Severely Injured Geriatric Patients Return to Independent Living:: A Study of Factors Influencing Function and Independence

Our previous work demonstrated that geriatric trauma patients (age ≥ 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 ≥ 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 ≤ 7 (p = 0.001), age ≥ 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 ≥ 75, the presence of head injury and/or a GCS score ≤ 7, and sepsis.