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Published on: September 30, 2020
Associations between impaired intrinsic capacity and emergency room visits among community-dwelling older adults
Wen-Hsuan Hou1, Nguyen Thanh Nhu2, Jia-Ni Xie3
1Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochran Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Background:
Emergency room (ER) visits in older adults are associated with increased morbidity and mortality. The World Health Organization's Integrated Care for Older People (ICOPE) framework assesses intrinsic capacity (IC), but the association between IC impairments and ER visit risk remains underexplored. This study examined whether IC impairments were associated with ER visits among community-dwelling older adults.
Methods:
This retrospective cohort study used Taiwan's Integrated Care for Older People (ICOPE) database linked to National Health Insurance claims and the Death Registry. A total of 244,899 adults aged ≥65 years were followed from 2022 to 2023. Six IC domains (cognition, mobility, vitality, vision, hearing, and psychological well-being) were assessed. IC impairment severity was categorized as low (0 impairments), moderate (1-2 impairments), or high (≥3 impairments). Latent class analysis (LCA) identified IC impairment patterns. Poisson regression estimated rate ratios (RRs), adjusting for confounders.
Results:
Over 213,528 person-years, 96,889 ER visits occurred (453.75/1,000 person-years). Impairments in all six IC domains were significantly associated with higher ER visit risk, with malnutrition showing the strongest association (aRR = 1.27, 95% CI: 1.24-1.31). Greater IC impairment severity was associated with higher ER visit risk. Five IC impairment patterns were identified, and the "impairments in all domains" group had the highest risk (aRR = 1.47, 95% CI: 1.41-1.54).
Conclusion:
IC impairments, particularly greater impairment severity, were associated with a higher risk of ER visits. Routine ICOPE assessment in community and primary care settings may help identify at-risk older adults early and guide targeted, integrated interventions, with closer follow-up for those with multiple impairments.
