Outcome From Serious Injury in Older Adults

Purpose: The purpose of this paper is to analyze the research published in peer-reviewed journals between 1996 and 2005 that examine factors affecting the physical outcomes of older adults after serious traumatic injury. Organizing Construct: 27 primary research studies published in the last 10 years describe in-hospital and long-term outcomes of serious injury among older adults. Research specific to isolated hip injury, traumatic brain injury and burn trauma was excluded. Methods: An integrative review of research published between January 1996 and January 2005 was carried out to examine the relationship between older age and outcome from severe injury. MEDLINE, BIOSIS previews, CINAHL and PsycINFO databases were searched using the MeSH terms: injury, serious injury, trauma and multiple trauma, and crossed with type, severity, medical/surgical management, complication, outcome, mortality, morbidity, survival, disability, quality of life, functional status, functional recovery, function, and placement. Findings: Older adults experience higher short and long-term mortality when compared to younger adults. The relationship between older age and poorer outcome persists when adjusting for injury severity, number of injuries, comorbidities, and complications. At the same time, injury severity, number of injuries, complications, and gender each independently correlate to increased mortality among older adults. The body of research is limited by over-reliance on retrospective data and heterogeneity in definitional criteria for the older adult population. Conclusions: Additional research is needed to clarify the contributory effect of variables such as psychosocial sequelae and physiologic resilience on injury outcome. The field of geriatric trauma would benefit from further population-based prospective investigation of the determinants of injury outcome in older adults in order to guide interventions and acute care treatment