臺灣博碩士論文加值系統

研究背景和目的
老年族群是否衰弱之所以重要，是因為衰弱可做為健康預後的指標。目前全世界對於急診衰弱長者的相關研究其實相對缺乏，而對於老年族群的衰弱議題若不夠警覺，則可能讓因非典型症狀來急診的老年族群有較差的急診品質。
透過本研究，我們希望可以了解到使用急診醫療的老年族群中生理、心理、社會衰弱的比率，同時也能了解台灣老年族群急診就診前是否衰弱，對於預後的影響與關聯性。
研究方法
本研究為前瞻性之觀察性世代研究，針對2022/12/15~2023/03/02至新竹臺大分院生醫醫院竹北院區急診醫學部就診之病患進行收案，資料分析分為探討(1) 急診使用之老年族群是否生理、心理、社會衰弱(2)以及透過多變項羅吉斯迴歸，加入共變項探討生理、心理、社會衰弱，對一個月後追蹤是否再返急診、住院以及死亡有影響。共變項包括年齡、過去病史、一年內跌倒次數、性別、是否為機構住民、是否有多重用藥、當次就醫是否住院等。
研究結果
研究期間共收案207位民眾，其中有46.38%有生理衰弱，41.06%有心理衰弱， 48.79%有社會衰弱，可發現社會衰弱比率大於生理衰弱再大於心理衰弱。以羅吉斯迴歸分析生理衰弱、心理衰弱、社會衰弱對於一個月預後的影響，發現在調整共變項後，有生理衰弱的長者其一個月內再返急診的風險為沒有生理衰弱的長者的4.43倍(OR=4.43, p<0.01)，有生理衰弱的長者其一個月內再住院的風險為沒有生理衰弱的長者的3.62倍(OR=3.62, p<0.05)，有心理衰弱的長者其一個月內再返急診的風險為沒有心理衰弱的長者的2.23倍(OR=2.23, p<0.05)。另發現社會衰弱有較易一個月住院(OR=2.39, p=0.059)、一個月內死亡(OR=9.00, p=0.052)之傾向。
討論
本研究之生理衰弱、心理衰弱及社會衰弱比率是比過去研究社區取樣之比率來得高，推論為不同面向衰弱與急診醫療使用的需求有關。此外與過去社區研究不同的是社會衰弱比率高於生理心理衰弱比率，推測可能是因為社會衰弱長者因為社會網絡或支持較薄弱，較有急診醫療需求。以及未來若能針對社區之社會衰弱長者進行介入，或許有機會降低長者急診使用率。
本研究發現急診長者生理衰弱及心理衰弱與一個月再返急診之風險有關，前者也與一個月再住院風險有關，而社會衰弱的長者其一個月內再住院及一個月死亡的風險則有較高的傾向。若在急診就診時能篩檢出衰弱，則有機會針對此族群進行介入，像是轉介老年醫學科或是長期照顧管理中心等，可以提升照顧品質，也降低之後的醫療資源的使用。
結論
本研究是第一個在急診場域同時進行生理、心理、社會衰弱的三面向評估，也點出了急診場域與社區場域之衰弱比率差異，以及衰弱比率與急診一個月預後指標之關聯性，同時也推論社會衰弱與急診醫療使用的關聯性。

Introduction
The significance of frailty in the elderly lies in its role as an indicator of health outcomes. Research on the prevalence of frail elderly individuals presenting to the emergency department is lacking worldwide. The aim of this study is to find out the prevalence of frailty among elderly individuals who utilize emergency medical services, and to investigate the relationship between physical, psychological, and social frailties and health outcomes for these elderly individuals in Taiwan.
Method
This was a prospective observational cohort study that aimed to enroll patients who sought medical attention at the Emergency Medicine Department of National Taiwan University BioMedical Park Hospital Zhubei Branch, from December 15, 2022, to March 2, 2023. The data analysis was divided into two parts: (1) The assessment of physical, psychological, and social frailty among the study participants, and (2) Multivariable logistic regression analysis was conducted to investigate the impact of physical, mental, and social frailty on revisits to the emergency department, readmissions, and mortality within one month of follow-up. Covariates included age, medical history, number of falls within one year, gender, institutional residency, polypharmacy, index admission.
Result
A total of 207 participants were enrolled. Among them, 46.38% were identified as physical frailty, 41.06% as psychological frailty, and 48.79% as social frailty. Elderly individuals with physical frailty had a 4.43 times higher risk (OR=4.43, p<0.01) of revisit to the emergency department within one month compared to those without physical frailty; and a 3.62 times higher risk (OR=3.62, p<0.05) of readmission within one month compared to the other groups. Elderly individuals with psychological frailty had a 2.23 times higher risk (OR=2.23, p<0.05) of revisit at the emergency department within one month compared to those without psychological frailty. Social frailty was associated with a higher likelihood of readmission (OR=2.39, p=0.059) and mortality (OR=9.00, p=0.052) within one month.
Discussion
The rates of physical frailty, psychological frailty, and social frailty in this study were higher compared to rates obtained from community samples. This suggests a relationship between different dimensions of frailty and the need for emergency medical care. Furthermore, the rate of social frailty was higher than that of physical frailty, which suggested that older adults experiencing social frailty may have a greater need for emergency medical care due to a lack of social network or support. This higher rate of social frailty compared to psychological frailty highlights the importance of addressing social frailty in interventions targeting social frailty in the community, as it may help reduce the rate of emergency department utilization among older adults in the future.
This study found that the risk of revisiting the emergency department within one month among older adults was associated with physiological frailty and physical frailty. Moreover, the risk of readmission within one month was associated with physical frailty. Additionally, older adults experiencing social frailty have a higher tendency towards readmission within one month and higher risk of mortality within one month. Screening frailty during emergency department visits presents an opportunity for intervention and effective reduction of healthcare resources utilization in this population.
Conclusion
The findings of this study indicated that the prevalence of frailty among elderly individuals in the emergency department wa significantly higher than in the community. Additionally, the presence of physical frailty can assist in predicting the risk of revisit at the emergency department and readmission within one month for elderly patients seeking emergency care. Similarly, the presence of psychological frailty can help assess the risk of revisit at the emergency department within one month for elderly patients seeking emergency care. Most importantly, interventions aimed at reducing frailty in older adults after their discharge from the emergency room are crucial.

第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 2
第三節 研究問題和目的 3
第二章 文獻探討 4
第一節 衰弱的定義及不同面向 4
第二節 衰弱在不同場域之呈現 5
第三節 衰弱測量工具 7
一、衰弱測量工具的發展 7
二、生理衰弱測量工具 8
三、心理衰弱測量工具 8
四、社會衰弱測量工具 9
第四節 急診預後指標 10
一、再返診 10
二、再住院 11
三、死亡 11
第五節 衰弱與醫療預後的關聯 11
第六節 研究缺口 13
第三章 研究方法 14
第一節 研究設計 14
第二節 研究架構 14
第三節 研究假說 15
第四節 研究對象 15
第五節 收案方式與流程 15
第六節 研究工具與研究變項 16
一、基本人口學資料 16
二、多重用藥 16
三、就診兩周前之生理、心理、社會衰弱狀況 17
四、當次就醫是否住院及一個月急診預後指標 17
第七節 統計方法 18
一、單變項分析：描述性分析，研究各變項分布情形 18
二、雙變量分析 19
二、多變項分析 19
第四章 研究結果 20
第一節 研究對象的描述性分析 20
第二節 一個月的預後指標與其他人口學變項及衰弱指標的分析 22
一、是否一個月內再返急診與其他指標的分析 22
二、是否一個月內再住院與其他指標的分析 22
三、是否一個月內死亡與其他指標的分析 22
第三節 衰弱指標對於一個月的預後指標的影響 26
一、生理衰弱對於是否一個月內再返急診的影響 26
二、心理衰弱對於是否一個月內再返急診的影響 26
三、社會衰弱對於是否一個月內再返急診的影響 26
四、生理衰弱對於是否一個月內再住院的影響 26
五、心理衰弱對於是否一個月內再住院的影響 27
六、社會衰弱對於是否一個月內再住院的影響 27
七、生理衰弱對於是否一個月內死亡的影響 28
八、心理衰弱對於是否一個月內死亡的影響 28
九、社會衰弱對於是否一個月內死亡的影響 28
第五章 討論 38
第一節 急診長者的生理、心理、社會衰弱比率及預後表現 38
第二節 生理、心理、社會衰弱對於一個月急診預後之影響 40
一、生理衰弱 40
二、心理衰弱 42
三、社會衰弱 43
第三節 其他因素對於一個月急診預後之影響 44
第四節：研究限制 46
第六章 結論與建議 48
第一節 研究結論 48
第二節 建議 48
一、政策建議 48
二、研究建議 49
三、實務建議 49
參考文獻 50

Aminzadeh, F., & Dalziel, W. B. (2002). Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med, 39(3), 238-247. https://doi.org/10.1067/mem.2002.121523
Arendts, G., Fitzhardinge, S., Pronk, K., Hutton, M., Nagree, Y., & Donaldson, M. (2013). Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department. Intern Emerg Med, 8(3), 249-254. https://doi.org/10.1007/s11739-012-0895-5
Blomaard, L. C., Speksnijder, C., Lucke, J. A., de Gelder, J., Anten, S., Schuit, S. C. E., Steyerberg, E. W., Gussekloo, J., de Groot, B., & Mooijaart, S. P. (2020). Geriatric Screening, Triage Urgency, and 30-Day Mortality in Older Emergency Department Patients. J Am Geriatr Soc, 68(8), 1755-1762. https://doi.org/10.1111/jgs.16427
Bogh, S. B., Fløjstrup, M., Möller, S., Bech, M., Lassen, A. T., Brabrand, M., & Mogensen, C. B. (2023). Readmission trends before and after a national reconfiguration of emergency departments in Denmark. J Health Serv Res Policy, 28(1), 42-49. https://doi.org/10.1177/13558196221108894
Boyle, P. A., Buchman, A. S., Wilson, R. S., Leurgans, S. E., & Bennett, D. A. (2010). Physical frailty is associated with incident mild cognitive impairment in community-based older persons. J Am Geriatr Soc, 58(2), 248-255. https://doi.org/10.1111/j.1532-5415.2009.02671.x
Braes, T., Moons, P., Lipkens, P., Sterckx, W., Sabbe, M., Flamaing, J., Boonen, S., & Milisen, K. (2010). Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging Clin Exp Res, 22(4), 345-351. https://doi.org/10.1007/bf03324938
Bunt, S., Steverink, N., Olthof, J., van der Schans, C. P., & Hobbelen, J. S. M. (2017). Social frailty in older adults: a scoping review. Eur J Ageing, 14(3), 323-334. https://doi.org/10.1007/s10433-017-0414-7
Buta, B. J., Walston, J. D., Godino, J. G., Park, M., Kalyani, R. R., Xue, Q. L., Bandeen-Roche, K., & Varadhan, R. (2016). Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev, 26, 53-61. https://doi.org/10.1016/j.arr.2015.12.003
Carpenter, C. R., Cameron, A., Ganz, D. A., & Liu, S. (2018). Older Adult Falls in Emergency Medicine-A Sentinel Event. Clin Geriatr Med, 34(3), 355-367. https://doi.org/10.1016/j.cger.2018.04.002
Carpenter, C. R., Shelton, E., Fowler, S., Suffoletto, B., Platts-Mills, T. F., Rothman, R. E., & Hogan, T. M. (2015). Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med, 22(1), 1-21. https://doi.org/10.1111/acem.12569
Chien, C. Y., Chaou, C. H., Yeh, C. C., Hsu, K. H., Gao, S. Y., & Ng, C. J. (2022). Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department. BMC Emerg Med, 22(1), 86. https://doi.org/10.1186/s12873-022-00646-0
Chong, E., Zhu, B., Ng, S. H. X., Tan, H., Goh, E. F., Molina, J. C., Pereira, M. J., Kaur, P., Baldevarona-Llego, J., Chia, J. Q., Chong, A., Cheong, S., Foo, C. L., Chan, M., & Lim, W. S. (2022). Emergency department interventions for frailty (EDIFY): improving functional outcomes in older persons at the emergency department through a multicomponent frailty intervention. Age Ageing, 51(2). https://doi.org/10.1093/ageing/afab251
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. Lancet, 381(9868), 752-762. https://doi.org/10.1016/s0140-6736(12)62167-9
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc, 51(4), 451-458. https://doi.org/10.1046/j.1532-5415.2003.51152.x
Cunha, A. I. L., Veronese, N., de Melo Borges, S., & Ricci, N. A. (2019). Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis. Ageing Res Rev, 56, 100960. https://doi.org/10.1016/j.arr.2019.100960
Davis, P., & Evans, D. D. (2021). The Undertriage of Older Adults in the Emergency Department: A Review of Interventions. Adv Emerg Nurs J, 43(3), 178-185. https://doi.org/10.1097/tme.0000000000000359
de Gelder, J., Lucke, J. A., de Groot, B., Fogteloo, A. J., Anten, S., Heringhaus, C., Dekkers, O. M., Blauw, G. J., & Mooijaart, S. P. (2018). Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department. J Am Geriatr Soc, 66(4), 735-741. https://doi.org/10.1111/jgs.15301
de Oliveira, D. C., Máximo, R. O., Ramírez, P. C., de Souza, A. F., Luiz, M. M., Delinocente, M. L. B., Steptoe, A., de Oliveira, C., & Alexandre, T. D. S. (2023). Does the incidence of frailty differ between men and women over time? Arch Gerontol Geriatr, 106, 104880. https://doi.org/10.1016/j.archger.2022.104880
Dendukuri, N., McCusker, J., & Belzile, E. (2004). The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc, 52(2), 290-296. https://doi.org/10.1111/j.1532-5415.2004.52073.x
Drame, M., Jovenin, N., Novella, J. L., Lang, P. O., Somme, D., Laniece, I., Voisin, T., Blanc, P., Couturier, P., Gauvain, J. B., Blanchard, F., & Jolly, D. (2008). Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging, 12(8), 599-604. https://doi.org/10.1007/bf02983207
Emergency Care Institute. (2012). Emergency Department Models of Care. NSW MINISTRY OF HEALTH Retrieved from https://aci.health.nsw.gov.au/__data/assets/pdf_file/0005/273794/emergency-department-models-of-care-july-2012.pdf
Ensrud, K. E., Ewing, S. K., Cawthon, P. M., Fink, H. A., Taylor, B. C., Cauley, J. A., Dam, T. T., Marshall, L. M., Orwoll, E. S., & Cummings, S. R. (2009). A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc, 57(3), 492-498. https://doi.org/10.1111/j.1532-5415.2009.02137.x
Ensrud, K. E., Ewing, S. K., Taylor, B. C., Fink, H. A., Cawthon, P. M., Stone, K. L., Hillier, T. A., Cauley, J. A., Hochberg, M. C., Rodondi, N., Tracy, J. K., & Cummings, S. R. (2008). Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med, 168(4), 382-389. https://doi.org/10.1001/archinternmed.2007.113
Ensrud, K. E., Kats, A. M., Schousboe, J. T., Taylor, B. C., Cawthon, P. M., Hillier, T. A., Yaffe, K., Cummings, S. R., Cauley, J. A., & Langsetmo, L. (2018). Frailty Phenotype and Healthcare Costs and Utilization in Older Women. J Am Geriatr Soc, 66(7), 1276-1283. https://doi.org/10.1111/jgs.15381
Fan, J., Worster, A., & Fernandes, C. M. (2006). Predictive validity of the triage risk screening tool for elderly patients in a Canadian emergency department. Am J Emerg Med, 24(5), 540-544. https://doi.org/10.1016/j.ajem.2006.01.015
Fan, L., Xue, H., Wang, Q., Yan, Y., & Du, W. (2022). Development and Validation of a Nomogram for Predicting Risk of Emergency Department Revisits in Chinese Older Patients. Risk Manag Healthc Policy, 15, 2283-2295. https://doi.org/10.2147/rmhp.S391731
Fitten, L. J. (2015). Psychological Frailty in the Aging Patient. Nestle Nutr Inst Workshop Ser, 83, 45-53. https://doi.org/10.1159/000382060
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci, 59(3), 255-263. https://doi.org/10.1093/gerona/59.3.m255
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A. (2001). Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 56(3), M146-156. https://doi.org/10.1093/gerona/56.3.m146
Fujiwara, Y., Kondo, K., Koyano, W., Murayama, H., Shinkai, S., Fujita, K., Arai, H., & Horiuchi, F. (2022). Social frailty as social aspects of frailty: Research, practical activities, and prospects. Geriatr Gerontol Int, 22(12), 991-996. https://doi.org/10.1111/ggi.14492
Fukutomi, E., Okumiya, K., Wada, T., Sakamoto, R., Ishimoto, Y., Kimura, Y., Kasahara, Y., Chen, W. L., Imai, H., Fujisawa, M., Otuka, K., & Matsubayashi, K. (2013). Importance of cognitive assessment as part of the "Kihon Checklist" developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2-year follow up. Geriatr Gerontol Int, 13(3), 654-662. https://doi.org/10.1111/j.1447-0594.2012.00959.x
Galvin, J. E., Roe, C. M., Powlishta, K. K., Coats, M. A., Muich, S. J., Grant, E., Miller, J. P., Storandt, M., & Morris, J. C. (2005). The AD8: a brief informant interview to detect dementia. Neurology, 65(4), 559-564. https://doi.org/10.1212/01.wnl.0000172958.95282.2a
Garre-Olmo, J., Calvó-Perxas, L., López-Pousa, S., de Gracia Blanco, M., & Vilalta-Franch, J. (2013). Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age Ageing, 42(1), 46-51. https://doi.org/10.1093/ageing/afs047
Genell Andrén, K., & Rosenqvist, U. (1987). Heavy users of an emergency department--a two year follow-up study. Soc Sci Med, 25(7), 825-831. https://doi.org/10.1016/0277-9536(87)90040-2
Gobbens, R. J., Boersma, P., Uchmanowicz, I., & Santiago, L. M. (2020). The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity. Clin Interv Aging, 15, 265-274. https://doi.org/10.2147/cia.S243233
Gobbens, R. J., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010). In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc, 11(5), 338-343. https://doi.org/10.1016/j.jamda.2009.09.015
Gobbens, R. J., van Assen, M. A., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010a). Determinants of frailty. J Am Med Dir Assoc, 11(5), 356-364. https://doi.org/10.1016/j.jamda.2009.11.008
Gobbens, R. J., van Assen, M. A., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010b). The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc, 11(5), 344-355. https://doi.org/10.1016/j.jamda.2009.11.003
Gobbens, R. J. J., & Andreasen, J. (2020). The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): A prospective cohort study among acutely admitted older patients. Arch Gerontol Geriatr, 89, 104077. https://doi.org/10.1016/j.archger.2020.104077
Gobbens, R. J. J., van Assen, M., Augustijn, H., Goumans, M., & van der Ploeg, T. (2021). Prediction of Mortality by the Tilburg Frailty Indicator (TFI). J Am Med Dir Assoc, 22(3), 607.e601-607.e606. https://doi.org/10.1016/j.jamda.2020.07.033
Graf, C. E., Giannelli, S. V., Herrmann, F. R., Sarasin, F. P., Michel, J. P., Zekry, D., & Chevalley, T. (2012). Identification of older patients at risk of unplanned readmission after discharge from the emergency department - comparison of two screening tools. Swiss Med Wkly, 142, w13327. https://doi.org/10.57187/smw.2012.13327
Gregersen, M., Hansen, T. K., Jørgensen, B. B., & Damsgaard, E. M. (2020). Frailty is associated with hospital readmission in geriatric patients: a prognostic study. Eur Geriatr Med, 11(5), 783-792. https://doi.org/10.1007/s41999-020-00335-w
Gutiérrez-Valencia, M., Izquierdo, M., Cesari, M., Casas-Herrero, Á., Inzitari, M., & Martínez-Velilla, N. (2018). The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol, 84(7), 1432-1444. https://doi.org/10.1111/bcp.13590
Hajek, A., Brettschneider, C., Röhr, S., Gühne, U., van der Leeden, C., Lühmann, D., Mamone, S., Wiese, B., Weyerer, S., Werle, J., Fuchs, A., Pentzek, M., Weeg, D., Mösch, E., Heser, K., Wagner, M., Maier, W., Riedel-Heller, S. G., Scherer, M., & König, H. H. (2020). Which Factors Contribute to Frailty among the Oldest Old? Results of the Multicentre Prospective AgeCoDe and AgeQualiDe Study. Gerontology, 66(5), 460-466. https://doi.org/10.1159/000508723
Hallgren, J., & Aslan, A. K. D. (2018). Risk factors for hospital readmission among Swedish older adults. Eur Geriatr Med, 9(5), 603-611. https://doi.org/10.1007/s41999-018-0101-z
Hammouda, N., Vargas-Torres, C., Doucette, J., & Hwang, U. (2021). Geriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study. Am J Emerg Med, 44, 148-156. https://doi.org/10.1016/j.ajem.2021.02.004
Han, S. J., Jung, H. W., Lee, J. H., Lim, J., Moon, S. D., Yoon, S. W., Moon, H., Lee, S. Y., Kim, H., Lee, S. R., & Jang, I. Y. (2021). Clinical Frailty Scale, K-FRAIL questionnaire, and clinical outcomes in an acute hospitalist unit in Korea. Korean J Intern Med, 36(5), 1233-1241. https://doi.org/10.3904/kjim.2020.677
Hao, S., Jin, B., Shin, A. Y., Zhao, Y., Zhu, C., Li, Z., Hu, Z., Fu, C., Ji, J., Wang, Y., Zhao, Y., Dai, D., Culver, D. S., Alfreds, S. T., Rogow, T., Stearns, F., Sylvester, K. G., Widen, E., & Ling, X. B. (2014). Risk prediction of emergency department revisit 30 days post discharge: a prospective study. PLoS One, 9(11), e112944. https://doi.org/10.1371/journal.pone.0112944
Hastings, S. N., Purser, J. L., Johnson, K. S., Sloane, R. J., & Whitson, H. E. (2008). Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc, 56(9), 1651-1657. https://doi.org/10.1111/j.1532-5415.2008.01840.x
Hogervorst, V. M., Buurman, B. M., De Jonghe, A., van Oppen, J. D., Nickel, C. H., Lucke, J., Blomaard, L. C., Thaur, A., Mooijaart, S. P., Banerjee, J., Wallace, J., de Groot, B., & Conroy, S. P. (2021). Emergency department management of older people living with frailty: a guide for emergency practitioners. Emerg Med J, 38(9), 724-729. https://doi.org/10.1136/emermed-2020-210014
Hoogendijk, E. O., Afilalo, J., Ensrud, K. E., Kowal, P., Onder, G., & Fried, L. P. (2019). Frailty: implications for clinical practice and public health. Lancet, 394(10206), 1365-1375. https://doi.org/10.1016/s0140-6736(19)31786-6
Hosseinpour, H., El-Qawaqzeh, K., Stewart, C., Akl, M. N., Anand, T., Culbert, M. H., Nelson, A., Bhogadi, S. K., & Joseph, B. (2022). Emergency readmissions following geriatric ground-level falls: How does frailty factor in? Injury, 53(11), 3723-3728. https://doi.org/10.1016/j.injury.2022.08.048
Hsu, C. W., Lee, C. W., Hsu, S. C., Huang, W. C., Hsu, Y. P., & Chi, M. J. (2023). Improvement of the Identification of Seniors at Risk scale for predicting adverse health outcomes of elderly patients in the emergency department. Int Emerg Nurs, 68, 101274. https://doi.org/10.1016/j.ienj.2023.101274
Hsueh, J. T., Peng, T. C., Chen, W. L., Wu, L. W., Chang, Y. W., Yang, W. S., & Kao, T. W. (2018). Association between frailty and a measure of cognition: a cross-sectional study on community-dwelling older adults. Eur Geriatr Med, 9(1), 39-43. https://doi.org/10.1007/s41999-017-0012-4
Hu, S. C. (1992). Analysis of patient revisits to the emergency department. Am J Emerg Med, 10(4), 366-370. https://doi.org/10.1016/0735-6757(92)90022-p
Huang, H. H., Chang, J. C., Tseng, C. C., Yang, Y. J., Fan, J. S., Chen, Y. C., Peng, L. N., & Yen, D. H. (2021). Comprehensive geriatric assessment in the emergency department for the prediction of readmission among older patients: A 3-month follow-up study. Arch Gerontol Geriatr, 92, 104255. https://doi.org/10.1016/j.archger.2020.104255
Hutchinson, C. L., Curtis, K., McCloughen, A., Qian, S., Yu, P., & Fethney, J. (2021). Identifying return visits to the Emergency Department: A multi-centre study. Australas Emerg Care, 24(1), 34-42. https://doi.org/10.1016/j.auec.2020.05.007
Hutchinson, C. L., Curtis, K., McCloughen, A., Qian, S., Yu, P., & Fethney, J. (2022). Predictors and outcomes of patients that return unplanned to the Emergency Department and require critical care admission: A multicenter study. Australas Emerg Care, 25(1), 88-97. https://doi.org/10.1016/j.auec.2021.04.003
Hutchinson, C. L., McCloughen, A., & Curtis, K. (2019). Incidence, characteristics and outcomes of patients that return to Emergency Departments. An integrative review. Australas Emerg Care, 22(1), 47-68. https://doi.org/10.1016/j.auec.2018.12.003
Jørgensen, R., & Brabrand, M. (2017). Screening of the frail patient in the emergency department: A systematic review. Eur J Intern Med, 45, 71-73. https://doi.org/10.1016/j.ejim.2017.09.036
Jarrett, P. G., Rockwood, K., Carver, D., Stolee, P., & Cosway, S. (1995). Illness presentation in elderly patients. Arch Intern Med, 155(10), 1060-1064.
Jenkins, N. D., Welstead, M., Stirland, L., Hoogendijk, E. O., Armstrong, J. J., Robitaille, A., & Muniz-Terrera, G. (2023). Frailty trajectories and associated factors in the years prior to death: evidence from 14 countries in the Survey of Health, Aging and Retirement in Europe. BMC Geriatr, 23(1), 49. https://doi.org/10.1186/s12877-023-03736-1
Joosten, E., Demuynck, M., Detroyer, E., & Milisen, K. (2014). Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr, 14, 1. https://doi.org/10.1186/1471-2318-14-1
Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O'Keeffe, T., Tang, A., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg, 149(8), 766-772. https://doi.org/10.1001/jamasurg.2014.296
Jujo, K., Kagiyama, N., Saito, K., Kamiya, K., Saito, H., Ogasahara, Y., Maekawa, E., Konishi, M., Kitai, T., Iwata, K., Wada, H., Kasai, T., Nagamatsu, H., Ozawa, T., Izawa, K., Yamamoto, S., Aizawa, N., Yonezawa, R., Oka, K., . . . Matsue, Y. (2021). Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE-HF Registry Subanalysis. J Am Heart Assoc, 10(17), e019954. https://doi.org/10.1161/jaha.120.019954
Kaeppeli, T., Rueegg, M., Dreher-Hummel, T., Brabrand, M., Kabell-Nissen, S., Carpenter, C. R., Bingisser, R., & Nickel, C. H. (2020). Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med, 76(3), 291-300. https://doi.org/10.1016/j.annemergmed.2020.03.028
Kemp, K., Alakare, J., Harjola, V. P., Strandberg, T., Tolonen, J., Lehtonen, L., & Castrén, M. (2020). National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med, 20(1), 83. https://doi.org/10.1186/s12873-020-00379-y
Kiely, D. K., Cupples, L. A., & Lipsitz, L. A. (2009). Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc, 57(9), 1532-1539. https://doi.org/10.1111/j.1532-5415.2009.02394.x
Kim, S. Y., Woo, S. H., Lee, W. J., Kim, D. H., Seol, S. H., Lee, J. Y., Jeong, S., Park, S., Cha, K., & Youn, C. S. (2021). The qSOFA score combined with the initial red cell distribution width as a useful predictor of 30 day mortality among older adults with infection in an emergency department. Aging Clin Exp Res, 33(6), 1619-1625. https://doi.org/10.1007/s40520-020-01738-2
Kolk, D., Kruiswijk, A. F., MacNeil-Vroomen, J. L., Ridderikhof, M. L., & Buurman, B. M. (2021). Older patients' perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study. BMC Public Health, 21(1), 1709. https://doi.org/10.1186/s12889-021-11755-z
Lang, P. O., Michel, J. P., & Zekry, D. (2009). Frailty syndrome: a transitional state in a dynamic process. Gerontology, 55(5), 539-549. https://doi.org/10.1159/000211949
Lanièce, I., Couturier, P., Dramé, M., Gavazzi, G., Lehman, S., Jolly, D., Voisin, T., Lang, P. O., Jovenin, N., Gauvain, J. B., Novella, J. L., Saint-Jean, O., & Blanchard, F. (2008). Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units. Age Ageing, 37(4), 416-422. https://doi.org/10.1093/ageing/afn093
Lau, S. R., Waldorff, F., Holm, A., Frølich, A., Andersen, J. S., Sallerup, M., Christensen, S. E., Clausen, S. S., Due, T. D., & Hølmkjær, P. (2023). Disentangling concepts of inappropriate polypharmacy in old age: a scoping review. BMC Public Health, 23(1), 245. https://doi.org/10.1186/s12889-023-15013-2
Li, G., Ioannidis, G., Pickard, L., Kennedy, C., Papaioannou, A., Thabane, L., & Adachi, J. D. (2014). Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort. BMC Musculoskelet Disord, 15, 185. https://doi.org/10.1186/1471-2474-15-185
Liang, C. K., Chou, M. Y., Hsu, Y. H., Wang, Y. C., Liao, M. C., Chen, M. T., Hsiao, P. Y., Chen, L. K., & Lin, Y. T. (2023). The association of potentially inappropriate medications, polypharmacy and anticholinergic burden with readmission and emergency room revisit after discharge: A hospital-based retrospective cohort study. Br J Clin Pharmacol, 89(1), 187-200. https://doi.org/10.1111/bcp.15457
Lin, C. F., Lin, P. C., Hu, S. Y., Tsan, Y. T., Liao, W. K., Lin, S. Y., & Lin, T. C. (2021). Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department. Int J Environ Res Public Health, 18(11). https://doi.org/10.3390/ijerph18116164
Lin, K. P., Chen, P. C., Huang, L. Y., Mao, H. C., & Chan, D. D. (2016). Predicting Inpatient Readmission and Outpatient Admission in Elderly: A Population-Based Cohort Study. Medicine (Baltimore), 95(16), e3484. https://doi.org/10.1097/md.0000000000003484
Lowthian, J., Straney, L. D., Brand, C. A., Barker, A. L., Smit Pde, V., Newnham, H., Hunter, P., Smith, C., & Cameron, P. A. (2016). Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project. Age Ageing, 45(2), 255-261. https://doi.org/10.1093/ageing/afv198
Ma, L., Sun, F., & Tang, Z. (2018). Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality. J Nutr Health Aging, 22(8), 989-995. https://doi.org/10.1007/s12603-018-1054-0
Makizako, H., Shimada, H., Doi, T., Tsutsumimoto, K., Hotta, R., Nakakubo, S., Makino, K., & Lee, S. (2018). Social Frailty Leads to the Development of Physical Frailty among Physically Non-Frail Adults: A Four-Year Follow-Up Longitudinal Cohort Study. Int J Environ Res Public Health, 15(3). https://doi.org/10.3390/ijerph15030490
Makizako, H., Shimada, H., Tsutsumimoto, K., Lee, S., Doi, T., Nakakubo, S., Hotta, R., & Suzuki, T. (2015). Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability. J Am Med Dir Assoc, 16(11), 1003.e1007-1011. https://doi.org/10.1016/j.jamda.2015.08.023
Martin-Gill, C., & Reiser, R. C. (2004). Risk factors for 72-hour admission to the ED. Am J Emerg Med, 22(6), 448-453. https://doi.org/10.1016/j.ajem.2004.07.023
Matsue, Y., Kamiya, K., Saito, H., Saito, K., Ogasahara, Y., Maekawa, E., Konishi, M., Kitai, T., Iwata, K., Jujo, K., Wada, H., Kasai, T., Nagamatsu, H., Ozawa, T., Izawa, K., Yamamoto, S., Aizawa, N., Yonezawa, R., Oka, K., . . . Kagiyama, N. (2020). Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail, 22(11), 2112-2119. https://doi.org/10.1002/ejhf.1926
Mitnitski, A. B., Mogilner, A. J., & Rockwood, K. (2001). Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal, 1, 323-336. https://doi.org/10.1100/tsw.2001.58
Moons, P., De Ridder, K., Geyskens, K., Sabbe, M., Braes, T., Flamaing, J., & Milisen, K. (2007). Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med, 14(6), 315-323. https://doi.org/10.1097/MEJ.0b013e3282aa3e45
Mowbray, F., Brousseau, A. A., Mercier, E., Melady, D., Émond, M., & Costa, A. P. (2020). Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study. Cjem, 22(1), 74-81. https://doi.org/10.1017/cem.2019.432
Naseer, M., Agerholm, J., Fastbom, J., Schön, P., Ehrenberg, A., & Dahlberg, L. (2020). Factors associated with emergency department revisits among older adults in two Swedish regions: A prospective cohort study. Arch Gerontol Geriatr, 86, 103960. https://doi.org/10.1016/j.archger.2019.103960
Naseer, M., K, J. M., Ehrenberg, A., Schön, P., & Dahlberg, L. (2022). Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study. BMJ Open, 12(2), e055484. https://doi.org/10.1136/bmjopen-2021-055484
Newgard, C. D., Lin, A., Caughey, A. B., McConnell, K. J., Bulger, E., Malveau, S., Staudenmayer, K., Griffiths, D., & Eckstrom, E. (2022). Falls in Older Adults Requiring Emergency Services: Mortality, Use of Healthcare Resources, and Prognostication to One Year. West J Emerg Med, 23(3), 375-385. https://doi.org/10.5811/westjem.2021.11.54327
Olsson, H., Karlson, B. W., Herlitz, J., Karlsson, T., Hellberg, J., Prytz, M., Sernert, N., & Ekerstad, N. (2022). Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department: an observational study. BMC Emerg Med, 22(1), 15. https://doi.org/10.1186/s12873-022-00571-2
Ono, R., Makiura, D., Nakamura, T., Okumura, M., Fukuta, A., Saito, T., Inoue, J., Oshikiri, T., Kakeji, Y., & Sakai, Y. (2021). Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer. J Am Med Dir Assoc, 22(9), 1825-1830.e1821. https://doi.org/10.1016/j.jamda.2021.03.025
Park, H., Jang, I. Y., Lee, H. Y., Jung, H. W., Lee, E., & Kim, D. H. (2019). Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling Older Koreans: Aging Study of PyeongChang Rural Area. Int J Environ Res Public Health, 16(16). https://doi.org/10.3390/ijerph16162809
Parker, S. G., McCue, P., Phelps, K., McCleod, A., Arora, S., Nockels, K., Kennedy, S., Roberts, H., & Conroy, S. (2018). What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing, 47(1), 149-155. https://doi.org/10.1093/ageing/afx166
Pedersen, M. K., Meyer, G., & Uhrenfeldt, L. (2017). Risk factors for acute care hospital readmission in older persons in Western countries: a systematic review. JBI Database System Rev Implement Rep, 15(2), 454-485. https://doi.org/10.11124/jbisrir-2016-003267
Platts-Mills, T. F., Travers, D., Biese, K., McCall, B., Kizer, S., LaMantia, M., Busby-Whitehead, J., & Cairns, C. B. (2010). Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med, 17(3), 238-243. https://doi.org/10.1111/j.1553-2712.2010.00670.x
Provencher, V., Sirois, M. J., Ouellet, M. C., Camden, S., Neveu, X., Allain-Boulé, N., & Emond, M. (2015). Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc, 63(5), 860-868. https://doi.org/10.1111/jgs.13389
Quan, H., Li, B., Couris, C. M., Fushimi, K., Graham, P., Hider, P., Januel, J. M., & Sundararajan, V. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol, 173(6), 676-682. https://doi.org/10.1093/aje/kwq433
Rashid, K., Ullah, M., Ahmed, S. T., Sajid, M. Z., Hayat, M. A., Nawaz, B., & Abbas, K. (2021). Accuracy of Emergency Room Triage Using Emergency Severity Index (ESI): Independent Predictor of Under and Over Triage. Cureus, 13(12), e20229. https://doi.org/10.7759/cureus.20229
Rising, K. L., Padrez, K. A., O'Brien, M., Hollander, J. E., Carr, B. G., & Shea, J. A. (2015). Return visits to the emergency department: the patient perspective. Ann Emerg Med, 65(4), 377-386.e373. https://doi.org/10.1016/j.annemergmed.2014.07.015
Robinson, T., & Kerse, N. (2012). Medical readmissions amongst older New Zealanders: a descriptive analysis. N Z Med J, 125(1367), 24-34.
Rockwood, K. (2005). Frailty and its definition: a worthy challenge. J Am Geriatr Soc, 53(6), 1069-1070. https://doi.org/10.1111/j.1532-5415.2005.53312.x
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Cmaj, 173(5), 489-495. https://doi.org/10.1503/cmaj.050051
Rosted, E., Schultz, M., Dynesen, H., Dahl, M., Sørensen, M., & Sanders, S. (2014). The Identification of Seniors at Risk screening tool is useful for predicting acute readmissions. Dan Med J, 61(5), A4828.
Sørup, C. M., Jacobsen, P., & Forberg, J. L. (2013). Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures. Scand J Trauma Resusc Emerg Med, 21, 62. https://doi.org/10.1186/1757-7241-21-62
Salvi, F., Morichi, V., Grilli, A., Lancioni, L., Spazzafumo, L., Polonara, S., Abbatecola, A. M., De Tommaso, G., Dessi-Fulgheri, P., & Lattanzio, F. (2012). Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging, 16(4), 313-318. https://doi.org/10.1007/s12603-011-0155-9
Shah, S. J., Oreper, S., Jeon, S. Y., Boscardin, W. J., Fang, M. C., & Covinsky, K. E. (2023). Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. Proc Natl Acad Sci U S A, 120(7), e2209414120. https://doi.org/10.1073/pnas.2209414120
Shang, N., Liu, H., Wang, N., Guo, S., & Ma, L. (2022). Comparison of three frailty screening instruments for prediction of adverse outcomes among older adults in the emergency department. Geriatr Gerontol Int, 22(10), 851-856. https://doi.org/10.1111/ggi.14469
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health.
Silverstein, M. D., Qin, H., Mercer, S. Q., Fong, J., & Haydar, Z. (2008). Risk factors for 30-day hospital readmission in patients ≥65 years of age. Proc (Bayl Univ Med Cent), 21(4), 363-372. https://doi.org/10.1080/08998280.2008.11928429
Singler, K., Heppner, H. J., Skutetzky, A., Sieber, C., Christ, M., & Thiem, U. (2014). Predictive validity of the identification of seniors at risk screening tool in a German emergency department setting. Gerontology, 60(5), 413-419. https://doi.org/10.1159/000358825
Sirois, M. J., Griffith, L., Perry, J., Daoust, R., Veillette, N., Lee, J., Pelletier, M., Wilding, L., & Émond, M. (2017). Measuring Frailty Can Help Emergency Departments Identify Independent Seniors at Risk of Functional Decline After Minor Injuries. J Gerontol A Biol Sci Med Sci, 72(1), 68-74. https://doi.org/10.1093/gerona/glv152
Somme, D., Lazarovici, C., Dramé, M., Blanc, P., Lang, P. O., Gauvain, J. B., Voisin, T., Gonthier, R., De Wazières, B., Jeandel, C., Couturier, P., Blanchard, F., & Saint-Jean, O. (2011). The geriatric patient: use of acute geriatrics units in the emergency care of elderly patients in France. Arch Gerontol Geriatr, 52(1), 40-45. https://doi.org/10.1016/j.archger.2010.01.018
Spector, W. D., Mutter, R., Owens, P., & Limcangco, R. (2012). Thirty-day, all-cause readmissions for elderly patients who have an injury-related inpatient stay. Med Care, 50(10), 863-869. https://doi.org/10.1097/MLR.0b013e31825f2840
Sri-On, J., Tirrell, G. P., Bean, J. F., Lipsitz, L. A., & Liu, S. W. (2017). Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients. Ann Emerg Med, 70(4), 516-521.e512. https://doi.org/10.1016/j.annemergmed.2017.05.023
Sri-On, J., Tirrell, G. P., Kamsom, A., Marill, K. A., Shankar, K. N., & Liu, S. W. (2018). A High-yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Acad Emerg Med, 25(8), 927-938. https://doi.org/10.1111/acem.13413
Stuck, A. E., Siu, A. L., Wieland, G. D., Adams, J., & Rubenstein, L. Z. (1993). Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet, 342(8878), 1032-1036. https://doi.org/10.1016/0140-6736(93)92884-v
Tan, M. P., Kamaruzzaman, S. B., Zakaria, M. I., Chin, A. V., & Poi, P. J. (2016). Ten-year mortality in older patients attending the emergency department after a fall. Geriatr Gerontol Int, 16(1), 111-117. https://doi.org/10.1111/ggi.12446
Theou, O., Campbell, S., Malone, M. L., & Rockwood, K. (2018). Older Adults in the Emergency Department with Frailty. Clin Geriatr Med, 34(3), 369-386. https://doi.org/10.1016/j.cger.2018.04.003
Tomata, Y., Hozawa, A., Ohmori-Matsuda, K., Nagai, M., Sugawara, Y., Nitta, A., Kuriyama, S., & Tsuji, I. (2011). [Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: the Ohsaki Cohort 2006 Study]. Nihon Koshu Eisei Zasshi, 58(1), 3-13.
Tsai, Y. C., Chen, Y. M., Wen, C. J., Wu, M. C., Chou, Y. C., Chen, J. H., Lin, K. P., Chan, D. C., & Lu, F. P. (2023). Multimorbidity and prior falls correlate with risk of 30-day hospital readmission in aged 80+: A prospective cohort study. J Formos Med Assoc. https://doi.org/10.1016/j.jfma.2023.03.009
Uchmanowicz, I., Kuśnierz, M., Wleklik, M., Jankowska-Polańska, B., Jaroch, J., & Łoboz-Grudzień, K. (2018). Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res, 30(6), 617-623. https://doi.org/10.1007/s40520-017-0824-6
Ukkonen, M., Jämsen, E., Zeitlin, R., & Pauniaho, S. L. (2019). Emergency department visits in older patients: a population-based survey. BMC Emerg Med, 19(1), 20. https://doi.org/10.1186/s12873-019-0236-3
van Dam, C. S., Labuschagne, H. A., van Keulen, K., Kramers, C., Kleipool, E. E., Hoogendijk, E. O., Knol, W., Nanayakkara, P. W. B., Muller, M., Trappenburg, M. C., & Peters, M. J. L. (2022). Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department. Eur Geriatr Med, 13(4), 849-857. https://doi.org/10.1007/s41999-022-00664-y
van Oostrom, S. H., van der, A. D., Rietman, M. L., Picavet, H. S. J., Lette, M., Verschuren, W. M. M., de Bruin, S. R., & Spijkerman, A. M. W. (2017). A four-domain approach of frailty explored in the Doetinchem Cohort Study. BMC Geriatr, 17(1), 196. https://doi.org/10.1186/s12877-017-0595-0
Vermeiren, S., Vella-Azzopardi, R., Beckwée, D., Habbig, A. K., Scafoglieri, A., Jansen, B., & Bautmans, I. (2016). Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc, 17(12), 1163.e1161-1163.e1117. https://doi.org/10.1016/j.jamda.2016.09.010
Verver, D., Merten, H., de Blok, C., & Wagner, C. (2019). A cross sectional study on the different domains of frailty for independent living older adults. BMC Geriatr, 19(1), 61. https://doi.org/10.1186/s12877-019-1077-3
Wahl, T. S., Graham, L. A., Hawn, M. T., Richman, J., Hollis, R. H., Jones, C. E., Copeland, L. A., Burns, E. A., Itani, K. M., & Morris, M. S. (2017). Association of the Modified Frailty Index With 30-Day Surgical Readmission. JAMA Surg, 152(8), 749-757. https://doi.org/10.1001/jamasurg.2017.1025
Wallis, S. J., Wall, J., Biram, R. W., & Romero-Ortuno, R. (2015). Association of the clinical frailty scale with hospital outcomes. Qjm, 108(12), 943-949. https://doi.org/10.1093/qjmed/hcv066
Wang, H. Y., Chew, G., Kung, C. T., Chung, K. J., & Lee, W. H. (2007). The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours. Chang Gung Med J, 30(5), 437-444.
Williamson, J., Stokoe, I. H., Gray, S., Fisher, M., Smith, A., McGhee, A., & Stephenson, E. (1964). OLD PEOPLE AT HOME. THEIR UNREPORTED NEEDS. Lancet, 1(7343), 1117-1120. https://doi.org/10.1016/s0140-6736(64)91803-3
Xu, L., Zhang, J., Shen, S., Liu, Z., Zeng, X., Yang, Y., Hong, X., & Chen, X. (2021). Clinical Frailty Scale and Biomarkers for Assessing Frailty in Elder Inpatients in China. J Nutr Health Aging, 25(1), 77-83. https://doi.org/10.1007/s12603-020-1455-8
Yamada, M., & Arai, H. (2018). Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults. J Am Med Dir Assoc, 19(12), 1099-1103. https://doi.org/10.1016/j.jamda.2018.09.013
Yiadom, M., Domenico, H. J., Byrne, D. W., Hasselblad, M., Kripalani, S., Choma, N., Tucker-Marlow, S., Gatto, C. L., Wang, L., Bhatia, M. C., Morrison, J., Harrell, F. E., Hartert, T. V., Lindsell, C. J., & Bernard, G. R. (2020). Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30): A Pragmatic Randomized Controlled Real-world Effectiveness Trial. Med Care, 58(9), 785-792. https://doi.org/10.1097/mlr.0000000000001353
Yorikawa, F., Ishikawa, J., Tamura, Y., Murao, Y., Toba, A., Harada, K., & Araki, A. (2023). Determinants of depressive symptoms in older outpatients with cardiometabolic diseases in a Japanese frailty clinic: Importance of bidirectional association between depression and frailty. PLoS One, 18(2), e0281465. https://doi.org/10.1371/journal.pone.0281465
Yu, S., Wang, J., Zeng, L., Yang, P., Tang, P., & Su, S. (2023). The prevalence of social frailty among older adults: A systematic review and meta-analysis. Geriatr Nurs, 49, 101-108. https://doi.org/10.1016/j.gerinurse.2022.11.009
Zachariasse, J. M., van der Hagen, V., Seiger, N., Mackway-Jones, K., van Veen, M., & Moll, H. A. (2019). Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open, 9(5), e026471. https://doi.org/10.1136/bmjopen-2018-026471
Zelis, N., Buijs, J., de Leeuw, P. W., van Kuijk, S. M. J., & Stassen, P. M. (2020). A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score. Eur J Intern Med, 77, 36-43. https://doi.org/10.1016/j.ejim.2020.02.021
Zeng, X. Z., Jia, N., Meng, L. B., Shi, J., Li, Y. Y., Hu, J. B., Hu, X., Li, H., Xu, H. X., Li, J. Y., Qi, X., Wang, H., Zhang, Q. X., Li, J., & Liu, D. P. (2022). A study on the prevalence and related factors of frailty and pre-frailty in the older population with hypertension in China: A national cross-sectional study. Front Cardiovasc Med, 9, 1057361. https://doi.org/10.3389/fcvm.2022.1057361
Zhang, X., Tan, S. S., Franse, C. B., Alhambra-Borrás, T., Durá-Ferrandis, E., Bilajac, L., Markaki, A., Verma, A., Mattace-Raso, F., Voorham, A. J. J., & Raat, H. (2019). Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Public Health, 29(5), 936-942. https://doi.org/10.1093/eurpub/ckz099
Zhang, X. M., Cao, S., Gao, M., Xiao, S., Xie, X., & Wu, X. (2023). The Prevalence of Social Frailty Among Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc, 24(1), 29-37.e29. https://doi.org/10.1016/j.jamda.2022.10.007
行政院主計總處. (2021). 國情統計通報（第037號）. Retrieved from https://www.stat.gov.tw/public/Data/132162358VPAVQ8D.pdf
周美香, 陳芬如, 邱群芳, & 林育德. (2019). 高齡住院病人衰弱現況及其影響因子. 榮總護理, 36(1), 27-38.
胡倍瑜, 游曉微, 邱慈穎, 林莉玲, 陳端容, & 陳雅美. (2019). Study of Osteoporotic Fractures (SOF Index) 衰弱量表的效度驗證-一般社區長者以及獨居長者的應用. 台灣公共衛生雜誌, 38(6), 648-659.
陳端容, & 陳雅美. (2020). 減緩老化衰弱的社會因素：「社會衰弱」(social frailty)的測量、變化趨勢及預測效果. https://www.grb.gov.tw/search/planDetail?id=13552397
衛生福利部統計處. (2021). 108年度全民健康保險醫療統計年報. Retrieved from https://www.mohw.gov.tw/dl-70641-33764b1d-b662-4c0c-b01a-e57bd6949084.html
鐘子婷, 陳端容, 陳秀熙, 葉彥伯, 張睿詒, 陳殷正, 陳鵬宇, & 陳雅美. (2020). 社區長者身, 心, 社會衰弱量表之切點初探: 以台北兩行政區為例. 台灣公共衛生雜誌, 39(6), 671-685.