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Traumatic Injury in Older Adults
Therese
S. Richmond, PhD, FAAN, CRNP
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Therese
S. Richmond, PhD, FAAN, CRNP, is
Associate Professor of Trauma and Critical Care
Nursing. She also serves
as the Research Director of the Firearm
Injury Center at Penn where she works with
an interdisciplinary team to fulfill the Center’s
mission “to
create safer communities through the systematic
reduction of firearm injury and its repercussions
to the individual, family, and society.”
Dr.
Richmond’s research interests focus
on the repercussions of injury and the factors
influencing recovery. She is currently the Principal
Investigator for a five-year NIMH-funded study “Major
Depression following Minor Injury.” She
believes that it makes
sense to think of firearm violence as a health
issue. “It’s
a disease where you have a bullet in your body,” she
explains. “When you’re shot, where are
you brought? You’re brought to the hospital.”
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Drs.
Richmond and Schwab |
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| Currently Funded Grants |
| Currently
Funded Grants (Richmond) |
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| Previous
Study on Serious Trauma in Older Adults |
Characteristics
and outcomes of serious traumatic injury in older
adults
Richmond TS, Kauder D, Strumpf N, Meredith T.
School of Nursing, University of Pennsylvania, Philadelphia
19104, USA.
terryr@nursing.upenn.edu
OBJECTIVES: To describe the seriously injured older adult;
characterize and compare the differences in injury characteristics
and outcomes in three subgroups of seriously injured
older adults: aged 65 to 74, 75 to 84, and 85 and older;
and identify risk factors for death, complications, and
discharge placement at hospital discharge. DESIGN:
A retrospective secondary analysis of a statewide trauma
data set from 1988 through 1997.
SETTING: Data submitted
from all designated trauma centers in Pennsylvania.
PARTICIPANTS: The data set yielded 38,707 patients
with a mean age of 77.5 years with serious injury (mean
number of injuries=3.6, mean number of body systems
involved=2). MEASUREMENTS:
Key outcomes were mortality, complications, and discharge
placement. Abbreviated Injury Score categorized injuries
and Injury Severity Score (ISS) quantified anatomic
severity of injury.
RESULTS:
Mortality was 10%. Mean length of stay was 11.5 days.
Just over half (52.2%) of survivors were discharged
home; 25.4% were discharged to a skilled nursing facility.
Injury severity, total number of injuries, complications,
and increasing age were predictors of mortality (P <.01).
The presence of preexisting comorbid medical conditions
increased the odds of experiencing a complication over
threefold. Increasing age, total number of injuries,
injury to extremities or abdominal contents, injuries
due to falls, and lower functional level predicted
discharge to a skilled nursing facility (P <.01).
CONCLUSIONS: Traumatic injuries affect older
adults of all ages and are typically multisystem and
life threatening. The standard ISS does not fully capture
the potential for mortality in older adults and does
not predict discharge placement. The majority of older
adults survive multisystem injury. Our findings indicate
the need to examine outcomes beyond mortality and to
make the identification and management of comorbid
conditions a priority. A geriatric consultation service
could be an important addition to the interdisciplinary
trauma team.
J Am Geriatr Soc. 2002 Feb;50(2):215-22.
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