Understanding Functional Recovery in Burn Survivors Aged 80 Years and Older: A Burn Model System Study

The global demographic shift toward an aging population is transforming burn care, yet the "oldest old" (adults ≥80 years) remain poorly understood. Standard geriatric guidelines are not specific to this subgroup, a group exhibiting unique physiological needs and vulnerabilities. We conducted a retrospective analysis of the Burn Model System (BMS) National Database for adults aged 80 years or older (N=104).1 Physical Function, Ability to Participate in Social Roles, and Pain Interference were assessed at 6 and 12 months post-burn and compared to pre-burn and US population norm (aged ≥75 years) data. Despite sustaining moderate injuries (Mean TBSA: 11.7%), our cohort required prolonged hospitalization (Mean: 26.9 days). We identified a functional recovery paradox: while Physical Function scores were low (40.1) at 12 months, Social Roles scores were average (50.0 at 6 months and 51.9 at 12 months). Notably, referral to inpatient rehabilitation (IPR) was highly variable (8.6% to 42.1%) and correlated strongly with social support; patients living alone were three times less likely to receive IPR than those with co-habitants (17.7% vs 61.7%). In conclusion, burn survivors aged 80 years and older face persistent reduction in physical function but demonstrate resilience in maintaining social roles, suggesting that slow physical recovery does not preclude quality of life. Prolonged acute hospitalizations and variable IPR access highlight the need for geriatric-specific guidelines to address the unique physiological, social, and systemic barriers that challenge the "oldest old."