Exploring the Role of the Electronic Frailty Index (eFI) in Identifying Vulnerable Older Adults in a Healthcare Setting

Healthcare organizations play a key role in supporting health for a growing population of older adults. With the emergence of electronic health records, routinely collected data can be leveraged to identify vulnerable older adults more easily. Healthcare organizations can employ risk stratification, interventions, population management strategies, and community partnerships to enhance health and care for high-risk populations. Frailty, an internationally recognized indicator of vulnerability associated with numerous adverse outcomes, has received attention as a viable target for intervention as it provides a multidimensional view of an individual’s health status. This dissertation contains three studies that examine how structured data from the electronic medical record might be leveraged to identify older adults with elevated risk of experiencing adverse events. The first study explores the joint association of frailty and neighborhood disadvantage with emergency and inpatient utilization and considers how area-level variables may contribute to recognizing older adults with unmet needs across functional, medical, and social domains. The second and third studies leverage longitudinal frailty measures to explore frailty transitions in a unique healthcare context to inform strategies for the prevention, delay, or even reversal of frailty. The third manuscript considers how rural residence modifies the associations between frailty state transitions and individual-level predisposing and need factors as well as contextual-level predisposing factors.