Enhancing Outcomes for Older Trauma Patients Through a Collaborative Geriatric–Palliative Care Model in DGH Trauma Unit

Background:
Geriatric trauma admissions continue to rise, yet optimal care pathways for this population remain poorly defined. Although trauma centre care improves outcomes in the general trauma population and palliative care is known to support patients with complex needs, their combined value in geriatric trauma remains unclear. At The Hillingdon Hospitals (THH), we observed that older trauma patients frequently lacked timely recognition of dying, received delayed or absent ceilings of care, and often underwent prolonged active treatment despite frailty, comorbidities, or prior care preferences. This contributed to missed opportunities for symptom management and timely discharge planning.

Aim:
To evaluate the impact of an integrated trauma care model involving a dedicated Care of the Elderly (CoE) consultant and early palliative care engagement for older adults with traumatic injuries who are not actively dying but may benefit from supportive decision‑making, advance care planning, and facilitated discharge.

Methods:
A series of geriatric trauma cases were reviewed to assess points where early involvement from CoE and palliative teams could have improved care alignment, reduced uncertainty, and avoided prolonged admissions. Key elements of the collaborative model included early palliative review in cases of prognostic uncertainty, direct referral pathways from ED for frail or significantly injured patients, use of Unified Care Plans (UCPs) for older adults with poor prognostic indicators, and weekly multidisciplinary team (MDT) assessments.

Results & Conclusions:
Preliminary findings suggest that early geriatric–palliative collaboration may reduce unnecessary hospital stays, support timely identification of ceilings of care, and improve alignment with patient wishes. Case examples will be presented to demonstrate the clinical impact and potential for wider implementation.