Are Elderly Trauma Patients Getting Short-changed?

As the population of elderly citizens continues to increase, trauma centers are being challenged to provide these patients with same quality of care that younger patients receive during a medical emergency. Research published in the Annals of Surgery indicates that that trauma centers that excel in the care of severely injured young patients do not necessarily provide the same quality of care to elderly ones.

The study, which utilized the American College of Surgeons National Trauma Databank, also cited growing evidence that elderly injured patients have unique needs, and helped the investigators identify some ways in which trauma centers can improve their care of the elderly. Researchers analyzed data on 87,754 trauma patients of all ages treated at 132 facilities in Canada and the US; about one in four patients were elderly.

Lead researcher Avery B. Nathens, MD, PhD, of St. Michael’s Hospital, University of Toronto, and colleagues compared the performance of the 132 facilities, and identified centers with both the highest and lowest death rates. When patients in all age groups were studied together, 14 centers were high performers, with lower than expected rates of death. When young and elderly patients were considered separately, seven centers were high performers for young patients, and nine were high performers for the elderly. However, there was little overlap: only two centers were high performers for both the young and the elderly.

“In the study we showed that although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly,” said investigator Barbara Haas, MD, in a press release. “We’ve shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care.”

Elderly patients, for example, are more likely to have coexisting diseases than younger patients, according to Nathens. “The elderly patients often have heart disease, lung disease, diabetes, and might be on blood thinners,” he said. “All of these things need to be addressed at the same time the injuries are cared for.” Elderly patients are also more likely to have reduced organ function, what physicians describe as “physiologic reserve,” he said, further complicating their ability to recover from injuries.

The researchers found that elderly patients seen in trauma centers were mostly women and were more likely to have blunt injury, specifically from falls. Severe head and leg injuries were also more predominant in this patient population.

Nathens pointed to two potential approaches that may lead to better results among elderly trauma patients. One involves putting intensive care patients under the care of an intensivist once he or she is moved from the emergency room to the ICU. The second involves more frequent use of the expertise of geriatricians who specialize in the care of the elderly. “The collaboration between a trauma surgeon, intensivist and a geriatric specialist would provide all the critical resources to ensure the best possible care for these patients,” Nathens said. “These factors, along with an understanding that these patients have unique needs, would go a long way to improving their quality of care.”

Future studies, said the researchers, should focus on identifying specific processes that can improve trauma care for the elderly, and on what happens to elderly trauma patients after discharge from the hospital.