Long-term Postinjury Functional Recovery: Outcomes of Geriatric Consultation | Geriatrics | JAMA Surgery | JAMA Network
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Author Lillian Min, MD, MSHS, discusses Long-term Postinjury Functional Recovery.

1.
Rzepka  SG, Malangoni  MA, Rimm  AA.  Geriatric trauma hospitalization in the United States: a population-based study.  J Clin Epidemiol. 2001;54(6):627-633.PubMedGoogle ScholarCrossref
2.
Campbell  PR.  Population Projections For States by Age, Sex, Race, and Hispanic Origin: 1995 to 2025: Population Projections Branch. Washington, DC: Population Division, US Bureau of the Census; 1996.
3.
Givens  JL, Sanft  TB, Marcantonio  ER.  Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium.  J Am Geriatr Soc. 2008;56(6):1075-1079.PubMedGoogle ScholarCrossref
4.
Close  J, Ellis  M, Hooper  R, Glucksman  E, Jackson  S, Swift  C.  Prevention of falls in the elderly trial (PROFET): a randomised controlled trial.  Lancet. 1999;353(9147):93-97.PubMedGoogle ScholarCrossref
5.
Taylor  MD, Tracy  JK, Meyer  W, Pasquale  M, Napolitano  LM.  Trauma in the elderly: intensive care unit resource use and outcome.  J Trauma. 2002;53(3):407-414.PubMedGoogle ScholarCrossref
6.
McKevitt  EC, Calvert  E, Ng  A,  et al.  Geriatric trauma: resource use and patient outcomes.  Can J Surg. 2003;46(3):211-215.PubMedGoogle Scholar
7.
Shabot  MM, Johnson  CL.  Outcome from critical care in the “oldest old” trauma patients.  J Trauma. 1995;39(2):254-259, discussion 259-260.PubMedGoogle ScholarCrossref
8.
van der Sluis  CK, Klasen  HJ, Eisma  WH, ten Duis  HJ.  Major trauma in young and old: what is the difference?  J Trauma. 1996;40(1):78-82. PubMedGoogle ScholarCrossref
9.
Perdue  PW, Watts  DD, Kaufmann  CR, Trask  AL.  Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.  J Trauma. 1998;45(4):805-810.PubMedGoogle ScholarCrossref
10.
Knudson  MM, Lieberman  J, Morris  JA  Jr, Cushing  BM, Stubbs  HA.  Mortality factors in geriatric blunt trauma patients.  Arch Surg. 1994;129(4):448-453.PubMedGoogle ScholarCrossref
11.
McGwin  G  Jr, MacLennan  PA, Fife  JB, Davis  GG, Rue  LW  III.  Preexisting conditions and mortality in older trauma patients.  J Trauma. 2004;56(6):1291-1296.PubMedGoogle ScholarCrossref
12.
DeMaria  EJ, Merriam  MA, Casanova  LA, Gann  DS, Kenney  PR.  Do DRG payments adequately reimburse the costs of trauma care in geriatric patients?  J Trauma. 1988;28(8):1244-1249.PubMedGoogle ScholarCrossref
13.
Schwab  CW, Kauder  DR.  Trauma in the geriatric patient.  Arch Surg. 1992;127(6):701-706.PubMedGoogle ScholarCrossref
14.
Ross  N, Timberlake  GA, Rubino  LJ, Kerstein  MD.  High cost of trauma care in the elderly.  South Med J. 1989;82(7):857-859.PubMedGoogle ScholarCrossref
15.
Covington  DL, Maxwell  JG, Clancy  TV.  Hospital resources used to treat the injured elderly at North Carolina trauma centers.  J Am Geriatr Soc. 1993;41(8):847-852.PubMedGoogle Scholar
16.
van Aalst  JA, Morris  JA  Jr, Yates  HK, Miller  RS, Bass  SM.  Severely injured geriatric patients return to independent living: a study of factors influencing function and independence.  J Trauma.1991;31(8):1096-1101; discussion 1101-1102. PubMedGoogle Scholar
17.
Glance  LG, Osler  TM, Dick  A, Mukamel  D.  The relation between trauma center outcome and volume in the National Trauma Databank.  J Trauma. 2004;56(3):682-690.PubMedGoogle ScholarCrossref
18.
Oreskovich  MR, Howard  JD, Copass  MK, Carrico  CJ.  Geriatric trauma: injury patterns and outcome.  J Trauma. 1984;24(7):565-572.PubMedGoogle ScholarCrossref
19.
Livingston  DH, Lavery  RF, Mosenthal  AC,  et al.  Recovery at one year following isolated traumatic brain injury: a Western Trauma Association prospective multicenter trial.  J Trauma. 2005;59(6):1298-1304, discussion 1304.PubMedGoogle ScholarCrossref
20.
Mosenthal  AC, Livingston  DH, Lavery  RF,  et al.  The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial.  J Trauma. 2004;56(5):1042-1048.PubMedGoogle ScholarCrossref
21.
Ruhm  CJ.  Commentary: mortality increases during economic upturns.  Int J Epidemiol. 2005;34(6):1206-1211.PubMedGoogle ScholarCrossref
22.
Jacobs  DG, Plaisier  BR, Barie  PS,  et al; EAST Practice Management Guidelines Work Group.  Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group.  J Trauma. 2003;54(2):391-416.PubMedGoogle ScholarCrossref
23.
McGwin  G  Jr, Melton  SM, May  AK, Rue  LW.  Long-term survival in the elderly after trauma.  J Trauma. 2000;49(3):470-476.PubMedGoogle ScholarCrossref
24.
Gillick  MR.  Rethinking the role of tube feeding in patients with advanced dementia.  N Engl J Med. 2000;342(3):206-210.PubMedGoogle ScholarCrossref
25.
Fried  TR, Bradley  EH, Towle  VR, Allore  H.  Understanding the treatment preferences of seriously ill patients.  N Engl J Med. 2002;346(14):1061-1066.PubMedGoogle ScholarCrossref
26.
Kurella Tamura  M, Covinsky  KE, Chertow  GM, Yaffe  K, Landefeld  CS, McCulloch  CE.  Functional status of elderly adults before and after initiation of dialysis.  N Engl J Med. 2009;361(16):1539-1547.PubMedGoogle ScholarCrossref
27.
Saliba  D, Orlando  M, Wenger  NS, Hays  RD, Rubenstein  LZ.  Identifying a short functional disability screen for older persons.  J Gerontol A Biol Sci Med Sci. 2000;55(12):M750-M756.PubMedGoogle ScholarCrossref
28.
Kelley-Quon  L, Min  L, Morley  E, Hiatt  JR, Cryer  H, Tillou  A.  Functional status after injury: a longitudinal study of geriatric trauma.  Am Surg. 2010;76(10):1055-1058.PubMedGoogle Scholar
29.
Kennie  DC, Reid  J, Richardson  IR, Kiamari  AA, Kelt  C.  Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial.  BMJ. 1988;297(6656):1083-1086.PubMedGoogle ScholarCrossref
30.
Marcantonio  ER, Flacker  JM, Wright  RJ, Resnick  NM.  Reducing delirium after hip fracture: a randomized trial.  J Am Geriatr Soc. 2001;49(5):516-522.PubMedGoogle ScholarCrossref
31.
Saliba  D, Elliott  M, Rubenstein  LZ,  et al.  The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.  J Am Geriatr Soc. 2001;49(12):1691-1699.PubMedGoogle ScholarCrossref
32.
Min  LC, Wenger  NS, Reuben  DB, Saliba  D.  A short functional survey is responsive to changes in functional status in vulnerable older people.  J Am Geriatr Soc. 2008;56(10):1932-1936.PubMedGoogle ScholarCrossref
33.
Baker  SP, O’Neill  B, Haddon  W  Jr, Long  WB.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.  J Trauma. 1974;14(3):187-196.PubMedGoogle ScholarCrossref
34.
American College of Surgeons.  National Trauma Data Bank Research Data Set Version 7.0 User Manual. Chicago, IL: American College of Surgeons; 2007.
35.
Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis. 1987;40(5):373-383.PubMedGoogle ScholarCrossref
36.
Malani  PN.  Functional status assessment in the preoperative evaluation of older adults.  JAMA. 2009;302(14):1582-1583.PubMedGoogle ScholarCrossref
37.
Min  LC, Elliott  MN, Wenger  NS, Saliba  D.  Higher vulnerable elders survey scores predict death and functional decline in vulnerable older people.  J Am Geriatr Soc. 2006;54(3):507-511.PubMedGoogle ScholarCrossref
38.
Min  L, Yoon  W, Mariano  J,  et al.  The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients.  J Am Geriatr Soc. 2009;57(11):2070-2076.PubMedGoogle ScholarCrossref
39.
Kempen  GI, Suurmeijer  TP.  The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders.  Gerontologist. 1990;30(4):497-502.PubMedGoogle ScholarCrossref
40.
Dudgeon  BJ, Hoffman  JM, Ciol  MA, Shumway-Cook  A, Yorkston  KM, Chan  L.  Managing activity difficulties at home: a survey of Medicare beneficiaries.  Arch Phys Med Rehabil. 2008;89(7):1256-1261.PubMedGoogle ScholarCrossref
41.
Demetriades  D, Karaiskakis  M, Velmahos  G,  et al.  Effect on outcome of early intensive management of geriatric trauma patients.  Br J Surg. 2002;89(10):1319-1322.PubMedGoogle ScholarCrossref
42.
Fallon  WF  Jr, Rader  E, Zyzanski  S,  et al.  Geriatric outcomes are improved by a geriatric trauma consultation service.  J Trauma. 2006;61(5):1040-1046.PubMedGoogle ScholarCrossref
43.
Glance  LG, Dick  A, Osler  TM, Mukamel  D.  Judging trauma center quality: does it depend on the choice of outcomes?  J Trauma. 2004;56(1):165-172.PubMedGoogle ScholarCrossref
44.
Agostini JV, Baker DI, Inouye SK, Bogardus ST. Multidisciplinary geriatric consultation services. In: Making Health Care Safer: A Critical Analysis of Patient Safety Practices: Evidence Report/Technology Assessment, No. 43: AHRQ Publication No. 01-E058. Rockville, MD: Agency for Healthcare Research and Quality; 2001. http://archive.ahrq.gov/clinic/tp/ptsaftp.htm. Accessed on April 3, 2013.
45.
Deschodt  M, Flamaing  J, Haentjens  P, Boonen  S, Milisen  K.  Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis.  BMC Med. 2013;11:48.PubMedGoogle ScholarCrossref
46.
Bachmann  S, Finger  C, Huss  A, Egger  M, Stuck  AE, Clough-Gorr  KM.  Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials.  BMJ.2010;340:c1718. PubMedGoogle ScholarCrossref
47.
Marcantonio  ER, Flacker  JM, Michaels  M, Resnick  NM.  Delirium is independently associated with poor functional recovery after hip fracture.  J Am Geriatr Soc. 2000;48(6):618-624.PubMedGoogle Scholar
48.
Rudolph  JL, Schreiber  KA, Culley  DJ,  et al.  Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review.  Acta Anaesthesiol Scand. 2010;54(6):663-677.PubMedGoogle ScholarCrossref
49.
Sager  MA, Franke  T, Inouye  SK,  et al.  Functional outcomes of acute medical illness and hospitalization in older persons.  Arch Intern Med. 1996;156(6):645-652.PubMedGoogle ScholarCrossref
50.
McCusker  J, Kakuma  R, Abrahamowicz  M.  Predictors of functional decline in hospitalized elderly patients: a systematic review.  J Gerontol A Biol Sci Med Sci. 2002;57(9):M569-M577.PubMedGoogle ScholarCrossref
51.
Sager  MA, Rudberg  MA, Jalaluddin  M,  et al.  Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization.  J Am Geriatr Soc. 1996;44(3):251-257.PubMedGoogle Scholar
52.
Wu  HY, Sahadevan  S, Ding  YY.  Factors associated with functional decline of hospitalised older persons following discharge from an acute geriatric unit.  Ann Acad Med Singapore. 2006;35(1):17-23.PubMedGoogle Scholar
Original Investigation
SURGICAL CARE OF THE AGING POPULATION
January 2014

Long-term Postinjury Functional Recovery: Outcomes of Geriatric Consultation

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
Abstract

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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