Investigating the effects of frailty on longer-term outcomes in older major trauma patients: a multi-site study.

Abstract

Abstract Background Frailty is associated with adverse in-hospital outcomes after major trauma in older people, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older patients at six months after major trauma centre (MTC) admission. Methods This was a multi-centre study of patients aged ≥65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5L VAS at follow up. Results Fifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p=0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p=0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤50) for frail patients (Frail: 65% vs. Not-frail: 30% p<0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p=0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p=0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p=0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p=0.01). Conclusions Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. For older trauma patients frailty is a predictor of poor longer-term HRQoL after injury should enable early specialist review and discharge planning.