Major trauma in the elderly: Frailty decline and patient experience after injury

Abstract

IntroductionThe prevalence of major trauma in the elderly is increasing with ageing western societies. Frailty is now a well-recognised predictor of poor outcome after injury; however, few studies have focused on the progression of frailty and patients’ perceptions of their injuries after discharge.AimWe hypothesised that the number of elderly patients that survive major trauma is low and, of those that do, frailty post injury worsens with overall negative views about quality of life. To investigate this, we examined mortality, frailty and patient experience for elderly major trauma admissions to a level 1 trauma centre at one year after admission.MethodAll consecutive patients > 75 with an injury severity score of > 15 were included in the study. Patients were invited to participate in a structured telephone interview to assess change in frailty status as well as assess patient experience after injury.ResultsA total of 79 patients met inclusion criteria; 34 patients had died and 17 were uncontactable; 88% had become more frail (p < 0.05), and more than half commented positively on their overall quality of life following injury.ConclusionsThese findings highlight the elevated mortality in elderly major trauma patients, but also indicate that preconceived opinions on quality of life, post injury, might not be appropriate.

New Horizons in Understanding Appropriate Prehospital Identification and Trauma Triage for Older Adults

“…Only one study from the UK assessed frailty during follow-up period and showed that patients aged >75 years with major trauma (Injury Severity Score [ISS] >15) had significant worsening of frailty at one-year after injury compared to pre-injury (8% of the study group were frail at pre-injury phase compared to 46% at one-year post injury). 48 It also reported that 57% had positive comments on their mental health, quality of life, and functional status whereas 29% of the participants have negative comments on the same aspects at one-year following major trauma. 48 Inaba et al 49 showed a significant decline in seven of eight health domains using the 36-item Short Form survey (SF-36) at 2.8 years after trauma for trauma patients aged ≥65 years compared to non-injured residents of the same age ( Table 2 ).…”

“… 48 It also reported that 57% had positive comments on their mental health, quality of life, and functional status whereas 29% of the participants have negative comments on the same aspects at one-year following major trauma. 48 Inaba et al 49 showed a significant decline in seven of eight health domains using the 36-item Short Form survey (SF-36) at 2.8 years after trauma for trauma patients aged ≥65 years compared to non-injured residents of the same age ( Table 2 ).…”

Frailty in Clinical Care

“…1 Integration of frailty models using the Golden Gate Bridge analogy. (Used with permission from the Journal of the American Geriatric Society) including mortality, morbidity, functional decline, and major adverse cardiac and cerebrovascular events (Sepehri et al 2014;Kim et al 2016) In critical care settings, frailty is common and is clearly associated with worse outcomes (Muscedere et al 2017;Koizia et al 2019).…”

Frailty and length of stay in older adults with blunt injury in a national multicentre prospective cohort study

“…As populations age and life expectancies increase, trauma in the elderly has more than doubled within the last decade [ 1 ]. This is a common cause of death [ 2 ], with low falls being the most common mechanism of injury (MOI), followed by motor vehicle accidents (MVAs) and high falls [ 1 , 2 ]. Although there are varying definitions of low fall such as <2 meters and patient height [ 2 ], a lower definition of <0.5 meters has been proposed [ 3 – 5 ], in keeping with video-capture studies demonstrating that most falls in the elderly happen from the seated or standing position [ 3 ].…”

“…This is a common cause of death [ 2 ], with low falls being the most common mechanism of injury (MOI), followed by motor vehicle accidents (MVAs) and high falls [ 1 , 2 ]. Although there are varying definitions of low fall such as <2 meters and patient height [ 2 ], a lower definition of <0.5 meters has been proposed [ 3 – 5 ], in keeping with video-capture studies demonstrating that most falls in the elderly happen from the seated or standing position [ 3 ]. In previous studies, we found that low falls were associated with higher readmission and mortality rates compared to higher-velocity mechanisms such as MVAs [ 4 , 5 ].…”