Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.

dc.contributor.author

Wong, Ting-Hway

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Tan, Timothy Xin Zhong

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Malhotra, Rahul

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Nadkarni, Nivedita V

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Chua, Wei Chong

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Loo, Lynette Ma

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Iau, Philip Tsau Choong

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Ang, Arron Seng Hock

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Goo, Jerry Tiong Thye

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Chan, Kim Chai

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Matchar, David Bruce

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Seow, Dennis Chuen Chai

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Nguyen, Hai V

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Ng, Yee Sien

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Chan, Angelique

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Fook-Chong, Stephanie

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Tang, Tjun Yip

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Ong, Marcus Eng Hock

dc.date.accessioned

2022-01-03T02:18:15Z

dc.date.available

2022-01-03T02:18:15Z

dc.date.issued

2021-11-27

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2022-01-03T02:18:14Z

dc.description.abstract

Objective

Frailty is associated with morbidity and mortality in older injured patients. However, for older blunt-trauma patients, increased frailty may not manifest in longer length of stay at index admission. We hypothesized that owing to time spent in hospital from readmissions, frailty would be associated with less total time at home in the 1-year postinjury period.

Design

Prospective, nationwide, multicenter cohort study.

Setting and participants

All Singaporean residents aged ≥55 years admitted for blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS) ≥10 from March 2016 to July 2018.

Methods

Frailty (by modified Fried criteria) was assessed at index admission, based on questions on preinjury weight loss, slowness, exhaustion, physical activity, and grip strength at the time of recruitment. Low time at home was defined as >14 hospitalized days within 1 year postinjury. The contribution of planned and unplanned readmission to time at home postinjury was explored. Functional trajectory (by Barthel Index) over 1 year was compared by frailty.

Results

Of the 218 patients recruited, 125 (57.3%) were male, median age was 72 years, and 48 (22.0%) were frail. On univariate analysis, frailty [relative to nonfrail: odds ratio (OR) 3.45, 95% confidence interval (CI) 1.33-8.97, P = .01] was associated with low time at home. On multivariable analysis, after inclusion of age, gender, ISS, intensive care unit admission, and surgery at index admission, frailty (OR 5.21, 95% CI 1.77-15.34, P < .01) remained significantly associated with low time at home in the 1-year postinjury period. Unplanned readmissions were the main reason for frail participants having low time at home. Frail participants had poorer function in the 1-year postinjury period.

Conclusions and implications

In the year following blunt trauma, frail older patients experience lower time at home compared to patients who were not frail at baseline. Screening for frailty should be considered in all older blunt-trauma patients, with a view to being prioritized for postdischarge support.
dc.identifier

S1525-8610(21)00936-1

dc.identifier.issn

1525-8610

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1538-9375

dc.identifier.uri

https://hdl.handle.net/10161/24181

dc.language

eng

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Elsevier BV

dc.relation.ispartof

Journal of the American Medical Directors Association

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10.1016/j.jamda.2021.10.016

dc.subject

Geriatric trauma

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blunt trauma

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frailty

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modified Fried criteria

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time at home

dc.title

Health Services Use and Functional Recovery Following Blunt Trauma in Older Persons - A National Multicentre Prospective Cohort Study.

dc.type

Journal article

duke.contributor.orcid

Matchar, David Bruce|0000-0003-3020-2108

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School of Medicine

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Duke Global Health Institute

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Pathology

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Medicine, General Internal Medicine

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Duke

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University Institutes and Centers

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Institutes and Provost's Academic Units

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Clinical Science Departments

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Medicine

pubs.publication-status

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