The need for long-term support: Five-year outcomes after severe injury in older adults

Background — While the short-term risks of severe injury among older adults (age≥65) are well studied, little is known about long-term functional outcomes in this population. This knowledge gap impacts clinicians’ ability to counsel patients and provide care aligned with their values. Our objective was to evaluate the association between severe injury and the likelihood of an older adult remaining alive and living in their own home five years later.

Methods — This was a retrospective, matched, population-based cohort study using administrative health data in a large regional trauma system (2006–2019). Community-dwelling older adults presenting with severe injury were matched with uninjured controls from the general population on age, sex, rurality, social determinants of health, comorbidity, and frailty. Time from injury to nursing home admission or death was compared between injured patients and matched controls using Kaplan-Meier analysis and extended Cox models.

Results — A total of 20,217 older adults admitted with severe injury were identified and matched with controls. Median ISS was 16 (IQR 16–21), and in-hospital mortality was 22.8% (n = 4615). After five years, the probability of remaining alive and home was 40% for all included cases and 64% for controls. Median time spent alive and home for cases was 2.7 years and exceeded the 5-year follow-up period for controls. While the risk of nursing home admission or death decreased over time, cases remained at elevated risk compared to controls for at least 5 years (years 2–5, HR 1.18, 95% CI 1.13–1.24).

Conclusion — Most severely injured older adults survive to live in their own home for several years following injury. Nonetheless, patients who survive their injury have an increased risk of nursing home admission or death for at least five years. Long-term supports are necessary to ensure that patients remain alive and independent for years following their injury.