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Citation
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Maxwell CA, Mion LC, Mukherjee K, Dietrich MS, Minnick A, May A, Miller RS. J. Trauma Acute Care Surg. 2015; 80(2): 195-203. |
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Affiliation
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Vanderbilt University School of Nursing, 461 21st Ave. S. Nashville, TN 37240, Cathy.maxwell@vanderbilt.edu Vanderbilt University School of Nursing, 461 21st Ave. S. Nashville, TN 37240, lorraine.c.mion@vanderbilt.edu Loma Linda University, 11234 Anderson St. Loma Linda, CA, 92350, kmukherjee@llu.edu Vanderbilt University, 461 21st Ave. S. Nashville, TN, 37240, mary.dietrich@vanderbilt.edu Vanderbilt University School of Nursing, 461 21st Ave. S. Nashville, TN 37240, ann.minnick@vanderbilt.edu Vanderbilt University School of Medicine, 1211 21st Ave. S. Nashville, TN 37212, Addison.may@vanderbilt.edu Vanderbilt University School of Medicine, 1211 21st Ave. S. Nashville, TN 37212, Richard.miller@vanderbilt.edu. |
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Abstract
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BACKGROUND: Injury is an external stressor that often initiates a cycle of decline in many older adults. The influence of physical frailty and cognitive decline on 6 month and 1 year outcomes after injury is unreported. We hypothesized that physical frailty and cognitive impairment would be predictive of 6-month and 1-year post-injury function and overall mortality.
METHODS: Sample: Patients ≥ age 65 admitted to a level I trauma center between October 2013 and March 2014 with a primary injury diagnosis. PROCEDURE: Surrogates of 188 patients were interviewed within 48 hours of hospital admission to determine pre-injury cognitive and physical frailty impairments using brief screening instruments. Follow-up was completed on 172 patients at 6 months and 176 patients at 1 year to determine post-hospitalization status and outcomes. DATA ANALYSIS: frequencies, measures of central tendency, Chi-Square analyses, linear and logistic regression.
RESULTS: Mean age: 77, Median ISS: 10, Mechanism: falls from standing: n=101, 54%, Pre-injury vulnerabilities: cognitive impairment (AD8 ≥ 2): n=93, 50%, physical frailty (VES-13 ≥ 4): n= 94, 50%. Overall, median physical frailty scores did not return to baseline in the majority of survivors at 1 year. Multivariate regression analysis revealed that pre-injury cognitive impairment (6 months: AD8: Beta = -0.20 [p=0.002]) and [pre-injury physical frailty (6 months: Barthel Index: Beta=0.60 [p < 0.001]; 1 year: Barthel Index: Beta= 0.52 [p<0.001]) are independently associated with physical function (frailty). Multivariate logistic regression analysis revealed that age (O.R. 1.08 [CI 1.04-1.14]]), injury severity (O.R. 1.03 [CI 1.02-1.12]) and pre-injury physical frailty (O.R. 1.28 [CI 1.14-1.47]) are independently associated with overall mortality at 1 year.
CONCLUSIONS: Pre-injury physical frailty is the predominant predictor of post-injury functional status and mortality in geriatric trauma patients. Identification of frailty and appropriate follow-up are crucial for decision-making by providers, patients and family caregivers. LEVEL OF EVIDENCE: Level II STUDY TYPE: Prospective cohort longitudinal study.
Language: en |