Impact of geriatric trauma service on the outcome of older trauma patents

Abstract

Aim The number of geriatric trauma patients is rising; yet, there is no established best team to care for them. This study analyzed a geriatric trauma service (GTS) that is integrated into the trauma surgery workflow rather than a separate consultation service. We hypothesize this team will lead to decreased mortality, shorter length of stay and increased favorable discharges for geriatric trauma patients. Methods In July 2017, we established a GTS consisting of geriatric nurse practitioners who were part of the hospital's geriatrics service, trauma surgeons and surgery residents on the acute care surgery service. The geriatric nurse practitioners were integrated into the trauma surgery workflow and functioned as independent members. The GTS responded to traumas and consultations for patients aged ≥65 years. Trauma surgeons carried out intensive care and operative management, while the geriatric nurse practitioners managed medical issues, family communication and end‐of‐life planning. We carried out a 2 year retrospective analysis of trauma patients aged ≥65 years seen at Dell Seton Medical Center at the University of Texas, Austin, Texas, USA, comparing patient outcomes before and after the GTS. The primary outcome was mortality, whereas secondary outcomes included hospital days, intensive care unit days, and discharge disposition. Results We found no difference in mortality, intensive care unit days or hospital days with the GTS. However, post‐GTS patients were more often discharged to home, rehabilitation, or hospice, and less often to nursing homes. Conclusion An integrated geriatric and trauma team is feasible, and significant changes in disposition can be made by utilizing geriatric nurse practitioners. Geriatr Gerontol Int 2020; 20: 817–821.

Exploration of Smart Elderly Service Supply and Demand Matching for Multi-source Data

“…Although the "13th Five-Year Plan" has initially formed a "home-based, community-based, institutional supplemented by a combination of medical and nursing" pension service system [2][3], the aging process of the population has deepened and accelerated, and the power of the pension supply is becoming increasingly insufficient, and the contradiction between the supply and demand of pension services is becoming more and more prominent. However, the process of population aging is deepening and accelerating, the power of pension supply is becoming increasingly insufficient, the contradiction between supply and demand of pension services is becoming more and more prominent, coupled with the existence of interprovincial differences in the degree of China's aging, and the uneven level of economic development of various regions has led to the overall development of the pension service industry is unbalanced, inadequate and other realities of the dilemma is a problem that China urgently needs to be addressed [4][5]. Therefore, the "wisdom" embedded in the development of the aging society can realize the online and offline linkage supply of elderly services, the multi-dimensional transformation of the forms and methods of elderly services, and the optimal allocation and reorganization of elderly resources [6][7].…”

Exploring geriatric trauma unit experiences through patients’ eyes: a qualitative study

“…In response, various treatment models of orthogeriatric care have been developed in the last decade to better serve the complex healthcare requirements of this demographic [10,11]. Comanaged care, where surgical and geriatric expertise converge within specialized units, has been most effective in enhancing patient outcomes [7,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Although comanaged care has been implemented under various names [5, 7-10, 12, 13, 17, 19-37] worldwide, its fundamental aim remains consistent: optimizing patient outcomes and improving quality of life.…”

A descriptive qualitative study exploring clinicians’ perspectives of the management of older trauma care in rural Australia

“…New models of care are emerging, including specialised geriatric trauma centres integrating trauma surgery and geriatric medicine, as well as, proactive geriatric consultation services (14)(15)(16)(17)(18). However, it is not certain that these models are adapted to trauma care provision in the rural setting.…”