OLDER PEOPLE ARE NOT ALL THE SAME: LESSONS FROM A MAJOR TRAUMA DATABASE
Authors: Sammy I , Lecky F , O'Cathain A 
Published: November 2016

Objectives & Background

While there is extensive research on the differences between older and younger patients with serious injuries, little is known about variations within the older age group. However, increased frailty over the age of 85 suggests that these ‘oldest old’ patients are likely to be significantly different to younger seniors.

Methods

The aim of this study was do determine whether the demographic, premorbid and injury characteristics of older patients (aged ≥65) varied with age. A cross-sectional study of of patients from the Trauma Audit and Research Network (TARN) admitted between June 2013 and May 2015 was undertaken, comparing those aged 65 to 74; 75–84 and ≥85 years old. Demographic, premorbid and injury characteristics were compared using Chi-squared analysis, while multiple logistic regression was used to calculate risk adjusted mortality, utilising the PS14 TARN predictive model.

Results

51,491 patients on the TARN database were eligible for inclusion. Of these, 18,664 (36.3%) were≥85 years; 19,157 (37.2%) 75–84 years and 13670 (26.5%) 65–74 years. Patients ≥85 years were significantly more likely to be female (68.8% vs 46.6% aged 65–74 years, p<0.001) and suffer low level falls (89.0% vs 63.0% aged 65–74 years, p<0.001). These patients were also more likely to have multiple comorbidities, with a median Charlson comorbidity score of 4 (IQR 0–5) compared to a median CCI of 0 (IQR 0–4) in patients aged 65–74 years. Despite having the lowest median injury severity scores, patients aged ≥85 years had significantly higher crude mortality rates (12.9% vs 5.9% in patients aged 65–74 years). Risk adjusted mortality was also highest in patients ≥85 years, with an adjusted odds ratio of 4.55 (95% CI 3.87–5.35) compared to patients aged 65–74 years.

Conclusion

There are significant variations in the demographic, comorbid and injury characteristics between different age groups of older trauma patients, which are associated with marked differences in crude and risk adjusted mortality. The most senior (over 85) were the most likely to sustain major trauma and the least likely to survive.

Table 1

Characteristic of Older Trauma Patients

  65–74 years75–84 years>=85 yearsTotalp ValueTotal 13670 (26.5%)19157 (37.2%)18664 (36.3%)51491 (100%) GenderMale7303 (53.4%)8067 (42.1%)5826 (31.2%)21196 (41.2)<0.001 Female6367 (46.6%)11090 (57.9%)12838 (68.8%)30295 (58.8) Mechanism of InjuryFall<2 metres8612 (63%)15141 (79%)16610 (89%)40363 (78.4)<0.001 Fall >=2 meters2413 (17.7%)1988 (10.4%)1160 (6.2%)5561 (10.8%)  Road Traffic Collision/Incident2063 (15.1%)1633 (8.5%)671 (3.6%)4367 (8.5%)  Other582 (4.3%)395 (2.1%)223 (1.2%)1200 (2.3%) Injury Severity ScoreISS 1–82955 (21.6%)4662 (24.3%)4773 (25.6%)12390 (24.1%)<0.001 ISS 9–155573 (40.8%)7954 (41.5%)8379 (44.9%)21906 (42.5%)  ISS 16–242515 (18.4%)3154 (16.5%)2839 (15.2%)8508 (16.5%)  ISS >=252627 (19.2%)3387 (17.7%)2673 (14.3%)8687 (16.9%)  Median ISS (IQR)9 (9–18)9 (9–17)9 (8–16)9 (9–18) Number of Injuries1 Injury3795 (27.8%)6332 (33.1%)6971 (37.3%)17098 (33.2%)<0.001 2 Injuries3485 (25.5%)5465 (28.5%)5832 (31.2%)14782 (28.7%)  >= 3 Injuries6390 (46.7%)7360 (38.4%)5861 (31.4%)19611 (38.1%) Charlson Comorbidity IndexCCI=06997 (51.2%)7524 (39.3%)5921 (31.7%)20442 (39.7%)<0.001 CCI 1–53914 (28.6%)6651 (34.7%)7096 (38%)17661 (34.3%)  CCI 6–101253 (9.2%)2823 (14.7%)3276 (17.6%)7352 (14.3%)  CCI >10514 (3.8%)1038 (5.4%)1250 (6.7%)2802 (5.4%)  CCI Not Recorded992 (7.3%)1121 (5.9%)1121 (6%)3234 (6.3%)  Median CCI (IQR)0 (0–4)2 (0–4)4 (0–5)0 (0–4) Crude Mortality RateDied802 (5.9%)1778 (9.3%)2402 (12.9%)4982 (9.7%)<0.001