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Abstract
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 quantitative summary of an individual’s health status. This dissertation comprises three studies presented with a three-manuscript model that examine how structured data from electronic medical records might be used to identify older adults with an elevated risk of experiencing adverse events. The first manuscript 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 manuscript leverages longitudinal frailty measures to explore frailty transitions in a unique healthcare context to inform strategies that may prevent or delay progression to frailty or even reverse 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.