Doctors call for urgent action to improve injury care among elderly

Doctors in Southampton have called for urgent action to improve the detection of major trauma in the elderly across the UK.

Dr Andy Eynon, a consultant in intensive care at Southampton General Hospital, said patients over 65 with major trauma were being "overlooked".

He spoke out following new research which found injuries were missed in a quarter of patients in this group – which he blamed on an "ageist approach" to assessments.

The study, led by Dr Laura Tompsett, an anaesthetist in Southampton who has evaluated trauma care among the over 65s in the south central region, showed 67 of 282 patients reviewed from April 2012 to August 2014 suffered a missed injury or delayed diagnosis – despite 43% presenting with predictable signs of major trauma.

The most commonly missed injuries were spinal (38%) and head (25%), with almost a third (31%) requiring surgery for the missed injury.

The research also found that 84% of patients lived independently before admission but only 31% were discharged back to their homes, the remainder requiring ongoing higher levels of social care.

Major trauma is the term used to describe serious or life-threatening injuries commonly sustained through road traffic accidents, falls, violence or sporting injuries and it is the fifth most common cause of death in the elderly.

Over the past three years in Southampton alone, admissions among the over 65s as a result of accidents and falls have more than doubled, going from 88 in April 2012-13 to 211 in April 2014-15.

"The development of trauma networks across the country in 2012 has been a revelation, saving hundreds more lives a year, yet the elderly population seems to have been forgotten amid the successes," explained Dr Eynon, former director of major trauma at University Hospital Southampton NHS Foundation Trust.

"With admissions among this group increasing rapidly and a growing elderly population in the country, it is a problem that needs to be addressed urgently."

Dr Tompsett, whose own grandfather’s trauma injuries were missed in a UK hospital and resulted in him never returning to his own home, said many healthcare professionals were “simply not thinking trauma” when it came to the over 65s.

“The problems relating to elderly trauma are not localised, they are happening throughout the country – often because many suffer simple falls and do not activate specialist trauma teams or because they are seen as frail and put on a 'standard' elderly care pathway,” she explained.

“As a result, full diagnosis is often delayed as patients may not be referred to designated trauma centres, they aren't seen in a timely fashion and do not receive adequate imaging or input from senior doctors.”

At Southampton General Hospital, clinicians have developed a pioneering trauma and orthopaedic medical service for the over 65s, led by consultant ortho-geriatrician Dr Mark Baxter, to tackle the issue.

The hospital is one of only 12 centres across the country to offer the full range of specialist surgical, intensive care and supporting services for both adults and children who suffer major trauma and is supported by seven trauma units.

Dr Tompsett said there should now be a focus nationally on immediate input from elderly care specialists to help identify injuries earlier, so patients receive quicker access to treatment and a faster, more coordinated recovery and rehabilitation.

"This will not only save more lives in this group of patients by reducing complications, it will also allow rehabilitation to commence before patients deteriorate,” she said. “Hopefully this will enable them to get back to their original quality of life and have the ability to live independently."

She added: "We hope that by highlighting the Southampton model, we will provide a platform for other centres to build from that will help to improve care for these patients nationwide.

"In the meantime, all clinicians should make a start by taking more time over their assessments and asking themselves if a patient over 65 could have suffered major trauma to help to reduce the risk of missed injuries.”

Posted on Tuesday 20 October 2015