Older people's accidents mostly occur at home, clinical audit finds

CUH consultant in emergency medicine Conor Deasy was the clinical lead on the National Office of Clinical Audit research being published on Wednesday. Picture: Jim Coughlan

An audit of major trauma in older people has found that 70% of their accidents happened at home, the National Office of Clinical Audit has found.

Most traumas (82%) were caused by low falls of less than two metres from standing height, an analysis of the injuries suffered by 11,145 people aged 65 and over found.

Among people injured at home, limbs were the most commonly injured body parts at 27% of all injuries, followed by the head at 23%, the spine also at 23%, and the chest at 16%.

Older people stay longer in hospital

Severe injuries were suffered by one in three older patients in the audit, with an injury severity score of greater than 15.

When older patients stayed in hospital, the median length of stay was 12 days which the audit team said is “significantly longer” than the seven days required by younger patients.

The audit report covering 2017 to 2021 is being launched on Wednesday by Conor Deasy, the major trauma audit clinical lead and consultant in emergency medicine at Cork University Hospital. 

Low falls the leading cause of trauma 

Professor Deasy said: “Low falls are the leading cause of major trauma in older adults but that doesn’t always trigger a high level of suspicion compared to other accidents like car crashes.”

A low fall might seem innocuous but can lead to “serious life-threatening injuries”, the findings indicate.

He said older patients might also have other medical conditions, and this can complicate their treatment and recovery from an injury. He said: 

Older adults with trauma need a more tailored and specialised approach to their care. 

“The data in the report will enable these tailored pathways to be developed, ensuring a better quality service and ultimately better outcomes for older adults with major trauma.”

The audit team said these findings highlight the need for “a more responsive and tailored age friendly healthcare system for older adults”.

The healthcare system should ensure their “specific needs are recognised and managed promptly and effectively” during treatment.

Older people are noticeably more likely to be hurt at home than elsewhere compared to younger patients who suffer trauma at home in 36% of cases.

The median age of patients analysed was 79 and 74% of them had pre-existing conditions. Some 30% had surgery on their injuries.

Only 44% were discharged directly home from hospital, with 22% discharged to a nursing home.

Sadly, the mortality rates were higher among older adults at 7% compared to younger patients at 4%.

Recommendations 

The way an injury happened to an older person is unreliable as an indictor of whether major trauma was suffered or not, so “assessment should be approached with a high index of suspicion”, the audit group recommended.

The group recommends the use of an ‘older adults major trauma screening tool’ regardless of how the injury happened to lessen the risk of not recognising trauma in an emergency department.

The group also recommends that specific triage considerations for older adults’ traumatic injuries should be included in the pre-hospital triage tool.

• You can read the audit report at www.noca.ie