世界衛生組織推廣健康老化概念，並發展長者功能評估量表(Integrated Care for Older People, ICOPE)評估內在能力，以篩檢有健康風險的高齡者並即早介入。國民健康署於2020年執行「預防及延緩失能之長者功能評估服務試辦計畫」，於醫療院所施行ICOPE量表。然目前ICOPE量表本土化之信效度仍待驗證。本研究探討ICOPE量表的信效度，以及慢性疾病與內在能力的關聯。研究問題有：(1)檢測ICOPE量表於高齡門診病人之信效度；(2)內在能力與衰弱、失能的相關，及應用ICOPE量表於評估高齡者衰弱、失能之切分點；以及(3)不同慢性疾病與內在能力的相關。
研究設計為橫斷式回溯性研究。第一階段為問卷信效度檢驗及衰弱、失能之切分點分析，研究參與者為南部某醫院高齡醫學門診就診病人(n = 448)，經醫師評估病情需要，同時進行ICOPE量表與周全性老年評估(Comprehensive Geriatric Assessment, CGA)。使用ICOPE量表題目對應之CGA量表進行效標關聯效度，並進行再測信度驗證；以ROC曲線評估內在能力對衰弱、失能的預測及最佳切分點。第二階段為探究慢性疾病與內在能力的相關，研究參與者為南部某醫院醫療群相關診所就醫的高齡病人(n = 1181)，進行ICOPE量表評估與慢性疾病資料收集。利用邏輯斯迴歸，評估慢性疾病與內在能力異常之間的關係。
信效度部分，再測信度以營養(Kappa = 0.77)及用藥(Kappa = 1.00)較高。效標關聯效度七種能力與效標皆有顯著相關，以行動(Ф = 0.72)及聽力(Ф = 0.72)較高；而認知(97.33%)、行動(92.34%)、聽力(88.07%)的敏感度較高。營養(88.89%)、視力(97.93%)、聽力(87.80%)的特異度較高。切分點部分，以臨床衰弱量表(Clinical Frailty Scale, CFS)為黃金標準時，內在能力異常總數的AUC值(Area Under the Curve)為0.80(p < 0.001)，最佳切分點是3/4；以日常生活功能(Activity of Daily Living, ADL)為黃金標準時，內在能力異常總數的AUC值為0.81(p < 0.001)，最佳切分點是2/3。慢性疾病與內在能力的相關，認知能力障礙的顯著變項有高血壓(Exp(B) = 1.57, p = 0.006)、糖尿病(Exp(B) = 1.46, p = 0.034)、心臟病(Exp(B) = 1.62, p = 0.016)、腦中風(Exp(B) = 2.65, p = 0.008)；行動能力障礙的顯著變項有高血壓(Exp(B) = 2.33, p < 0.001)、糖尿病(Exp(B) = 2.55, p < 0.001)、腦中風(Exp(B) = 2.90, p = 0.007)、慢性腎臟病(Exp(B) = 1.67, p = 0.042)；營養不良的顯著變項有高血壓(Exp(B) = 1.71, p = 0.004)、糖尿病(Exp(B) = 1.66, p = 0.008)、腦中風(Exp(B) = 2.20, p = 0.045)；聽力障礙的顯著變項有高血脂(Exp(B) = 0.55, p = 0.009)、心臟病(Exp(B) = 1.54, p = 0.037)；憂鬱的顯著變項有高血壓(Exp(B) = 1.62, p = 0.005)、糖尿病(Exp(B) = 1.43, p = 0.045)；多重用藥的顯著變項有高血壓(Exp(B) = 1.43, p = 0.019)、糖尿病(Exp(B) = 1.51, p = 0.011)、慢性腎臟病(Exp(B) = 1.81, p = 0.005)。
本研究顯示，ICOPE量表內在能力以營養、聽力、用藥的信效度較佳。切分點部分，內在能力有三項及以上異常，高齡者有高機率發生衰弱或失能。罹患高血壓與糖尿病時，需注意特定內在能力異常的問題。整體而言，ICOPE量表操作簡單，具預測衰弱及失能的能力，同時與多項慢性疾病有顯著相關，可做為臨床篩檢的工具，以提升臨床照護品質。

The Health Promotion Administration in Taiwan extensively uses the Integrated Care for Older People (ICOPE) screening tool in hospitals and communities, but its reliability and validity in Taiwan need to be evaluated. This study aims to investigate the reliability and validity of the ICOPE scale, determine its cut-off points for frailty and disability, and examine the associations between intrinsic capacity and chronic diseases. The research design employed a cross-sectional study, which was conducted in a hospital and local medical clinics in Southern Taiwan. In the first part, the criterion-related validity was tested by comparing the ratings of the ICOPE scale with the Comprehensive Geriatric Assessment (CGA), and the test-retest reliability was tested. The ROC curve was used to identify the cut-off points of the ICOPE scale for frailty and disability. In the second part, logistic regression was used to explore the correlations between intrinsic capacity and chronic diseases. In terms of reliability and validity, nutrition (Kappa = 0.77) and medication (Kappa = 1.00) had good reliability; mobility (Ф = 0.72) and hearing (Ф = 0.72) exhibited good correlation coefficients for validity. For frailty, the best cut-off point was 3/4; and the best cut-off point for disability was 2/3. Logistic regression showed that chronic diseases were significantly associated with intrinsic capacity. The ICOPE scale which has predictive abilities is useful for clinical screening, improving care quality for older adults with chronic diseases.

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