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Geriatric Consultation Improves Care, Outcomes for Elderly Trauma Patients

LOS ANGELES – Traumatic injuries, even relatively mild ones such as rib fractures, are much more complicated when they involve elderly patients, with the potential for pneumonia, higher complexity pain management and mobility issues, according to a new study.

Bringing in a geriatrician to consult can not only improve in-hospital care but assure better functioning when the patients return home, according to an article in press published online by the Journal of the American College of Surgeons. The reportwill appear in a print issue this spring.

"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," explained the study's lead author Lillian Min, MD, MSHS, assistant professor of geriatric and palliative medicine at the University of Michigan Health System.

To examine whether involving geriatric specialists early on could improve outcomes for older adult trauma patients, the researchers 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. Patients' previous level of functioning, family support, financial challenges, mobility and cognition were assessed in a collaborative effort involving geriatric medicine specialists and the trauma surgery team.

Patients in the intervention group were compared to a group of 71 similar patients who were admitted to the hospital the year before, from December 2006 to November 2007, and were not routinely offered geriatric consultation. Using medical records, they calculated detailed quality-of-care scores based on 33 indicators that measured how well the medical team provided care for the older patients in such areas as cognition, mobility and functional status.

"If someone's grandmother was admitted for trauma care after a fall, the quality indicators reflect whether the team asked about her functional status before the fall," Min explained. "Was she running up the stairs with a full load of laundry or was she already frail and struggling with mobility? Those are two different levels of functionality. We think that knowing this information is crucial to determining the patients' hospital course, recovery, and how well the team can make a safe discharge plan."

Results indicate that the group routinely offered geriatric consultation passed 74% of the quality indicators concerning geriatric care, while the group without geriatric consultation passed only 68% of them, a statistically significant difference.

In addition, the consultations improved care for cognition and delirium by 8.4 percentage points.

"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.