Comprehensive Geriatric Assessment for Trauma: Operationalizing the Trauma Quality Improvement Program Directive

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Abstract

Elderly patients are the fastest growing trauma demographic and present some of the most complicated clinical challenges. This feasibility study employed observational data from a geriatric cohort. Comprehensive geriatric assessments (CGAs) were performed biweekly on eligible patients, 65 years or older, who met screening criteria. Mobility, activities of daily living impairment, frailty, and depression were screened and documented, and along with summative recommendations, were entered into the medical record, communicated to the patient's primary care provider, and discussed with family. From September 1, 2015, to February 1, 2016, 65 comprehensive geriatric assessments were performed, with 2 repeats. Thirty-two (49%) were men. Mean age was 76.9 (range, 65–97) years. Motor vehicle collisions and falls accounted for the majority of trauma mechanisms (52% and 40%, respectively). New action items from the CGA were in 2 main categories: (1) home or inpatient medication changes and (2) additional physical therapist/occupational therapist intervention. Comprehensive geriatric assessment can be successfully organized and performed in centers without a designated geriatric service using standard trauma team members. Objective assessments for functional mobility, activities of daily living, frailty, and depression can be performed easily using current staff and the data easily incorporated into the CGA. Advanced practice providers can feasibly serve as clinical leads even if faculty/residents are unavailable.

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