Long-term survival in the elderly after trauma

Background: In the elderly, trauma has been associated with increased, long term, all-cause mortality. Functional limitations secondary to injury may b e responsible for the reduced survival rate. The objective of this study wa s to test this hypothesis using data from the Longitudinal Study of Aging ( LSOA), Methods: The LSOA is an extension of the 1984 National Health Interview Sur vey, which focused on 7,527 persons who were 70 years and older in 1984, Us ing data from the LSOA, a cohort of elderly patients hospitalized for injur y in 1985 (N = 102) was identified from Medicare hospital discharge data. A n uninjured cohort (N = 408) was also identified using the LSOA and matched by age (within 1 year) and sex. Deaths in both cohorts were identified usi ng the National Death Index. Hazard ratios (HRs) for mortality within 6 yea rs subsequent to injury, adjusted for demographic, health status, and funct ional characteristics, were calculated. Results: The injured cohort had a significantly reduced rate of survival co mpared with the uninjured cohort (NR = 1.5; 95% confidence interval [CI] 1. 1-2.2), and this relationship persisted after adjusting for demographic and health characteristics (HR = 1.4; 95% CI 1.0-2.0), After additional adjust ment for measures of functional decline, the association diminished (HR = 1 .2: 95% CI 0.8-1.7), Functional decline remained a strong, independent fact or for the risk of mortality, Conclusion: Trauma in the elderly has both an acute and long-term influence on mortality; the latter seems to be mediated through a decline in functio n resulting from the injury. This study suggests that strategies to return the elderly patient to preinjury functional status are of paramount Importa nce. Future research should explore the impact of these interventions on lo ng-term survival.