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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

Background

Figure 1: PRISMA flow diagram [9]

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


General
Population
Working
Population

2010

2050

14% aged >=65

25% aged >=65

2002

2012

24% aged >=55

34% aged >=55

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, evidencebased 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 healthrelated quality of life (HRQoL) following traumatic injury in older people.

Methods

Discussion and Conclusions

Inclusion criteria

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

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

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

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)

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.

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.

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

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 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

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

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]

Table 2: Number of publications


by injury type

SF-36

Fracture

39%

GOS

TBI

28%

EuroQOL / EQ-5D

Fall-related injury

11%

FIM motor

SCI

6%

FIM / modified FIM

MVC injury

6%

GOS-E

Any injury

6%

SF-12

Moderate & major trauma

6%

WHOQOL-BREF

Total

18

100%

Table 1: Number of publications by


outcome measure/s used

References
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