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American Journal of Critical Care. 2006;15: 158-165
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A Feasibility Study of Methodological Issues and Short-Term Outcomes in Seriously Injured Older Adults

By Therese S. Richmond, PhD, CRNP, Hilaire J. Thompson, PhD, CRNP, CNRN, Donald Kauder, MD, Keith M. Robinson, MD and Neville E. Strumpf, PhD. From School of Nursing (TSR, NES), Division of Traumatology and Surgical Critical Care (DK) and Department of Rehabilitation Medicine (KMR), School of Medicine, University of Pennsylvania, Philadelphia, Pa, and Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Wash (HJT).

• Background For any given traumatic injury, older adults experience a longer hospitalization, more complications, and higher mortality than do younger patients.

• Objectives To prospectively identify problems in designing follow-up studies in seriously injured older adults without head injury and to examine outcomes after serious trauma in older adults who were sent to a level I trauma center.

• Methods A short-term descriptive follow-up design was used in which each patient served as his or her baseline. Eligible patients had injuries that required admission to an intensive care unit, a hospital length of stay longer than 72 hours, or surgery. Patients with isolated hip fractures, central nervous system injuries, and burn injuries were excluded. Data were collected by using standardized instruments during the acute hospital stay and 3 months after discharge from the hospital.

• Results During a representative 2-month period, 21% of a potential 77 subjects died in the hospital, 44% had cognitive impairment that precluded participation, and 17% declined to participate. Twenty older adults (mean age 73.5 years) who were injured in motor vehicle crashes (45%), falls (35%), or pedestrian accidents (15%) or who had gunshot wounds (5%) were enrolled. Ten percent died after discharge. Levels of physical disability at 3 months after discharge were higher than those before the injury (score on Sickness Impact Profile physical subscale 24.5 vs 10.9, P = .02), and psychological distress (Impact of Event Scale score 20.9) remained elevated.

• Conclusion Mortality, disability, and posttraumatic psychological distress after discharge are problems in seriously injured older adults.






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