Elderly patients may not receive same quality care as younger patients

A study of the American College of Surgeons National Trauma Databank has revealed that trauma centers which excel in the care of severely injured young patients do not necessarily provide the same quality of care to elderly patients.

The findings were published in the January 2011 issue of Annals of Surgery.

The study also cited growing evidence that elderly injured patients have unique needs, helping investigators identify some ways in which trauma centers can improve their care of elderly patients.

“Although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly,” study author Barbara Haas, MD, stated in a press release. “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.”

Little overlap

The investigators analyzed data on 87,754 trauma patients of all ages treated at 132 facilities. Approximately one in four of these patients were elderly.

Centers with the highest and lowest death rates were identified. When patients in all age groups were studied together, 14 centers were “high performers” that had lower than expected death rates. Once young and elderly patients were considered separately, seven centers were high performers for young patients and nine were high performers for elderly patients. However, the study noted, there was little overlap; two centers were high performers for both young and elderly patients.

According to the research, elderly patients seen in trauma centers were mostly women and were more likely to have blunt injury. Falls were a leading cause. Severe head and leg injuries were also more predominant in elderly patients.

Root of the problem

Lead investigator Avery B. Nathens, PhD, FACS, noted in the release that many trauma centers got their start in the 1980s in response to drug-related violence, eventually developing more experience caring for car crash victims — two types of injuries primarily involving young adults. Taking the same approaches when dealing with elderly patients could be problematic for numerous reasons, including the possibility of co-existing conditions.

“Elderly patients often have heart disease, lung disease, diabetes and might be on blood thinners,” Nathens stated. “All of these things need to be addressed at the same time the injuries are cared for.”

Elderly patients are also more likely to have reduced organ function, he added.

Potential approaches

The authors suggested two potential approaches that could lead to better elderly patient care. One involves placing intensive care patients under the care of an intensive care specialist once the patient is moved from the emergency room to the intensive care unit. The other involves more frequent use of the expertise of geriatricians who specialize in the care of the elderly.

“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,” Nathens stated. “These factors, along with an understanding that these patients have unique needs, would go a long way to improving their quality of care.”

References:
Haas B, et al. External benchmarking of trauma center performance: Have we forgotten our elders? Ann Surg. 2011;144-150. doi: 10.1097/SLA.0b013e3181f9be97.
www.facs.org
Disclosure: The study was supported by the Canada Research Chair Program.

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