title: Preinjury physical frailty and cognitive impairment among geriatric trauma patients determine postinjury functional recovery and survival.
abstract: BACKGROUND
  Injury is an external stressor that often initiates a cycle of decline in many older adults. The influence of physical frailty and cognitive decline on 6-month and 1-year outcomes after injury is unreported. We hypothesized that physical frailty and cognitive impairment would be predictive of 6-month and 1-year postinjury function and overall mortality.
  
  
  METHODS
  The sample involved patients who are 65 years or older admitted to a Level I trauma center between October 2013 and March 2014 with a primary injury diagnosis. Surrogates of 188 patients were interviewed within 48 hours of hospital admission to determine preinjury cognitive and physical frailty impairments using brief screening instruments. Follow-up was completed on 172 patients at 6 months and 176 patients at 1 year to determine posthospitalization status and outcomes. Data analysis involved frequencies, measures of central tendency, χ analyses, linear and logistic regression.
  
  
  RESULTS
  The mean age of the patients was 77 years. The median Injury Severity Score (ISS) was 10. The mechanism of injury involved falls from standing (n = 101, 54%). Preinjury vulnerabilities included cognitive impairment (AD8 Dementia Screen [AD8] score ≥ 2, n = 93, 50%) and physical frailty (Vulnerable Elders Survey [VES-13] score ≥ 4, n = 94, 50%). Overall, median physical frailty scores did not return to baseline in the majority of survivors at 1 year. Multivariate regression analysis revealed that preinjury cognitive impairment (6 months, AD8, β = -0.20, p = 0.002) and preinjury physical frailty (6 months, Barthel Index, β = 0.60, p < 0.001; 1 year, Barthel Index, β = 0.52, p < 0.001) are independently associated with physical function (frailty). Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04-1.14), injury severity (OR, 1.07; 95% CI, 1.02-1.12), and preinjury physical frailty (OR, 1.28; 95% CI, 1.14-1.47) are independently associated with overall mortality at 1 year.
  
  
  CONCLUSIONS
  Preinjury physical frailty is the predominant predictor of postinjury functional status and mortality in geriatric trauma patients. Identification of frailty and appropriate follow-up are crucial for decision making by providers, patients, and family caregivers.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: From the Schools of Nursing (C.A.M., L.C.M., A.Mi.), and Medicine (A.Ma., R.S.M.), Vanderbilt University (M.S.D.), Nashville, Tennessee; Loma Linda University (K.M.), Loma Linda, California.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Maxwell
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Mion
authors.forename: Kaushik
authors.initials: K
authors.lastname: Mukherjee
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Ann
authors.initials: A
authors.lastname: Minnick
authors.forename: Addison
authors.initials: A
authors.lastname: May
authors.forename: Richard S
authors.initials: RS
authors.lastname: Miller
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000523:psychology* / Q000628:therapy