Intrinsic Capacity (IC) proposed by the World Health Organization provides a new assessment framework for healthy aging policies.Objectives：This study aims to explore the associations between intrinsic capacity and psychological well-being, social participation, and health behaviors among older adults in Taiwan. It further examines the influence and moderating effects of sociodemographic variables such as social, economic, and disease status on these associations. The study also evaluates the predictive power and impact of various IC indicators on overall mental health, social participation, and health promotion in the elderly.Methods：Data were obtained from the 2019 Taiwan Longitudinal Study on Aging Survey Report (TLSA), with ineligible cases excluded, resulting in a total of 4,922 participants aged 50 and above. Based on the WHO framework, intrinsic capacity was divided into five domains (six aspects): locomotor capacity, sensory capacity (vision and hearing), vitality, cognitive capacity, and psychological capacity. Dependent variables included psychological well-being (well-being and loneliness), social participation (social activities and religious involvement), and health behaviors (self-health behaviors and self-rated health). Descriptive statistics, chi-square tests, and multiple logistic regression analyses were performed, with stratified analyses by gender, age, marital status, education level, living arrangement, residence, and economic status.Results：The study found significant associations between intrinsic capacity and multiple health aspects among older adults. IC impairment significantly affected psychological well-being. The greater the number of IC impairments, the lower the subjective well-being and the higher the prevalence of loneliness and psychological distress. Multiple logistic regression analyses showed that, compared to those without IC impairment, individuals with severe multiple IC impairments had a 13-fold increased risk of low well-being (OR=13.044, 95% CI: 9.15–18.60, p<0.001), and the risk of low well-being increased significantly with the number of IC impairments. The risk of high loneliness increased by about 22 times (OR=22.032, 95% CI: 11.85–40.97, p<0.001), while the risk of moderate loneliness increased by about 3.28 times (OR=3.281, 95% CI: 2.33–4.62, p<0.001). Both high and moderate loneliness were significantly associated with intrinsic capacity, and the risk increased with the severity of IC impairment.Intrinsic capacity also influenced the level of social participation. Multiple logistic regression analyses showed that, compared to those without IC impairment, individuals with severe multiple IC impairments were only about 40% as likely to participate in social activities (OR=0.409, 95% CI: 0.29–0.58, p<0.001). Religious participation was similarly affected, indicating that good intrinsic capacity is an important foundation for maintaining social participation.In terms of health behaviors, those with severe multiple IC impairments had twice the risk of smoking compared to those without any IC impairment (OR=2.044, 95% CI: 1.33–3.13, p=0.001), and the risk of smoking increased significantly with the accumulation of IC impairments. For alcohol consumption, older adults with drinking habits had a lower proportion of IC impairments, and the likelihood of drinking decreased as IC impairments increased. Regular exercise showed the strongest protective effect. Those who exercised regularly had significantly lower rates of IC impairment across all domains. Compared to those without any IC impairment, individuals with severe multiple IC impairments had only a 30% likelihood of exercising (OR=0.302, 95% CI: 0.22–0.41, p<0.001). This finding indicates that IC impairment limits exercise behavior, and the likelihood of developing an exercise habit decreases as IC impairment accumulates. Regarding self-rated health, those with severe multiple IC impairments had about a 19-fold increased risk of poor self-rated health compared to those without any IC impairment (OR=18.956, 95% CI: 12.76–28.16, p<0.001), making self-rated health the most important predictive indicator.Conclusion：There are complex and close interrelationships between intrinsic capacity and psychological well-being, social participation, and health behaviors among older adults in Taiwan. IC impairment significantly increases the risk of psychological distress, creating a negative cycle. Conversely, good intrinsic capacity promotes social participation, which in turn protects mental health. Good health behaviors and awareness are key strategies for maintaining intrinsic capacity. The findings provide important empirical evidence for developing healthy aging policies centered on intrinsic capacity and support the development of multi-faceted integrated interventions, ranging from early prevention to long-term care, to comprehensively enhance the health and well-being of Taiwan’s elderly population.Notes：1.This project was commissioned by the Health Promotion Administration, Ministry of Health and Welfare. The content of this report does not represent the opinions of the Health Promotion Administration.2.Project Number: MOHW113-HPA-H-114404.