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Elderly trauma victims likely to receive low quality care

Kathleen Blanchard's picture

Elderly trauma victims do not always receive the same quality of care as younger injured patients, found in a new study.

Researchers from the American College of Surgeons (ACS) National Trauma Databank (NTDB) investigated differences in trauma care between elders and younger trauma victims, finding disparities among hospitals. Elders are more likely to receive lower quality of care than younger trauma victims.

The researchers included U.S. trauma centers in the study and one in Canada. According to investigator Barbara Haas, MD, of St. Michael’s Hospital, University of Toronto, “We’ve shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care.” She notes that although overall performance among some of the hospitals was good, "these same centers might not be providing the same high-quality care to the elderly.”

Avery B. Nathens, MD, PhD, FACS, also of St. Michael’s Hospital, University of Toronto. “Today trauma centers are seeing a lot more elderly patients. He says what they are finding is that trauma centers caring for elders need to take a different approach.

In the study, only two trauma centers were found to deliver the same quality of care to both younger injured patients and elderly victims of injury, in an investigation of 132 hospitals. In all age groups, 14 hospitals were considered high performers for delivering trauma care that included lower rates of death.

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When the researchers separated care given to younger trauma victims, seven centers were high performers for young patients, and nine were high performers for treating elderly trauma victims.

Dr. Nathens explained. “The elderly patients often have heart disease, lung disease, diabetes, and might be on blood thinners.”, all of which require a different approach than treating younger injured populations.

Most of the elderly trauma victims seen at hospitals were women with blunt trauma from falls. The most common were severe head injuries and leg injuries.

Improving care for elderly trauma victims could be accomplished by engaging geriatricians after admission. Nathens also suggests placing elders under the care of an intensive care specialist in the ICU. He says, “The collaboration between a trauma surgeon, intensivist and a geriatric specialist would provide all the critical resources to ensure the best possible care for these patients."

The new study shows elderly trauma victims are not receiving the same quality of care as younger injured patients. The study authors say more research is needed to understand what can be done to improve elder trauma care. They also say there is a need to find out how elderly patients fare after being discharged from the hospital.

Haas, Barbara; Gomez, David; Xiong, Wei; Ahmed, Najma; Nathens, Avery B.
Annals of Surgery. 253(1):144-150, January 2011.
doi: 10.1097/SLA.0b013e3181f9be97
"External Benchmarking of Trauma Center Performance: Have We Forgotten Our Elders?"