The need for a more responsive and tailored age friendly healthcare system for older adults, ensuring their specific needs were recognised and managed promptly and effectively, was highlighted by the Major Trauma Audit Report Focused on Older Adults, published at the end of June.
The audit analysed the journey of 11,145 older adults (aged 65 and over) with major trauma injuries through the trauma system between 2017 and 2021.
Launched by Professor Conor Deasy, Clinical Lead for Major Trauma Audit (MTA) it sfindings included:
- Low falls, of less than 2 metres, were the leading cause of major trauma in this demographic, accounting for 82% of injuries.
- 70% of all accidents occurred at home, compared to 36% in younger patients.
- For those injured in the home, the most commonly injured body regions were 27% limbs, 23% head, 23% spine and 16% chest.
- One third of older patients in the audit had an injury severity score >15 indicating the most severe injury category.
- Older adults were significantly less likely than those under 65 to be Pre-alerted (9% vs. 22%) or Received by a trauma team (6% vs. 15%).
- The median age of patients was 79 years, with 74% having pre-existing comorbidities.
- 30% of older adults with major trauma underwent surgical intervention.
- The median length of hospital stay for older adults was 12 days, significantly longer than that of younger patients (7 days).
- 22% of older adults were discharged to a nursing home and only 44% were discharged directly home from hospital.
- Mortality rates were higher among older adults (7%) compared to younger patients (4%).
Professor Deasy said,”Older adults who have sustained trauma present differently than younger adults with relatively innocuous mechanisms of injury, like a low fall causing serious life threatening injuries. Many have other medical conditions in addition to the traumatic injuries, complicating their treatment and recovery. Low falls are the leading cause of major trauma in older adults but that doesn’t always trigger a high level of suspicion compared to other accidents like car crashes. Older adults with trauma need a more tailored and specialised approach to their care. The data in the report will enable these tailored pathways to be developed, ensuring a better quality service and ultimately better outcomes for older adults with major trauma”.
In line with the Trauma System Implementation Programme Clinical Guidance Document: Management of Major Trauma in Older Adults (HSE, 2024), this report highlights the need for improvement in several of the core principles, including Core Principle No. 2: “Injury in older adults often presents differently to younger adults and major trauma commonly occurs from standing height falls (<2 metres) at home. Mechanism of injury is unreliable as an indicator of major trauma and assessment should be approached with a high index of suspicion. Due to the risk of under-triage in the pre-hospital phase of care, this group recommends the use of an older adults major trauma screening tool regardless of mechanism of injury to reduce the risk of under-recognition of major injuries in the Emergency Department. The group also recommends that in the future, specific triage considerations for older adult traumatic injuries should be included in the pre-hospital triage tool”.
Major Trauma Audit is a clinically led initiative aimed at continuously improving the quality of trauma care in Ireland.
