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Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, Norwood S. Hospitalization and readmission after single-level fall: a population-based sample. Inj Epidemiol 2023; 10:49. [PMID: 37858271 PMCID: PMC10588028 DOI: 10.1186/s40621-023-00463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. METHODS We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. RESULTS Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. CONCLUSIONS SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.
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Affiliation(s)
- Alan Cook
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
| | - Rebecca Swindall
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - Katherine Spencer
- CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus Christi, 600 Elizabeth Street, 9B, Corpus Christi, TX, 78404, USA
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - S Andrew Cage
- Department of Sports Medicine, The University of Texas at Tyler, 3900 University Blvd., Tyler, TX, 75799, USA
| | - Musharaf Mohiuddin
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA.
| | - Yagnesh Desai
- Department of Emergency Medicine, UT Health East Texas, 1000 S. Beckham Ave., Tyler, TX, 75701, USA
| | - Scott Norwood
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
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Swindall R, Roden-Forman JW, Conflitti J, Cook A, Wadle C, Boyle J, Ward J, Gross B, Rogers F, Le TD, Norwood S. Elderly trauma associated with high-risk recreational activity: A population-based study, United States, 2010 through 2016. Surgery 2021; 171:1677-1686. [PMID: 34955287 DOI: 10.1016/j.surg.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding trends in prevalence and etiology is critical to public health strategies for prevention and management of injury related to high-risk recreation in elderly Americans. METHODS The National Emergency Department Sample from 2010 through 2016 was queried for patients with a principal diagnosis of trauma (ICD-9 codes 800.0-959.9) and who were 55 years and older. High-risk recreation was determined from e-codes a priori. Primary outcome measures were mortality and total hospital charges. RESULTS Of the 29,491,352 patient cohort, 458,599 (1.56%) engaged in high-risk activity, including those age 85 and older. High-risk cases were younger (median age 61 vs 70) and majority male (71.87% vs 39.24%). The most frequent activities were pedal cycling (45.81%), motorcycling (29.08%), and off-road vehicles (9.13%). Brain injuries (8.82% vs 3.88%), rib/sternal fractures (13.35% vs 3.53%), and cardiopulmonary injury (5.25% vs 0.57%) were more common among high-risk cases. Mortality (0.75% vs 0.40%) and total median hospital charges ($3,360 vs $2,312) were also higher for high-risk admissions, where the odds of mortality increased exponentially per year of age (odds ratio, 1.06; 99.5% CI, 1.05-1.08). High-risk recreation was associated with more than $1 billion in total hospital charges and more than 100 deaths among elderly Americans per year. CONCLUSION Morbidity, mortality, and resource utilization due to high-risk recreation extend into the ninth decade of life. The patterns of injury described here offer opportunities for targeted injury prevention education to minimize risk among this growing segment of the United States population.
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Affiliation(s)
- Rebecca Swindall
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX.
| | - Jacob W Roden-Forman
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Joseph Conflitti
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
| | - Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Julianna Boyle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Jeanette Ward
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Brian Gross
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Fred Rogers
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT
| | - Tuan D Le
- United States Army Institute of Surgical Research, Fort Sam Houston, TX
| | - Scott Norwood
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
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Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Luzzi S, Lucifero AG, Manzoni F, Ricevuti G, Bressan MA. Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center. J Emerg Trauma Shock 2021; 14:98-103. [PMID: 34321808 PMCID: PMC8312913 DOI: 10.4103/jets.jets_55_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction: Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes. Methods: We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75). Results: We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01). Conclusions: The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.
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Affiliation(s)
- Gabriele Savioli
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Sarah Macedonio
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sebastiano Gerosa
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirko Belliato
- Department of Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- Department of Hygiene and Health Prevention, Health Promotion-Environmental Epidemiology Unit, Health Protection Agency, Pavia, Italy
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Saint Camillus International University of Health Sciences, Rome, Italy
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Shorland J, Douglas J, O'Halloran R. Cognitive-communication difficulties following traumatic brain injury sustained in older adulthood: a scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:821-836. [PMID: 32706482 DOI: 10.1111/1460-6984.12560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/10/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Older adults are a peak incidence group for traumatic brain injury (TBI). However, empirical evidence on TBI in older adults is often limited to extrapolated findings from studies involving younger adults. While cognitive-communication deficits are an established consequence of TBI with substantial impact on social outcome for younger adults, little is known about the nature of cognitive-communication changes experienced by older adults following a new-onset TBI. In order to inform evidence-based service delivery and support older adults who sustain TBI, it is important to understand how these difficulties manifest in older adults. AIMS To review the empirical literature to determine the nature and breadth of research that has addressed the influence of older age on cognitive-communication outcomes following TBI sustained in older adulthood. METHODS & PROCEDURES A scoping review framework was used. Five electronic databases (Medline, PsycINFO, Embase, CINAHL and Scopus) were searched to locate peer-reviewed studies addressing cognitive-communication following TBI sustained at ≥ 55 years. Given the absence of dedicated investigations within the search yield, studies were included where at least 30% of participants were aged ≥ 55 years at injury, and age was a stated focus of the investigation. OUTCOMES & RESULTS A total of 2468 unique records were identified and reduced to 225 after title and abstract screening. Full-text review revealed only three studies that met the criteria. Collectively these studies included adults aged 55-93 years at injury. Two studies focused on age as a predictor for acute cognitive-communication difficulty, and one on the impact of age on facial emotion recognition in the chronic stages of injury. None of the studies had a dedicated focus on cognitive-communication outcomes for older adults who sustained a TBI within the defined period of older adulthood. CONCLUSIONS & IMPLICATIONS This scoping review produced limited results and insufficient evidence to inform rehabilitation for older adults. Indeed, very little is known about cognitive-communication outcomes for older adults who sustain a TBI. This review highlights the need, in the context of an ageing population, for research within this area to be prioritized. What this paper adds What is already known on the subject Empirical evidence to support the management of post-TBI cognitive-communication difficulties in adults predominantly stems from studies with young adults. However, the broader TBI literature suggests that outcome for older adults requires specific consideration due to its distinct nature and occurrence during a stage of life when there is the potential for subtle change to the processes of cognition and communication as part of typical ageing. What this paper adds to existing knowledge This scoping review identifies that research related to cognitive-communication outcomes for older adults who have sustained a TBI is very much in its infancy. Overarching statements about post-TBI cognitive-communication outcomes for older adults cannot be drawn, nor can it be determined if outcomes for older adults differ from younger adults. What are the potential or actual clinical implications of this work? The lack of research in this area means that tangible guidance cannot be provided to clinicians working with older adults following TBI to support evidence-based practice for cognitive-communication. This scoping review strongly supports the need for further research in this area.
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Affiliation(s)
- Joanna Shorland
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Speech Pathology Department, Acquired Brain Injury Unit, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Summer Foundation, Melbourne, VIC, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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Chang CP, Hsiao CT, Wang CH, Chen KH, Chen IC, Lin CN, Hsiao KY. Hyperglycemia as a positive predictor of mortality in major trauma. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920911254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hyperglycemia in the acute phase after trauma is a stress response and a metabolic reflection in humans with injury, which could adversely affect outcome in trauma patients. In this study, we attempted to identify if hyperglycemia a reliable predictor for mortality in major trauma patients. Objectives: In order to identify if hyperglycemia a reliable predictor for mortality in major trauma, we designed and proformed a prospective observational study in a tertiary hospital. Method: We performed a prospective observational study to review the records of 601 patients with major trauma (injury severity scores >15) who visited our hospital’s emergency department from August 2012 to July 2015. Logistic regression was performed to assess the effect of hyperglycemia on mortality. Result: Major trauma patients in the hyperglycemia group had low systolic/diastolic blood pressure at triage, low initial Glasgow Coma Scale score, high incidence of hypotension episodes, coagulopathy, acidosis, and anemia. Hyperglycemia was significantly correlated with mortality in major trauma patients in this study (odds ratio: 1.97, 95% confidence interval: 1.04–3.74). Conclusion: In major trauma patients with injury severity scores >15, hyperglycemia has a positive correlation with mortality, which could be a predictor of mortality in clinical practice.
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Affiliation(s)
- Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
- School of Medicine, Chang Gung University, Taoyuan
| | - Cheng-Hsien Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
| | - Kai-Hua Chen
- School of Medicine, Chang Gung University, Taoyuan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi
| | - I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
- School of Medicine, Chang Gung University, Taoyuan
| | - Chun-Nan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
| | - Kuang-Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi
- The Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung
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Culturally Safe Falls Prevention Program for Inuvialuit Elders in Inuvik, Northwest Territories, Canada: Considerations for Development and Implementation. Can J Aging 2019. [DOI: 10.1017/s0714980819000308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉLa théorie postcoloniale a été utilisée dans cette étude pour identifier les recommandations actuelles en matière de prévention des chutes qui sont proposées par les programmeurs locaux en prévention des chutes (PLPC), afin de réduire les taux de chutes chez les aînés inuvialuits à Inuvik, dans les Territoires du Nord-Ouest (Canada), et en vue de comprendre comment co-créer avec les participants des programmes de prévention des chutes qui soient culturellement sûrs pour les aînés inuvialuits. Les résultats ont montré que les aînés inuvialuits et les PLPC à Inuvik recommandent d’ajouter aux programmes existants des évaluations et des modifications environnementales, de l’activité physique et de la formation pour les aînés et les soignants. Pour que les programmes de prévention des chutes soient culturellement sûrs, les aînés considéraient aussi que ces programmes devraient inclure les stratégies suivantes : établir des liens de confiance et des relations au sein de la communauté, intégrer des interventions autochtones et non autochtones dans ces programmes, et assurer une formation sur les pratiques culturellement sécuritaires.
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Arakaki FH, Tufik S, Andersen ML. Naps and exercise: reinforcing a range of benefits for elderly health. Chronobiol Int 2019; 36:886-887. [PMID: 30987465 DOI: 10.1080/07420528.2019.1602050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
According to the United Nations, in 2017, people aged 60 or over in the world, comprised 13 per cent of the global population. It is a fact that elderly people are keeping a health lifestyle, such as practicing physical exercises and avoiding excessive dosages of medications. However, this population is also more prone to have injuries while practicing exercises. Sleep architecture is physiologically different among elderly, and naps can be very beneficial to improve their mental and physical health. Thus, in this article, we encourage health professionals to recommend regular naps to this population, which could lead to an improve in their well-being and quality of life.
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Affiliation(s)
- Felipe Hideki Arakaki
- a Department of Psychobiology , Universidade Federal de Sao Paulo , Sao Paulo/SP , Brazil
| | - Sergio Tufik
- a Department of Psychobiology , Universidade Federal de Sao Paulo , Sao Paulo/SP , Brazil
| | - Monica Levy Andersen
- a Department of Psychobiology , Universidade Federal de Sao Paulo , Sao Paulo/SP , Brazil
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de la Cuesta-Benjumea C, Ramis-Ortega E, Arredondo Gonzalez CP. To manage a complex dependency: The experience of caregiving after a fall. J Adv Nurs 2018; 75:138-149. [PMID: 30132964 DOI: 10.1111/jan.13831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/28/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
AIM To understand the experience of family members of an older relative who has had a fall which required medical attention. BACKGROUND There is abundant bibliography in caregiving, but little is known about the problems faced by caregivers and how family members cope when their older relative has a fall. DESIGN Qualitative study that used a symbolic interactionism perspective. METHODS Twenty-two people with older relatives, who had had a fall and contacted health services in Spain, participated in the study. Data were obtained via written accounts, focus groups, and semi-structured interviews between February 2014 - December 2015. Analysis was guided by grounded theory procedures. RESULTS With the fall, dependency becomes a complex issue for the family. To manage a complex dependency is the core issue that emerges from the data analysis. It depicts family efforts to assist their relative in gaining autonomy after a fall, in the best conditions they can provide. They do this with little guidance and support from healthcare professionals. CONCLUSIONS Guides and protocols for the care of a fragile older person, particularly after a fall, should not only include care but also support to caregivers. Health professionals and especially nurses need to be aware and respond to the family caregivers needs after a fall. To the fall prevention initiatives already in place, it must be added that those who support family members to cope with the care of an older person who has had a fall.
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Abstract
Study design for a quality improvement project. Objective was to implement a geriatric trauma protocol (GTP) based on American College of Surgeons recommendations to improve patient outcomes. Geriatric trauma patients comprise a vulnerable and high-risk trauma population, and must be treated with specific protocols that take into account physiological, psychosocial, environmental, and pharmacological needs. A growing body of research and organizations such as the American College of Surgeons and the Eastern Association for the Surgery of Trauma recommend that a specific trauma protocol for geriatric adults must be utilized in hospitals and trauma centers. A retrospective chart review was conducted to assess geriatric patient outcomes prior to GTP implementation. Surgical residents then received training on the GTP, including performing additional diagnostics, referrals, and discussing goals of care early in treatment. The GTP was then implemented for 8 weeks and monitored to determine its effects on patient outcomes. The training for surgical residents in the GTP yielded a 9.2% increase in provider knowledge. The results of the GTP showed a reduced length of stay and increased geriatric consultations. More patients received a full evaluation by the trauma team, contributing the reduced length of stay. The use of a GTP shows promise in being able to improve patient outcomes, including morbidity and mortality. The principles of the GTP can be applied in all clinical settings, especially emergency rooms, which are on the frontlines of initial evaluations. In order to improve health care delivery to an aging population, organizations and clinicians should adopt a specialized GTP into their practices.
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Ten year maturation period in a level-I trauma center, a cohort comparison study. Eur J Trauma Emerg Surg 2016; 43:685-690. [PMID: 27629235 PMCID: PMC5629235 DOI: 10.1007/s00068-016-0722-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/06/2016] [Indexed: 12/05/2022]
Abstract
Purpose Many changes have been made to improve trauma care. Improved trauma team response and usage of a hybrid resuscitation room are examples of how this trauma center has developed. The aim was to assess how the outcome of the trauma population was influenced by the maturation. Methods A cohort comparison, between June 2004–July 2005 and 2014, was performed. All adult trauma patients with an Injury Severity Score (ISS) >15 were included. Variables collected were: patient demographics, mechanism of trauma, total prehospital time, pre- and inhospital trauma scores, vital signs, blood values and interventions, and physician staffed helicopter emergency medical services (P-HEMS) involvement and outcome. Results From June 2004 to July 2005 219, patients were admitted, and for the year 2014, this was 282 patients. The 2014 cohort was significantly older (mean age of 53.6 ± 23.8 vs 45.6 ± 22.7 years). The mean RTS did not differ. P-HEMS assists increased to 116 (13.5 %). The number of CT scans, blood transfusion, and acute trauma surgical interventions decreased. Mean LOS, ICU admission, and ICU LOS did not differ. The mortality rate, however, decreased by 7.0 %, observed and predicted survival was significantly different in favour of the 2014 cohort, with a Z-score of 4.25. Conclusion An increase in age is seen, though trauma scores remain comparable. The number of blood products transfused and acute trauma surgical interventions performed declines. Mortality significantly decreased and a significant difference in observed and predicted survival is seen. Showing improved trauma care in our hospital, in favour of the second period.
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Expérience de fréquentation des lieux publics par des personnes âgées ayant subi un TCC en présence d'un accompagnateur-citoyen: projet pilote. Can J Aging 2016; 35:229-41. [PMID: 27223579 DOI: 10.1017/s0714980816000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This pilot project aims to test and see the relevance of the direct observation method to collect data on the barriers and facilitators to attending public places by seniors with TBI. The study is based on the conceptual framework VADA WHO which focuses on the development of friendly built and technological environments for seniors. Three elderly people participated in the study, recruited from an ongoing project, The Citizen Intervention in Community Living (APIC), in the presence of their personalized attendant. The study shows the feasibility of the method in terms of its acceptability and resources mobilized. It shows its relevance to access additional data that would have been difficult to obtain using others methods (e.g., semi-structured interview), such as the identification of the strategies used by the participants to address the obstacles encountered (avoidance, travel planning, use of physical and preventative support of the personalized attendant).
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