Functioning and health-related quality of life in older people following

traumatic injury – a systematic literature review

Katherine Brown1, Ian Cameron2, Lisa Keay1, Kristy Coxon1, Rebecca Ivers1

1 The George Institute for Global Health, Sydney Medical School, University of Sydney;

2 John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School Northern, The University of Sydney

Methods Inclusion criteria

• Subjects aged>=65 years, or reported as ‘aged’, ‘older’, ‘senior’, ‘elderly’ or ‘geriatric’

• Traumatic injury requiring hospitalisation or medical treatment (excluding burns, poisoning and drowning)

• Prospective cohort, follow-up, prognostic course or prognostic factor studies

• Study outcome measure/s measured general functioning or health-related quality of life, and had previously been used in research in general injury populations:

Glasgow Outcome Scale (GOS) or Glasgow Outcome Scale Extended (GOS-E)

European Quality of Life 5D (EQ-5D)

World Health Organisation Quality of Life Survey BREF (WHOQOL-BREF)

Short Form Health Survey 36 (SF-36) or Short Form Health Survey 12 (SF-12)

• English language publications between January 1995 and September 2014

• Search databases were Medline, Embase, PsycINFO and Cinahl, and for grey literature Google Scholar, ScienceDirect, reference lists and SafetyLit reports.

Procedure

• Comprehensive search strategies were developed for each database based on the inclusion and exclusion criteria (see above).

• PRISMA [6] reporting guidelines were used to conduct the search and report the results.

• Records were screened on title and abstract for eligibility, and those meeting criteria underwent full-text assessment by two independent reviewers.

• The QUIPS critical appraisal tool [7] was used to determine the quality of the studies.

2010 14% aged >=65

2050 25% aged >=65

2012 34% aged >=55

2002 24% aged >=55

General Population

Working Population

Background

Australia has an ageing population and workforce: [1] [2]

• The Australian Government is gradually increasing the aged pension eligibility age from the current age of 65 years, to 67 years by 2023, and 70 years by 2035. [3]

The burden of injury in older people is a significant issue

• 126,000 hospital admissions in people aged >=65 years (Australia, 2011-12). [4]

• Short- and long term effects for the injured person, their family, friends, support services, workplace and engagement in the wider community e.g. carer responsibilities.

• As the problem of injury in older people increases, so will the demand for high quality, evidence-based research in this area, at both patient and population level.

Research has been carried out into functional and health-related quality of life outcomes post-acute injury in the younger population, however there is scant evidence on generic health-related quality of life post-injury in older people

Aim A systematic literature review was undertaken to assess the evidence regarding functioning and health-related quality of life (HRQoL) following traumatic injury in older people.

Figure 1: PRISMA flow diagram [9]

Results • 18 records met the inclusion criteria for the review (see Figure 1).

• 55% of publications were specific to older people.

• Meta-analysis was not possible due to heterogeneity of results.

• Large variation between studies in terms of study population, setting and inclusion criteria; injury type, mechanism and severity and and outcome measures. Some studies used multiple outcome measures.

• 8 studies (44%) reported an association between increasing age (and one or more of): slower recovery, residual disability, decreased functional outcome or reduced HRQoL. [10] [11] [12] [13] [14] [15] [16] [17]

• 6 studies (33%) compared outcomes in older and younger people, of these, 5 studies reported poorer outcomes in older people compared to younger people.

• 2 studies reported poor HRQoL outcomes for vertebral fractures [17] [18], 1 study reporting worse 7 year HRQoL outcomes for vertebral but not hip fractures. [18]

• The site of fracture appeared to influence outcome, with poorer outcomes reported in hip fractures [19]

Discussion and Conclusions

• Limited research was found that described functional outcomes and quality of life in older people following injury

• No evidence was found about the impact of injury on older people in terms of voluntary work, caring duties, and participation in paid work.

• Population-based studies are available, but the absolute numbers of older subjects are generally very small or results are not presented by age, limiting the conclusions that can be drawn.

• Based on the available evidence, older people have poorer functional and health-related quality of life outcomes post-injury.

• More research is required, specifically prospective cohort studies of functioning and health-related quality of life following injury focused on older people that use standardised, consistent definitions and measures for older people, functioning and health-related quality of life.

• Previous research has identified preferred health-related quality of life outcome measures in general injury populations, for example, the GOS-E, SF-36 and EQ-5D [6] [7] [8]. This review provides information as to which functioning and HRQoL measures are used in current research on injury in older people, however more research is necessary to determine the most appropriate measures to use in the older population.

Acknowledgements The first author is a current PhD student at The George Institute for Global Health and is the recipient of an Australian Postgraduate Award (APA) scholarship with additional support from the NSW Motor Accidents Authority (MAA). The authors declare they have no competing interests.

For further information please contact Katherine Brown: kbrown@georgeinstitute.org.au

Table 1: Number of publications by outcome measure/s used n

SF-36 5

GOS 3

EuroQOL / EQ-5D 3

FIM motor 2

FIM / modified FIM 2

GOS-E 2

SF-12 2

WHOQOL-BREF 1

Table 2: Number of publications by injury type n %

Fracture 7 39%

TBI 5 28%

Fall-related injury 2 11%

SCI 1 6%

MVC injury 1 6%

Any injury 1 6%

Moderate & major trauma 1 6%

Total 18 100%

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