title: Functioning and health-related quality of life following injury in older people: a systematic review.
abstract: There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people.
  
  
  
  A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool.
  
  
  
  There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes.
  
  
  
  The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people.
  
  
  
  Further research is required on older people's postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Katherine
authors.identifier: 0000-0002-9390-9680
authors.initials: K
authors.lastname: Brown
authors.affiliation: John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, the University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
authors.affiliation: The George Institute for Global Health, Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Lisa
authors.identifier: 0000-0003-2215-0678
authors.initials: L
authors.lastname: Keay
authors.affiliation: The George Institute for Global Health, Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia.|School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Coxon
authors.affiliation: The George Institute for Global Health, Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology; D004185:Disability Evaluation; D006233:Persons with Disabilities; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006304:Health Status; D006620:Hip Fractures / Q000503:physiopathology; D006801:Humans; D011446:Prospective Studies; D011788:Quality of Life; D014947:Wounds and Injuries / Q000503:physiopathology*
keywords: Injury Diagnosis