Joseph Anthony P, Liu Bonnie M, Botha Martie, Wake Elizabeth, Hardy James E, Patel Bhavik, Hilmer Sarah N
Discipline of Emergency Medicine, Faculty of Medicine and Health. University of Sydney NSW, Australia.
Department of Aged Care, Royal North Shore Hospital, St Leonard NSW Australia; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, Australia.
Injury. 2025 Sep;56(9):112514. doi: 10.1016/j.injury.2025.112514. Epub 2025 Jun 3.
Major Trauma Hospitals are receiving increasing numbers of older patients after serious injury. Outcomes in these patients vary with the nature of the injury and other factors such as frailty. We aimed to determine the prevalence of frailty and adverse events in older patients managed by acute trauma services during the index hospital admission, and the frequency of adverse outcomes at three, six and twelve months after discharge in an Australian setting.
This study assessed the prevalence of frailty in a prospective multicentre cohort study of seriously injured patients aged ≥ 70 years admitted to three Major Trauma Services in Australia. Patients were followed for twelve months after injury to assess for adverse outcomes associated with the presence of frailty or other factors. During the index admission patients were assessed for frailty, co-morbidities, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Patients were monitored for adverse events and whether a Geriatrician review occurred. Outcomes assessed at three, six and twelve months included increased dependency, falls, confusion, readmission to hospital, transfer to a Residential Aged Care Facility and death.
217 patients were recruited between 2018 and 2023 across the three hospitals. At index admission, 32 (14.7%) patients were frail and another 28 (12.9%) were near frail. Geriatrician review was more likely for frail patients and there were similar rates of inpatient complications for both frail and non-frail patients. Frailty at index admission was associated with increased dependency, falls, readmission and confusion at three, six and twelve months and with an increased risk of death at three and six months.
Frailty was associated with delayed adverse outcomes up to 12 months following admission for serious trauma in older people at three major Australian trauma services. Assessment of frailty on admission may be useful in stratifying outcome risk for older patients. Further research into frailty interventions and pathways is recommended.
大型创伤医院接收的重伤老年患者数量日益增多。这些患者的预后因损伤性质以及诸如虚弱等其他因素而有所不同。我们旨在确定在澳大利亚，急性创伤服务机构管理的老年患者在首次住院期间虚弱和不良事件的发生率，以及出院后三个月、六个月和十二个月时不良结局的发生频率。
本研究在一项前瞻性多中心队列研究中评估了年龄≥70岁、入住澳大利亚三家大型创伤服务机构的重伤患者的虚弱发生率。患者受伤后随访十二个月，以评估与虚弱或其他因素相关的不良结局。在首次住院期间，对患者进行虚弱、合并症、日常生活活动能力（ADL）和工具性日常生活活动能力（IADL）评估。监测患者的不良事件以及是否有老年医学专家会诊。在三个月、六个月和十二个月时评估的结局包括依赖性增加、跌倒、意识模糊、再次入院、转至老年护理机构和死亡。
2018年至2023年期间，三家医院共招募了217例患者。首次住院时，32例（14.7%）患者虚弱，另有28例（12.9%）患者接近虚弱。虚弱患者更有可能接受老年医学专家会诊，虚弱和非虚弱患者的住院并发症发生率相似。首次住院时的虚弱与三个月、六个月和十二个月时的依赖性增加、跌倒、再次入院和意识模糊相关，且与三个月和六个月时的死亡风险增加相关。
在澳大利亚三家主要创伤服务机构中，虚弱与老年严重创伤患者入院后长达12个月的延迟不良结局相关。入院时评估虚弱可能有助于对老年患者的结局风险进行分层。建议对虚弱干预措施和途径进行进一步研究。
