Elderly patients who are admitted to the hospital for monitoring and surgical treatment of traumatic injuries could have better geriatric care if medical teams took one extra step by offering geriatric consultation, according to new research findings from surgical and geriatric medicine teams at the Ronald Reagan University of California at Los Angeles Medical Center.
Carol Roth, MPH, RN, a project associate at RAND Corporation, Santa Monica, Calif., is one of the authors of the study published online in the Journal of the American College of Surgeons, according to a news release. The article is scheduled to appear in a print edition this spring.
When a person over age 65 comes to the emergency room most commonly for severe injuries due to falls, according to the Centers for Disease Control and Prevention the most severely injured receives care from the trauma surgery team during his or her stay at the hospital. He will be monitored for any subsequent injuries like internal bleeding, and then usually discharged.
Trauma teams are generally good at making sure a range of specialists get involved like neurologists and orthopedists, but typically there is no geriatrician involved, the studys lead author Lillian Min, MD, MSHS, assistant professor of geriatric and palliative medicine at the University of Michigan Health System, said in the release.
Many hospitals, however, dont have a geriatric medicine team. If they do have geriatricians, they are typically consulted very late in the hospital course, sometimes on the day of discharge, said Min, who was on the geriatric medicine team at UCLA during the study.
Generally, older patients dont do as well as younger patients after traumatic injuries, Min said in the release. In fact, adults over age 65 are the only age group to see an increase in hospital admissions related to trauma, the study authors wrote. Even for something as simple as several rib fractures, an older patient would require a longer stay due to complications such as pneumonia, needing more pain management or more attention to helping them to walk and return home again, than a younger patient with the same injury, said Min in the release.
The research team wanted to examine whether involving geriatric specialists early on could improve outcomes for older adult trauma patients. They offered routine geriatric consultations to 76 patients over age 65 who were admitted to UCLA for trauma care for longer than 24 hours between December 2007 and November 2009, according to the release. Geriatric medicine specialists collaborated with the trauma surgery team to assess the patients previous level of functioning, family support, financial challenges, mobility and cognition.
This study is just a start, but the take-home message is that by involving geriatric consultations early on, we could detect that overall care was better, Min said in the release.
Ideally, more hospitals would have geriatric specialists available to assess frail older adults who are admitted for trauma care, as part of an overall strategy to avoid treatment complications and readmissions. Still, families of older adults can request a geriatric specialist, if one is available at the hospital, Min said in the release.
Min said that families often realize the need for such care if their aging family members come home from the hospital too soon. Then, these patients have to go back to the hospital because their pain is not under control, medications arent properly reconciled, or more therapy is needed to restore mobility and function.
This study was funded by the National Institutes of Aging, through grants to UCLA and the University of Michigan, which are both Claude D. Pepper Older Americans Independence Centers for geriatric
Other study authors are Henry Cryer, MD, PhD, FACS; Chiao-Li Chan, MSW and Areti Tillou, MD, MSEd, FACS.
For more information
Citation: Quality of Care Delivered Before Versus After a Quality Improvement Intervention for Acute Geriatric Trauma. Journal of American College of Surgeons.
To see study, visit http://dx.doi.org/10.1016/j.jamcollsurg.2014.12.041.