The impact of frailty on failure-to-rescue in geriatric trauma patients

Joseph, Bellal; Phelan, Herb A.; Hassan, Ahmed; Jokar, Tahereh Orouji; OʼKeeffe, Terence; Azim, Asad; Gries, Lynn; Kulvatunyou, Narong; Latifi, Rifat; Rhee, Peter

doi:10.1097/ta.0000000000001250

Cited by 86 publications

(71 citation statements)

References 22 publications

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“…43 Although failure to rescue depends on hospital characteristics relative to patient characteristics, recent studies of older surgical patients found higher rates of failure to rescue by patient characteristics relevant to an aging population, including frailty status and age. 16,[44][45][46][47][48] The mechanism of failure to rescue in frail patients is unclear and may relate to the definition of frailty, which is an inability to restore homeostasis following insults such as complications, or more subtle cultural influences such as reluctance to attempt rescue in frail surgical patients. 16,49 In our study, rates of failure to rescue did not vary by frailty status.…”

Section: Discussionmentioning

confidence: 99%

Frailty, hospital volume, and failure to rescue after head and neck cancer surgery

Nieman

Stewart

Eisele³

et al. 2017

The Laryngoscope

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Section: Discussionmentioning

confidence: 99%

Frailty, hospital volume, and failure to rescue after head and neck cancer surgery

Nieman

Stewart

Eisele³

et al. 2017

The Laryngoscope

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“…The prevalence of falls increases with age, affecting 28%–35% of older people globally every year. 1 Falls are the most common cause of trauma and trauma-related deaths among older people, 2 and morbidity and mortality after a fall are correlated with frailty, 3 while age constitutes the strongest predictor of mortality. 4 In 40%–60% of cases, falls are associated with major lacerations, fractures, or traumatic brain injuries, 5 resulting in reduced physical activity, deconditioning, functional decline, impaired ability to perform daily activities, social isolation, reduced quality of life, depression, increased risk of subsequent falls, and institutionalization.…”

Section: Introductionmentioning

confidence: 99%

Xerostomia and hyposalivation in orthogeriatric patients with fall history and impact on oral health-related quality of life

Barbe

Schmidt

Bussmann

et al. 2018

CIA

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PurposeFalls are a common cause of morbidity and mortality in older people, and identification of risk indicators and risk factors to prevent falling is essential. Dry mouth (xerostomia and hyposalivation) can exacerbate conditions known to be fall risk indicators, such as nutritional status and sarcopenia. But there is little evidence regarding whether it is an independent risk factor for falling. We explored xerostomia prevalence and intensity and objective salivation rates in hospitalized geriatric patients to determine whether they were associated with an increased risk of falling.Patients and methodsHospitalized geriatric patients with and without a fall history were compared. We investigated several oral health issues including xerostomia, stimulated and unstimulated salivation rates, total number of teeth and prosthetics, periodontal status, and oral health-related quality of life.ResultsForty patients were included, 28 in the fall history group and 12 in the control group. All patients had oral health issues that impacted on their oral health-related quality of life. However, there were no significant differences between the groups, including xerostomia and hyposalivation, apart from increased dysphagia and less flavor in food in patients with a fall history.ConclusionDry mouth does not appear to be an independent risk factor for falling in this population, but oral health was impaired. Thus, it is important that dentists and geriatricians are aware of and investigate these conditions in their patients and that appropriate action is taken to reduce the consequences of impaired oral health, including a potential reduction in falls.

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“…The morbidity and mortality seems correlated with frailty[15] and age constitutes the strongest, but not unique, predictor of mortality[16]. A recent systematic review identified six risk factors appearing in more than one study that could be used to predict falls in the geriatric population: Previous fall, living alone, walking aid, depression, cognitive deficit and use of > 6 medications[16].…”

Section: Mechanisms Of Injurymentioning

confidence: 99%

“…Given these limitations, the frailty index[15,44-46] can be of interest to predict which patients are at highest risk of having poor outcomes and then require focused interventions. Joseph et al[60] recently showed that frail patients were more likely to develop in-hospital complications (non-frail: 12%, pre-frail: 17.4%, and frail: 33.4%, P = 0.02) and an adverse discharge disposition.…”

Section: Can We Predict Outcome?mentioning

confidence: 99%

Severe trauma in the geriatric population

Llompart‐Pou¹,

Pérez-Bárcena²,

Chico‐Fernández³

et al. 2017

WJCCM

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Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury. Under-triage is common in this population. Evaluation of frailty could be helpful to solve this issue. Appropriate triaging and early aggressive management with correction of coagulopathy can improve outcome. Limitation of care and palliative measures must be considered in cases with a clear likelihood of poor prognosis.

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The impact of frailty on failure-to-rescue in geriatric trauma patients

Abstract: Prognostic study, level II.

Cited by 86 publications

References 22 publications

Frailty, hospital volume, and failure to rescue after head and neck cancer surgery

Frailty, hospital volume, and failure to rescue after head and neck cancer surgery

Xerostomia and hyposalivation in orthogeriatric patients with fall history and impact on oral health-related quality of life

Severe trauma in the geriatric population

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