Severely injured geriatric patients return to independent living: a study of factors influencing function and independence
van Aalst, J.A.; Morris, J.A.; Yates, H.K.; Miller, R.S.; Bass, S.M.
Journal of Trauma 31(8): 1096
1991
ISSN/ISBN: 0022-5282 PMID: 1875435 Document Number: 368013
Our previous work demonstrated that geriatric trauma patients (age .gtoreq. 65 years) consume disproportionate amounts of health care resources. In the past, we hypothesized that late mortality is high, long-term outcome is poor, and return to independence is low in a severely injured geriatric population. Of 6,480 trauma admissions over 5 years, geriatric patients (n = 495) with blunt trauma injury (n = 421) and an ISS .gtoreq. 16 (n = 105) who survived until discharge (n = 61) underwent long-term follow-up (mean = 2.82 years). We surveyed 20 measures of functional ability; 10 measures of independence; availability and use of rehabilitation resources; employment history; alcohol use; support systems; and nursing home requirements. Of the 105 patients, 7 were subsequently lost to follow-up. Among the remaining 98, 44 (44.9%) died in hospital and 54 (55.1%) were discharged and interviewed. The mean age of the contacted patients was 72.6; their mean ISS was 23.3. Forty eight of 54 (88.9%) were alive at the time of interview, while 6/54 (11.1%) had died. Although only 8/48 patients regained their preinjury level of function, 32/48 (67%) returned to independent living. The 32 independent patients, those with "acceptable" outcome, were compared with an "unacceptable" outcome group composed of the 44 in-hospital deaths, the 6 late deaths, and the 16 dependent patients. Factors associated with poor outcome include a GCS score .ltoreq. 7 (p = 0.001), age .gtoreq. 75 (p = 0.004), shock upon admission (p = 0.014), presence of head injury (p = 0.03), and sepsis (p = 0.03). Conclusions: (1) The majority of severely injured geriatric patients who survive their injury return to a level of independence; (2) factors associated with poor long-term outcome include shock upon admission, age .gtoreq. 75, the presence of head injury and/or a GCS score .ltoreq. 7, and sepsis.