The Trauma Dyad: The Role of Informal Caregivers for Older Adults After Traumatic Injury

Abstract

Objective: To investigate the association between higher injury severity and increased informal caregiving received by injured older adults. Summary of Background Data: Injured older adults experience high rates of functional decline and disability after hospitalization. Little is known about the scope of caregiving received post-discharge, particularly from informal caregivers such as family. Methods: We used the National Health and Aging Trends Study 2011 to 2018 linked to Medicare claims to identify adults ≥65 with hospital admission for traumatic injury and a National Health and Aging Trends Study interview within 12 months pre- and post-trauma. Injury severity was assessed using the injury severity score (ISS, low 0–9; moderate 10–15; severe 16–75). Patients reported the types and hours of formal and informal help received and any unmet care needs. Multi variable logistic regression models examined the association between ISS and increase in informal caregiving hours after discharge. Results: We identified 430 trauma patients. Most were female (67.7%), non-Hispanic White (83.4%) and half were frail. The most common mechanism of injury was fall (80.8%) and median injury severity was low (ISS = 9). Those reporting receiving help with any activity increased post-trauma (49.0% to 72.4%, P < 0.01), and unmet needs nearly doubled (22.8% to 43.0%, P < 0.01). Patients had a median of 2 caregivers and most (75.6%) were informal, often family members. Median weekly hours of care received pre- versus post-injury increased from 8 to 14 (P < 0.01). ISS did not independently predict increase in caregiving hours; pre-trauma frailty predicted an increase in hours ≥8 per week. Conclusions: Injured older adults reported high baseline care needs which increased significantly after hospital discharge and were mostly met by informal caregivers. Injury was associated with increased need for assistance and unmet needs regardless of injury severity. These results can help set expectations for caregivers and facilitate post-acute care transitions.

The burden of pre‐admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients

“…Over 40 million Americans identify as unpaid caregivers to adults 50 years of age or older and those numbers are climbing as the population ages 45 . Our data corroborates prior studies using national survey data showing that older trauma patients have high caregiving needs, caregiving hours, and that 20% require new informal caregiving post‐discharge 46,47 . While a majority of both groups had no caregiving needs prior to trauma, more than a quarter of those with serious illness received 30 or more hours of help per month.…”

“…45 Our data corroborates prior studies using national survey data showing that older trauma patients have high caregiving needs, caregiving hours, and that 20% require new informal caregiving post-discharge. 46,47 While a majority of both groups had no caregiving needs prior to trauma, more than a quarter of those with serious illness received 30 or more hours of help per month. In settings with limited resources, focusing caregiver support for those families with high caregiving needs before trauma may ameliorate risks of caregiver strain and poor health outcomes for patients and caregivers.…”

Postdischarge Caregiver Burden Among Family Caregivers of Older Trauma Patients

“…In the patient and caregiver model shown in Table 4, caregivers with lower self-efficacy and preparedness for caregiving were more likely to experience high caregiver burden (odds ratio [OR], 7.79; 95% CI, 2.54-23.82; P < .001; and OR, 5.76; 95% CI, 1.86-17.88; P = .003, respectively). Similar results were found when evaluating the associations between high caregiver burden and caregiver self-efficacy at the domain level (self-care and obtain respite: OR, 4 associations between patient factors (ie, readmission, discharge locations) and caregiver factors (ie, age, prior caregiving experience) and caregiver burden and preparedness for caregiving did not show significant differences (eTables 3-8 in Supplement 1).…”

“…Older injured adults are often frail or seriously ill with high illness burden before their trauma admission, which leads to poor outcomes, including high rates of functional disability, health care use, and high mortality . After discharge, these patients experience functional decline and high rates of institutionalization and hospital readmissions, which in turn increase their dependence on family caregivers …”

“…2,3 After discharge, these patients experience functional decline and high rates of institutionalization and hospital readmissions, which in turn increase their dependence on family caregivers. 4 Caregiver burden, characterized by psychological distress and physical morbidity, affects more than 50 million unpaid family caregivers of older adults nationally. 5 Family caregivers assist with activities of daily living, medical care, and financial and medical decisions and play a substantial and crucial role in the health care workforce for older people in the United States.…”