The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.

Abstract

Background: The number of older adults (>60 years) is projected to double by 2050 in Sub-Saharan Africa (SSA). This demographic shift has increased the number of traumatic injuries in this population with 1 in 10 trauma patients in Tanzania being an older adult. Geriatric specialization is all but absent in many LMICs healthcare systems including Tanzania. To inform interventions to optimize healthcare among this unique population, this study aimed to describe the characteristics of injuries and in-hospital complications among older adult trauma patients treated at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Northern Tanzania.Methods: This was a cross-sectional secondary analysis using an adult injury registry from the KCMC in Tanzania. KCMC is a tertiary hospital located in the Kilimanjaro region serving >15 million people. This study included all adult trauma patients (>18 years) from the trauma registry from 2020-2024. We described the injured older adult trauma patients’ socio-demographics, clinical characteristics, and injury patterns compared to younger patients. The main outcomes were length of stay (LOS) and in-hospital mortality. Ethics approval for the study was obtained from the following ethics boards: KCMC, the National Institute for Medical Research in Tanzania, and Duke University. Results: Our study included 3,296 adult injured patients with (13.3%) being older adults (>60 years). The median age of the sample was 34 years (IQR: 26-48) with older adults having a median age of 70 (IQR: 64-79). There were significant differences in all patient characteristics and in-hospital outcomes between older and younger injured adults. Older adult injured patients had higher female representativeness (43%) than younger patients (16%) (p<0.001). Older adult patients took an average of 4 hours longer to reach care following injury compared to younger adults (p<0.001). The majority of older adults had fall mechanisms (56%) while the majority of younger adults had road traffic crash mechanisms (67%) (p<0.001). The majority of older adults had mild severity of injury (86%) than younger adults (27%) (p<0.001). However, the majority of older adult patients required hospitalization (91%) or surgery (66%) following injury than younger adults (85%, 58% respectively) (p=0.002). Older adult injury patients had higher proportions of NCDs: diabetes (12%) and hypertension (26%) compared to younger patients (1% and 2% respectively) (p<0.001). Lastly, older adults spent on average 4 days more at the hospital than younger adults with higher proportions of in-hospital deaths (9%) than the younger adults (4%) (p<0.001). Conclusion: Our study demonstrates the significant differences between the injured older adult patients and the younger adult patients at KCMC. Specifically, older adults had a higher proportion of comorbidities; took longer times to reach care; required hospitalization and surgeries from minor mechanisms (falls); and had twice as long hospital stays and in-hospital deaths. Our findings highlight the differences in care required for older adult trauma patients and provide evidence to support the creation and implementation of older adult-specific interventions to improve outcomes and mobilize healthcare resources for this growing population following trauma.