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Comprehensive Geriatric Assessment for Trauma: Operationalizing the Trauma Quality Improvement Program Directive.
Stephanie Devore1, Sara E Parli, Douglas R Oyler
1Trauma and Acute Care Surgery, University of Kentucky UK Healthcare (Ms Devore and Dr Bernard), and Departments of Pharmacy Services and Pharmacy Practice and Science, UK HealthCare and University of Kentucky College of Pharmacy (Drs Parli and Oyler), Lexington, Kentucky.
Comprehensive geriatric assessments (CGAs) are feasible for elderly trauma patients, even without specialized geriatric services. This approach identifies key needs like medication adjustments and therapy interventions, improving care for this growing demographic.
Area of Science:
- Geriatric Medicine
- Trauma Surgery
- Internal Medicine
Background:
- Elderly patients represent a rapidly expanding demographic in trauma care.
- Geriatric trauma patients present unique and complex clinical challenges.
- Existing trauma care models may not fully address the multifaceted needs of older adults.
Purpose of the Study:
- To assess the feasibility of implementing Comprehensive Geriatric Assessments (CGAs) within a standard trauma setting.
- To evaluate the effectiveness of CGAs in identifying actionable interventions for elderly trauma patients.
- To determine if CGAs can be successfully integrated into routine care by existing trauma teams.
Main Methods:
- An observational feasibility study involving a cohort of geriatric patients (≥65 years) admitted for trauma.
- Biweekly CGAs were conducted, screening for mobility, activities of daily living (ADL) impairment, frailty, and depression.
- Data and recommendations were documented in medical records and communicated to primary care providers and families.
Main Results:
- Sixty-five CGAs were performed between September 2015 and February 2016.
- The majority of trauma mechanisms were motor vehicle collisions (52%) and falls (40%).
- Key action items identified included medication adjustments and referrals for physical/occupational therapy.
Conclusions:
- Comprehensive Geriatric Assessments are feasible and can be successfully implemented in centers lacking dedicated geriatric services.
- Standard trauma team members can perform objective assessments of functional mobility, ADLs, frailty, and depression.
- Advanced practice providers can effectively lead CGAs, even in the absence of dedicated geriatric faculty or residents.
