Frailty and Emergency Department Visits Among Chinese Middle-Aged and Older Adults: Implications for Nurse-Led Screening and Transitional Care

<title>Abstract</title> <p> Background Frailty is associated with increased healthcare utilization, yet evidence from Chinese populations—the world's largest and most rapidly aging population—remains limited. This study examined the association between frailty status and emergency department (ED) visits among Chinese adults aged 45 years and older using nationally representative data. Methods A cross-sectional analysis of 17,901 participants from the China Health and Retirement Longitudinal Study (CHARLS Wave 4 (2018) was conducted. A modified frailty phenotype based on self-reported CHARLS items was constructed using five components: weight loss, exhaustion, low physical activity, slowness, and weakness. Participants were classified as robust (0 components), prefrail (1–2), or frail (3–5). Logistic regression models examined the association between frailty (both continuous score and categorical status) and ED visits, adjusting for age, sex, and multimorbidity. Results <bold>The prevalence of frailty phenotypes was distributed as follows</bold> : 7.8% (n = 1,395) robust, 62.0% (n = 11,091) prefrail, and 30.2% (n = 5,415) frail. ED visit rates increased with frailty severity: 9.3% (robust), 14.2% (prefrail), and 23.2% (frail) (χ² = 273.8, p &lt; 0.001). After adjusting for age, sex, and multimorbidity, each unit increase in the frailty score was associated with 33.9% higher odds of ED visits (OR = 1.339, 95% CI: 1.289–1.392, p &lt; 0.001), demonstrating that frailty independently predicts ED utilization beyond chronic disease burden. Conclusions This study provides nationally representative evidence from China demonstrating a graded, dose-response association between frailty and ED visits among middle-aged and older adults, independent of multimorbidity. It validates a modified frailty phenotype operationalized entirely from self-reported items, facilitating assessment in large-scale surveys. the high prevalence of prefrailty (62.0%) identifies a substantial target population for early intervention. Geriatric nurses should integrate routine five-component frailty screening into community assessments and implement targeted transitional care protocols— <bold>ranging from risk stratification in the ED to post-discharge monitoring</bold> —to mitigate adverse outcomes in this vulnerable group. </p>