Geriatric Trauma: A Retrospective Cohort Study Reviewing Factors Affecting Mortality to Guide Advanced Care Planning

Introduction 
Older adults form an increasing proportion of trauma admissions, with low-level falls accounting for most injuries. Ageing is associated with reduced physiological reserve, multimorbidity, and greater vulnerability, leading to higher mortality even after low-energy trauma. As geriatric trauma increases, there is increasing emphasis on frailty assessment, prognostication, and advance care planning to support appropriate, patient-centred decisions.

This study aimed to identify which injury patterns contribute to increased mortality in the local geriatric trauma population and compare these with national data. It sought to determine the impact of frailty, cognitive impairment, and pre-existing medical conditions on short- and medium-term survival, and to review the hospital’s ability to establish advance care planning for patients at high risk of deterioration.

Method 
Included were 100 patients aged >65 admitted to a UK trauma unit between December 2023 and January 2024. Patients were identified through the National Major Trauma Registry and followed for 24 months. Data collected included frailty score, cognitive impairment, injury patterns, comorbidities, higher-level interventions, readmissions, and advance care planning documentation.

Results 
Long bone fractures were associated with the highest mortality, with rates of 20% for lower limb and 16.7% for upper limb injuries, likely reflecting immobility, frailty, and reduced independence. Frailty was more strongly associated with mortality than chronological age, with higher mean frailty scores in non-survivors. Cardiac and orthopaedic comorbidities were linked to poorer outcomes. Cognitive impairment also increased mortality risk, particularly when severe.

Only 36 patients had advance care planning documented before or within 24 hours of admission, suggesting room for improvement. Study limitations included small sample size, incomplete records, and lack of injury-severity adjustment.

Conclusion 
Frailty, cognitive impairment, and long bone injuries were the strongest predictors of two-year mortality. These findings support early frailty assessment, recognition of high-risk injury patterns, and proactive goals-of-care discussions to improve patient-centred decision-making.