背景與研究目的: 隨著全球人口以驚人的速度高齡化，維持老年人的功能已成為醫療照護中的首要目標。內在能力（Intrinsic Capacity, IC）涵蓋身體與心理功能面向，為世界衛生組織（WHO）健康老化框架中的核心要素之一。研究顯示，IC各功能面向之功能衰退（包含認知、行動力、營養、視力、聽力與心理社交健康），與失能、住院及死亡等不良健康結果密切相關。服藥順從性在老年人常見的慢性疾病管理中扮演關鍵角色，並可能透過不同路徑影響功能變化。儘管內在能力受損與服藥不順從之間的關聯已有初步文獻證據，至今仍缺乏長期追蹤的實證研究探討兩者之間是否存在縱向雙向關聯。因此，本研究旨在評估社區長者IC與服藥順從性之間的長期雙向關聯性。
研究方法: 本研究資料來源使用「後疫情時代無牆化健康照護體系」計畫中2022至2023年兩波追蹤調查。研究對象為第一波調查訪問的1,035名年滿60歲、至少罹患一項慢性疾病的長者，最終共有235人完成第二波追蹤。IC依據WHO「整合性高齡者照護」（ICOPE）的框架評估六大功能面向，總分範圍為0（高IC，無功能衰退）至6分（低IC，六大功能全面衰退），加總後並將IC狀態分兩類為高IC（總分為0分）與IC衰退（至少一項功能衰退）。服藥順從性採用「遵循醫囑領藥與使用藥物量表」（ARMS）評估(12題版)，總分越高代表順從性越差，分數達16分以上定義為服藥不順從。長期追蹤資料分析採用邏輯斯回歸模式之廣義估計方程式（GEE），並控制個人相關的社經背景、生活型態與臨床變項。為校正樣本失去追蹤所造成的潛在誤差，進行完全案例分析(CCA)與逆機率加權（IPAW）之敏感度分析。
研究結果: 基線調查結果顯示，80.68%的受訪者至少有一項IC功能受損，21.35%有服藥不順從的行爲。與高IC者相比，IC受損者年齡較大、教育程度較低、身體活動較少，罹患更多慢性疾病及睡眠品質較差。服藥不順從者亦表現出類似趨勢，包括較少運動、睡眠品質不佳與有超過10種的多重用藥。縱向分析結果顯示，內在能力較差的參與者在後續期間出現藥物服用不順從的機率較高，無加權模式下的比值比為1.68（95%信賴區間：1.09–2.58），穩定加權模式下的比值比為1.49（95%信賴區間：0.96–2.29）。然而，內在能力與藥物服用順從性之間的關係在相反方向上更為顯著：用藥不順從可顯著預測內在能力在後續時間內的下降，無加權模式下的比值比為1.78（95%信賴區間：1.10–2.87），穩定加權模式下的比值比為1.65（95%信賴區間：1.01–2.71）。
討論: 本研究提供了實證支持內在能力與服藥順從性之間存在縱向雙向影響，敏感度分析結果也顯示，儘管應用IPAW後估計值稍微變小，整體關聯與結果趨勢仍具一致性。服藥不順從對於後續IC功能退化的影響，較IC對於服藥順從性的影響更為顯著，顯示服藥行為不僅受功能狀況影響，亦可能加速功能退化。惟因本研究整體樣本追蹤的流失率高，結果仍須謹慎解讀。本研究結果凸顯將IC功能評估與服藥順從性支持納入老年人常規照護的重要性。透過定期監測IC各功能面向（如認知、行動力與心理社交功能），有助於早期辨識高風險族群，及時介入預防功能衰退。尤其是針對服藥順從性的相關介入措施，包含簡化用藥療程、加強衛教及為IC功能受損者提供個別化支持，有助於提升治療效果與維護IC，進一步延緩老化過程中的功能衰退。

Background and objectives: With the global population aging at an incredible rate, maintaining functional ability in older adults has become the priority for patient care. Intrinsic capacity (IC), encompassing the physical and mental domains, is one of the key components of the WHO’s healthy aging framework. Functional impairments across IC domains such as cognition, mobility, nutrition, vision, hearing, and psychosocial health have been associated with adverse outcomes, including disability, hospitalization, and mortality. Medication adherence plays an important role in the management of chronic diseases common in older adults and may influence functional trajectories through several pathways. Despite some evidence linking IC impairments to poor medication adherence, the potential bidirectional association between IC and adherence remains a research gap, particularly from a longitudinal perspective. Therefore, this study aimed to investigate the longitudinal bidirectional association between IC and medication adherence among community-dwelling older adults with chronic diseases.
Methods: Data were drawn from two waves (2022-2023) of the "Integrated Care Model for Older Adults in Post-COVID-19 Era" project. A total of 1,035 individuals aged 60 years and older with at least one chronic disease were included at baseline and only 235 people remained in the second wave. IC was assessed across six domains following the WHO Integrated Care for Older People framework, with scores ranging from 0 (high IC) to 6 (low IC) based on the sum of domain-specific impairments and categorized into binary variable: high IC (no impairment) and impaired IC (at least one impairment). Medication adherence was evaluated using the 12-item Adherence to Refills and Medications Scale (ARMS), with higher scores indicating poorer adherence. Poor adherence was defined by an ARMS score of at least 16. Generalized estimating equations with logistic regression models were applied to examine the association between IC and medication adherence, adjusting for relevant sociodemographic, lifestyle, and clinical covariates. Sensitivity analyses, including complete case analysis and inverse probability of attrition weighting, were performed to account for potential bias due to loss to follow-up.
Results: At baseline, 80.68% of participants exhibited at least one IC impairment, and 21.35% were classified as having poor medication adherence. Participants with impaired IC were significantly older, had a lower education level, were less physically active, and experienced more comorbidities and poorer sleep health compared to those with high IC. Poor adherence was associated with less physical activity, poor sleep quality, and excessive polypharmacy. Longitudinal analyses found that participants with poorer IC had increased odds of poor medication adherence over time in both the unweighted model (OR: 1.68; 95% CI: 1.09–2.58) and the stabilized weighted model (OR: 1.49; 95% CI: 0.96–2.29). The association between IC and adherence was stronger in the reverse direction: poor medication adherence significantly predicted declines in IC over time in both unweighted (OR: 1.78; 95% CI: 1.10–2.87) and stabilized weighted models (OR: 1.65; 95% CI: 1.01–2.71).
Discussions: This study provides robust evidence supporting a bidirectional relationship between IC and medication adherence among older adults with chronic diseases. Sensitivity analyses showed that while effect estimates were attenuated after applying inverse probability of attrition weighting, the overall direction and consistency of associations remained. The stronger association observed from poor adherence to IC decline suggests that adherence is not only influenced by functional status but may contribute to accelerated functional deterioration. Nevertheless, given the study sample’s high attrition rate, results should be interpreted with caution. These findings emphasize the importance of integrating IC assessment and medication adherence support into routine care for older adults. Regular monitoring of IC, including domains such as cognition, mobility, and psychosocial health, may help identify individuals at risk for poor adherence and functional decline. Furthermore, interventions targeting medication adherence, through simplified regimens, patient education, and tailored support for individuals with IC impairments, may help improve treatment outcomes, prevent adverse events and preserve IC.

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