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Original Investigation | SURGICAL CARE OF THE AGING POPULATION

Long-term Postinjury Functional Recovery:  Outcomes of Geriatric Consultation

Areti Tillou, MD, MSEd1; Lorraine Kelley-Quon, MD1; Sigrid Burruss, MD1; Eric Morley, MPH2; Henry Cryer, MD, PhD1; Marilyn Cohen, RN1; Lillian Min, MD, MSHS3
[+] Author Affiliations
1Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles
2Boston University School of Medicine, Boston, Massachusetts
3Division of Geriatrics, University of Michigan Medical School, Ann Arbor
JAMA Surg. 2014;149(1):83-89. doi:10.1001/jamasurg.2013.4244.
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Published online

Importance  Functional recovery is an important outcome following injury. Functional impairment is persistent in the year following injury for older trauma patients.

Objective  To measure the impact of routine geriatric consultation on functional outcomes in older trauma patients.

Design, Setting, and Participants  In this pretest-posttest study, the pretest control group (n = 37) was retrospectively identified (December 2006-November 2007). The posttest geriatric consultation (GC) group (n = 85) was prospectively enrolled (December 2007-June 2010). We then followed up both groups for 1 year after enrollment. This study was conducted at an academic level 1 trauma center with adults 65 years of age and older admitted as an activated code trauma.

Intervention  Routine GC.

Main Outcomes and Measures  The Short Functional Status survey of 5 activities of daily living (ADLs) at hospital admission and 3, 6, and 12 months postinjury.

Results  The unadjusted Short Functional Status score (GC group only) declined from 4.6 preinjury to 3.7 at 12 months postinjury, a decline of nearly 1 full ADL (P < .05). The ability to shop for personal items was the specific ADL more commonly retained by the GC group compared with the control group. The GC group had a better recovery of function in the year following injury than the GC group, controlling for age, sex, race/ethnicity, length of stay, comorbidity, injury severity, postdischarge rehabilitation, complication, and whether surgery was performed (P < .01), a difference of 0.67 ADL abilities retained by the GC group compared with the control group (95% CI, 0.06-1.4).

Conclusions and Relevance  Functional recovery for older adults following injury may be improved by GC. Early introduction of multidisciplinary care in geriatric trauma patients warrants further investigation.

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Figure 1.
Data Flow of Retrospective Control Group vs Prospective Geriatric Consult Group
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Figure 2.
Change in Functional Ability After Injury

There were 122 unique patients in the model who were observed at 3 months (n=86), 6 months (n=87), and 12 months (n=92). ADL indicates activity of daily living.aBootstrapped 95% CIs around the 12-month mean ADL-count change from baseline for the consultation group (−0.35 to −1) vs the control group (−1.05 to −1.8) were nonoverlapping.

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