Asan Medical Center Develops Korea’s First “Acute Care for Elders Risk Score” to Identify Early Risk in Elderly Inpatients

Clinical Data from More Than 20,000 Inpatients Analyzed with Machine Learning to Identify Key Predictive Factors

“A Practical Tool That Can Be Immediately Applied in Clinical Settings Without Complex Tests or Equipment”

▲ (From left) Professors Eunju Lee and Ji Yeon Baek, along with Clinical Fellow Geon Young Jang from the Division of Geriatrics at Asan Medical Center

Elderly patients are often vulnerable to various risks during hospitalization, such as delirium, falls, and complications. A patient assessment model developed by Korean researchers now makes it possible to accurately predict major risk factors on the very first day of admission in 8 out of 10 elderly patients.

Professors Eunju Lee and Ji Yeon Baek, along with Clinical Fellow Geon Young Jang from the Division of Geriatrics at Asan Medical Center, have developed Korea’s first “Acute Care for Elders Risk Score,” a tool that quantitatively evaluates the likelihood of common risks in patients aged 65 and older on the first day of hospitalization.

The Acute Care for Elders Risk Score is expected to play a significant role in improving patient outcomes by rapidly identifying high-risk elderly patients, accurately assessing their prognosis and potential for deterioration, and enabling focused management and care.

At Asan Medical Center, about 40 percent of inpatients are aged 65 and older, and the proportion of elderly patients has been increasing by around 1.5 percent each year. In particular, as a tertiary hospital, the center treats a relatively high proportion of critically ill elderly patients.

To address this, Asan Medical Center took the lead in Korea by introducing the Clinical Frailty Scale (CFS) to screen high-risk elderly patients at an early stage. However, since the tool primarily focused on assessing patients’ mobility, it did not fully utilize a wide range of clinical data and left room for evaluator subjectivity, which limited its predictive power.

In response, the geriatrics research team at Asan Medical Center worked to develop a new assessment tool by integrating the Clinical Frailty Scale with additional clinical data, aiming to more accurately predict major risk factors in elderly patients such as delirium, falls, pressure ulcers, and in-hospital mortality.

The research team analyzed clinical data from 21,757 patients aged 65 and older who were admitted to Asan Medical Center between May 2021 and November 2023. Using machine learning techniques, they reviewed 18 variables available in the electronic medical record (EMR) system on the first day of hospitalization.

The analysis identified five key predictors: ▲Clinical Frailty Scale ▲serum albumin level (nutrition and immunity) ▲C-reactive protein (CRP) level (inflammatory response) ▲hemoglobin level (anemia) ▲number of medications taken prior to admission. Based on these indicators, the team developed the Acute Care for Elders Risk Score and compared its predictive performance with existing tools such as the Clinical Frailty Scale and age.

As a result, the Acute Care for Elders Risk Score developed by the research team demonstrated excellent predictive performance, with an accuracy rate of 83.7 percent in forecasting risk factors among elderly patients. In comparison, the Clinical Frailty Scale showed an accuracy of 79.8 percent, while age alone achieved only 63 percent.

The Acute Care for Elders Risk Score further stratifies risk levels even among patients with the same Clinical Frailty Scale score. In other words, it precisely identifies which patients within the same “frail” category are at higher risk.

In addition, the study found that higher Acute Care for Elders Risk Scores were associated with increased risks of 30-day readmission, emergency department revisits, prolonged hospital stays, and rapid response team activations.

Asan Medical Center has integrated the Acute Care for Elders Risk Score into its medical information system and is now applying it in clinical practice. Physicians across departments can review the results in real time and establish tailored treatment plans, enabling faster and more systematic responses for high-risk patients.

▲ Professor Ji Yeon Baek (second from left) of the Division of Geriatrics at Asan Medical Center and the medical team assess the frailty level of an elderly inpatient while observing the patient’s mobility.

Professor Eunju Lee of the Division of Geriatrics at Asan Medical Center stated, “It is difficult to determine whether elderly patients are high risk based solely on their disease or age. The Acute Care for Elders Risk Score helps stratify potential risks and enables a more precise assessment. This allows medical staff to quickly identify patients who require intensive management and provide appropriate treatment.”

Professor Ji Yeon Baek of the Division of Geriatrics at Asan Medical Center said, “The Acute Care for Elders Risk Score is a practical tool that can be applied immediately in clinical settings without the need for complex tests or equipment. We hope it will become a new standard in elderly patient care in Korea, helping patients receive safe treatment and recover in good health without complications.”

The findings of this study were published in the latest issue of the ‘Journal of the American Medical Directors Association’ (JAMDA), one of the world’s most prestigious journals in geriatric medicine, ranking within the top 5 percent of the field.

Meanwhile, Asan Medical Center is operating an integrated care system tailored for elderly patients to enhance the quality of geriatric medical services, supporting both treatment and care from admission through post-discharge. Recently, the center filed a trademark application for this program under the name ‘WithONE,’ which is establishing itself as a comprehensive care model for critically ill elderly patients.