Geriatric Consultation Helps Restore Function After Injury

Marcia Frellick

November 27, 2013

Functional impairment is common and persistent among the elderly during the year after a traumatic injury, but new research indicates geriatric consultation (GC) may result in decreased decline.

Areti Tillou, MD, from the Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), and colleagues wanted to test the effect routine GC would have on elderly patients' functional status. They measured that status before and after traumatic injury by patients' ability to perform 5 activities of daily living (ADLs) over the course of a year: managing finances, shopping, bathing, walking across the room, and doing light housework. Results from those in the GC group (85 patients) were compared with data from a retrospective control group (37 patients).

The group receiving routine geriatric consultation was selected from all patients aged 65 years and older who were admitted to the UCLA trauma center from December 1, 2007, to June 30, 2010. The center's routine consultation includes geriatric faculty visiting daily to identify risk, detect delirium, review medication for harm, and review advance directives and psychosocial history.

The researchers found there were no statistically significant differences between the groups at 3 and 6 months. However, by 1 year, the GC group had recovered 0.67 ADLs more compared with the control group (P < .03). The study authors controlled for factors including sex, race/ethnicity, living situation, age, comorbidities, length of stay, nursing home or rehabilitation center discharge, any surgical procedure, and the baseline ADL score. Results were published online November 27 in JAMA Surgery.

The researchers saw the most benefit from GC intervention in shopping for personal items. Of the 5 ADLs, shopping was the most common new impairment after injury for both the GC and control groups. However, at 1 year postinjury, prevalence of functional impairment for this ADL was 39% for the GC group compared with 89% for the control group. Shopping for personal items, the only activity performed outside the home, is considered the most difficult of the 5 ADLs.

In an accompanying commentary, Michael E. Zenilman, MD, from the Department of Surgery, Johns Hopkins Medicine, Bethesda, Maryland, said he was disappointed the other ADLs did not show statistically significant benefit from the GC intervention. However, he attributes that to 3 things: the study was small, the patients were stratified by age and not vulnerability to geriatric risk, and the patients were in a level 1 trauma center, which are "typically well-oiled machines." Adding the consultation in such a trauma service "may just be icing on a very good cake," he said.

Dr. Zenilman said the need for such routine expert consultation is great: "Alone, we surgeons really do not have the skill set to manage the medical, social, psychological, and functional issues [inpatient geriatric] patients face."

This study is the first to show improved outcomes from expert geriatric counseling for this population but Dr. Zenilman expects there will be more. The challenge will be determining whether such services are cost effective for hospitals.

The authors have disclosed no relevant financial relationships.

JAMA Surgery. Published online November 27, 2013.


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