Interdisciplinary Care

An interdisciplinary care protocol for frail geriatric trauma patients significantly reduces the risk for delirium and 30-day readmission, according to a study published online April 5 in the Journal of the American College of Surgeons. Geriatric population is the fastest growing segment of the total population. They represent about 12 % of the US population.

Risk of trauma

By the year 2030 it has estimate that 19 % of the population will be older than 65 years. Currently elderly are more active and independent that increases the risk of trauma. Elderly are unique in their responses to trauma injury. The age-related physiological changes affect elderly ability to withstand trauma stress and increase the incidence of complications and deaths.

Trauma surgeons and staff awareness of age-related changes and challenges will improve trauma-related outcomes in geriatric trauma patients. In almost every developed country, the proportion of people over 60 years of age is growing faster than any other age group, as a result of longer life expectancy and declining birth rates. As a result, more elderly individuals are presenting to emergency departments following trauma.

So Elder patients are more susceptible to injury from minor mechanisms and less able to compensate from any injury. To manage their chronic ailments, elder patients are more likely to take multiple medications, some of which may blunt their response to the physiologic stress of trauma and increase their risk for complications.

Women’s Hospital in Boston

Elizabeth A. Bryant, M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues evaluated whether an interdisciplinary care pathway for frail trauma patients (≥65 years) improved in-hospital mortality, complications, and 30-day readmissions. The interdisciplinary protocol included early ambulation, bowel/pain regimens, nonpharmacological delirium prevention, nutrition/physical therapy consults, and geriatrics assessments.

So based on the 125 and 144 frail patients in the preintervention and postintervention cohorts, the researchers observed no significant demographic differences in complications (P = 0.93). However, following the intervention, there was a significant decrease in delirium (21.6 to 12.5 percent; P = 0.04) and 30-day readmission (9.6 to 2.7 percent; P = 0.01).
Lower delirium (odds ratio, 0.44; P = 0.02) and 30-day readmission rates (odds ratio, 0.25; P = 0.02) were seen postintervention compared with prepathway patients, even after adjusting for patient characteristics. Implementing pathways standardizing care for these vulnerable patients could improve their outcomes following trauma,” the authors write.