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Geriatric consult after trauma can improve independence: study

Wednesday December 4, 2013
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Older patients who received extra geriatric care after a traumatic injury were able to return to more daily activities than those without a consultation, according to a recent small study.

Researchers from the University of Michigan Health System in Ann Arbor and the University of California, Los Angeles, tracked 122 patients ages 65 and older. These patients were admitted to a level 1 academic trauma center from 2006-10 after experiencing injuries varying in severity such as a minor rib fracture from a bad fall and a serious head injury or multiple fractures suffered as a driver, passenger or pedestrian in a vehicle accident.

Study participants were assigned to a control group (37 patients), who received standard hospital care for their injuries, or an intervention group (85 patients), who also met with a geriatrician during their hospital stays.

Researchers questioned the participants using the Short Functional Status survey of five activities of daily living at admission and three, six and 12 months after the injury. The survey asks patients about how well they were able return to independence in regular activities including walking, bathing, managing finances, light housework and simple shopping trips.

The patients who saw an additional geriatrician during their hospital stay were more independent a year later — most notably in their ability to leave the house to shop for personal items — according to the findings, published Nov. 27 on the website of JAMA Surgery.

“Trauma surgeons have long struggled with the fragility of their older trauma patients who have much greater health risks for the same injuries experienced by younger patients,” Lillian Min, MD, MSHS, assistant professor of internal medicine, Division of Geriatric Medicine at U-M Medical School and senior author, said in a news release. “We’ve come a long way in improving our survival rates of these patients, but what we didn’t know was whether we were returning them to their homes and communities sicker than they were before.

“What we found was that geriatric interventions helped older patients take better care of themselves and be more independent,” Min said in the release.

Based on the SFS survey scores, patients who had a consult were able to complete 0.67 more ADLs than those who did not, according to the study.

Adults ages 65 and older are estimated to make up 40% of all trauma patients during the next four decades, as the population ages. Overall, senior patients who had been hospitalized for a trauma injury were not able to return to all of the daily tasks they had been doing before, the study found. Most of the new impairments were in shopping for personal items, which is the one activity performed out of the home. This difficulty may reflect fatigue, physical disability or fear of going out, the authors wrote.

Participants who received the intervention had access to geriatricians who were able to discontinue unnecessary medications, avoid medications older patients are sensitive to, promote physical rehabilitation, prevent delirium and pay attention to where patients lived and who their caretakers were. Those in the intervention group were more likely to retain the ability to shop for personal items than were those in the control group. Even when researchers controlled for factors such as age, sex, length of stay, race and ethnicity, comorbidities, injury severity, rehabilitation and whether surgery took place, patients who received an extra geriatrician consult had better recovery of function than those who did not.

“This information compels us to do more to help our older patients get back to normal life,” Min said in the release. “Our findings suggest that even small changes in care can lead to decreased complications and improve health outcomes for a vulnerable group.”

Study abstract: http://archsurg.jamanetwork.com/article.aspx?articleid=1782087


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