Exploring the needs and preferences of older trauma patients: A qualitative study

doi:10.21203/rs.3.rs-4942016/v1

Download PDF

Research Article

Exploring the needs and preferences of older trauma patients: A qualitative study

https://doi.org/10.21203/rs.3.rs-4942016/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: Trauma in older people is emerging as a major health issue, with falls being the most common cause. Despite existing guidelines for trauma care of older populations, adoption is limited and undertreatment persists. This study aimed to explore the needs and preferences of older people and their families following traumatic injuries and define key components of a trauma care model for older populations.

Methods: This research adopted participatory design principles, engaging older people and their families, who had interacted with local healthcare services, to participate in a workshop which included structured activities and questions designed to facilitate discussion of the participants’ experiences of trauma and subsequent healthcare. Qualitative data were collected, coded, and analyzed using thematic analysis.

Results: Seven patients and six family members attended one of two workshops. Most patient participants were women, with a mean age of 82 years. Participants reported negative feelings following trauma, including uncertainty, shock and fear, decreased confidence, and feeling burdensome. Recovery goals were focused on regaining independence, participating in movement and exercise, and maximizing social connection. Communication, empathy and interpersonal skills in care, and system-related factors were identified as key factors impacting care and recovery experience following trauma. To improve trauma care, participants recommended care coordination, improved access to home support and rehabilitation, investment in staff expertise and training, and a dedicated trauma service for older adults.

Conclusions: This study underscores the importance of a comprehensive and person-centered approach to trauma care for older people, offering valuable insights for healthcare providers and policymakers striving to enhance the quality of care and improve outcomes for this vulnerable population.

healthcare experience

falls

rehabilitation

critical pathways

recovery pathway

care model

older adults

trauma

Demographic projections indicate a worldwide proportional rise in the population of older adults [1, 2]. In Australia, the number of people aged 85 years and over is projected to double by 2042 [3], with a consequent increased demand on healthcare services. Policy makers and healthcare providers are being urged to develop systems that effectively meet the needs of our growing, ageing population [4, 5].

The number of older adults hospitalised for trauma in Western countries is rapidly growing [6–8]. In Australia, the proportion of older patients in the major trauma population has increased, with an older person falling from standing height being the most common type of trauma [6]. Older patients frequently present with a clinical picture of major trauma, through a relatively minor or low energy injury mechanism [8, 9]. The presence of frailty or comorbidities contribute to a more severe consequence of trauma than in a younger person with equivalent injury severity, including a trajectory of functional decline, loss of independence, poorer quality of life, increased complications, and mortality [10–13]. Health systems need to develop specialised trauma care models and systems to effectively meet the needs of older patients [7, 14–16].

Trauma care of older people is supported by guidelines [17–19] and several targeted models of care, such as geriatric co-management and consultation, and have demonstrated potential for reduction of adverse outcomes for older patients following trauma [20–23]. Despite this, older patients remain under-triaged and undertreated, with health services lacking comprehensive adoption of recommended standards [21, 24]. Experts in emergency and geriatric care have identified research priorities as a need to 1. understand older people’s preferred goals of trauma care and 2. identify what combination of trauma and geriatric care is needed [24].

Engaging consumers can support the understanding of their needs and preferences [25, 26] and subsequently, assist in developing acceptable models of trauma care for older people.

The primary objective of this study was to understand the needs and preferences for healthcare and recovery from the perspective of older patients and their families following trauma.

The secondary objective was to define components and attributes of a model of trauma care recommended by consumers.

Study design

The nature of this research warranted adoption of principles for participatory design methodology. The Experience-Based Co-Design (EBCD) cycle is commonly used as a healthcare quality improvement tool [27], engaging patients, carers, and staff to collaboratively identify improvement priorities, design and implement changes, and jointly reflect on their achievements. In this research, we sought to gather information about consumer (patients and family/carers) needs and preferences that are expected to form part of a larger program of research relating to trauma care for older people.

A workshop was designed, aimed at fostering participant ownership over workshop outcomes, as recommended by Donetto et al [27]. The workshops involved structured activities and facilitated discussions, guided by The Field Guide to Human Centred Design (IDEO.org, 2015), exploring participant experiences, perceptions, needs, and preferences and generating qualitative data addressing the research question.

Ethical approval was granted by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 – LNR/23/SAC/101.

Participants

Older people (65 + years) who had experienced trauma requiring emergency care and their families were invited to participate in one of two workshops. All patient participants accessed healthcare through the Southern Adelaide Local Health Network (SALHN) in South Australia and were identified through subacute and community services. Eligibility criteria included living at home, without a diagnosis of dementia, able to provide informed consent, and able to independently access and participate in workshop activities.

A short pre-workshop demographic and background information survey was developed, including participant reported age, gender, country of birth (or year of arrival in Australia), language spoken at home, level of confidence in understanding health information [3], and questions relating to health services accessed through their trauma healthcare experience.

Study procedures

Clinical staff identified potential participants, based on the eligibility criteria, and provided provisional study information. The project team provided further information and sought consent from potential participants. Prior to attending the workshop, participants completed the pre-workshop survey via telephone.

Consumer workshops were facilitated by researchers experienced in qualitative research and held in a community hub. Participants attended one of two workshops and were provided with a $70AUD gift card honorarium.

Data analysis

Participant demographic and characteristics data were entered into a Microsoft Excel spreadsheet. Workshop group discussions were audio recorded and professionally transcribed.

Data coding and analysis of qualitative data were conducted by two members of the research team (JW and MCh), with the adoption of grounded theory principles, in which the systematic and iterative process of data coding and analysis provides insights into the factors, processes, and interactions that influence the experience, needs, and preferences of consumers. This approach is well suited to the pursuit of understanding health consumer experiences and perspectives [28] and was enacted through a process of reflexive thematic analysis [29].

Coding was conducted using NVivo 1.7.1 software. To ensure coherence across themes, the researchers conducted a shared review of data against minor and major themes. Final definitions, naming of themes, and report planning included review by a third, senior qualitative researcher (KL).

Between August and November 2023, 13 participants attended the workshops, including “patients” who had experienced trauma (n = 7) and “family members” who had supported the patient following trauma (n = 6). All patients presented to the emergency department following a fall (via ambulance n = 6 and directly n = 1) and were admitted to acute wards. Most had surgical interventions (n = 5) and inpatient rehabilitation (n = 6). Hospital-in-the-home services were accessed by 3 patient participants. All had accessed outpatient healthcare services (rehabilitation, physiotherapy, and/or group exercise such as hydrotherapy). Community-based exercise groups were accessed by four patient participants at the time of the workshop, with others intending to access when available. Health literacy confidence varied within both patient and family participant groups, indicated by responses in Table 1 to the statement ‘I always understand health information well enough to know what to do’ [30].

Table 1

*Participant characteristics (N = 13)*
Variable	‘Patient’ participants n = 7 (53.8%)	‘Family’ participants n = 6 (46.1%)
Sex
Male, n	1	4
Female, n	6	2
Age, years
Min-max	80–87	42–87
Median (mean)	80 (82)	71 (67.3)
Country of birth
Australia, n	4	5
England, n Netherlands, n Northern Ireland, n	1 1 1	1
Health literacy ¹
Strongly agree, n	0	3
Somewhat agree, n	5	2
Neither agree, nor disagree, n	1	0
Somewhat disagreed, n	0	1
Disagree, n	1	0

¹ Response to: “it is always easy for me to understand health information well enough to know what to do”question from the Australian Bureau of Statistics National Health Survey: Health literacy.

During the workshops, participants shared their experiences of trauma, and it’s impacts, of health system interactions and perceptions and perspectives related to the needs and preferences of older trauma patients. This led to the emergence of key themes related to; (1) negative feelings post trauma, (2) goals for recovery, (3) factors influencing the experience of care and recovery following trauma, and (4) recommendations to improve the experience of care following trauma, each with associated subthemes (Table 2).

Table 2

*summary of the identified themes and subthemes*
Theme	Subtheme
Negative feelings post trauma	Shock and fear
	Uncertainty
	Decreased confidence
	Feeling burdensome
Recovery goals	Regaining independence and a “full” recovery
	Movement and exercise
	Social connection
Factors Influencing the Older Patient’s Experience of Care and Recovery Following Trauma	Communication
	Empathy and interpersonal skills in care
	System-related factors in healthcare
Participant recommendations	Care coordination for the older trauma patient and family
	Support for the transition to home
	Extended and flexible rehabilitation options
	Investment in staff expertise
	Dedicated service

Negative feelings post trauma

1. Shock and fear

At the time of injury, all participants experienced distress, expressed as feelings of shock, closely followed by fear:

“I… couldn’t believe it was happening to me… how was I going to get help?” - Patient

2. Uncertainty

Participants expressed considerable uncertainty during recovery and when returning home:

“[I was] fearful…I was not ready to go home” – Patient

“you feel as though you could go home when you're in hospital, but once you get home, it's a different… entirely different, you don't feel as capable as what you do when you're in hospital” – Patient

3. Decreased confidence

Participants expressed a loss of confidence, frequently related to mobility and fear of falling:

“I [lost] my confidence in walking, [fearful] that I might have another fall ……. every time you fall, your confidence goes down.” - Patient

“[such] a long time before I got my confidence back”- Patient

4. Feeling burdensome

Participants consistently reported feeling “burdensome” for both health service staff and family:

“managing all the medications, lots of pills, trying to be nurse, doctor etc, going home quickly helped me but not [my husband]” – Patient

Recovery Goals

1. Regaining independence & “full” recovery hopes

Universal goals for participants were to regain independence, particularly relating to mobility, activities of daily living, and driving. Participants valued returning to social and family activities, and hobbies such as gardening:

“getting [back] to normal household activities again too, that's a big thing” - Patient

“being able to get out into it” - Family

Participants agreed that an ideal outcome would be complete recovery, but that for some, this was not necessarily realistic or not yet attained:

“to get back to 100 percent… it's been a little bit disappointing” - Patient

“I thought I did all the right things, but [I still need to use] a walker” - Patient

2. Moving and exercise

Moving and exercising with confidence was a common goal. All patient participants sought to join community exercise groups upon discharge:

I've had [exercises] with my legs and just been not able to... and [anticipating] the joy of being able to get up and do it again.

3. Social connection

Reconnecting socially with family and friends was a priority recovery goal for all participants:

“getting out… going to people's houses or having them come to your house” - Patient

“It makes so much difference…[resuming a] social life, yeah.” - Family

Factors Influencing the Older Patients Experience of Care Following Trauma

1. Communication

Information sharing with patient and family. At initial interaction with health services, participants described a “blur” of “quick” actions that were not always well-communicated, nor understood by the patient and family. Several participants described the interaction as a period in which they felt “uninformed”, with “no communication” relating to assessments, diagnoses, and plans for management, creating a distressing experience:

“just to be… told nothing really, not given any information is off-putting… it’s frustrating” - Patient

Communication between staff and services. Poor communication between healthcare staff, services, and consumers, particularly during transitions in care, was a source of concern:

“When she was given the information, it was never followed through with… they said she'd be going to this ward, she's going to that ward… she never went anywhere” – Family

Effective communication after discharge. Communication with patients and families following discharge was collectively important to participants, providing “checking-in” opportunities and facilitating coordination of follow-up appointments and services. Supports to connect with community services for longer term recovery progress was important and sometimes lacking:

“there’s that gap after rehab when you go home, when there’s no-one helping you find exercise in the community or at home after that, so there’s no follow up”- Family

“you sort of feel ignored” – Patient

2. Empathy and Interpersonal Skills in Care

Impact of staff workload. Patients and their families emphasized the profound impact of empathy during healthcare interactions. Participants shared the view that empathy and subsequently, quality of care was impacted when healthcare staff faced high workloads:

“if you meet somebody who's rushed off their feet and has too many people to look after, they won't have the time to look after you” - Patient

Positive and valued experiences. Empathy and dignity were demonstrated in the manner that health and care needs were met, particularly when staff extended this beyond the essentials of clinical care, and provided attention to patient comfort and dignity:

“those small acts of kindness” – Patient

“just those small, dignified things” - Family

Negative and distressing experiences. Several participants described distressing experiences, linked with both a perceived lack of healthcare staff empathy and poor interpersonal skills. This manifested in situations where patients felt dismissed, with timely pain management potentially impacted:

“[the healthcare staff] made it quite clear I was just a pest” - Patient

“they sort of didn't believe you… the pain you're in… [they] didn’t take it seriously” - Patient

Perception of being a low priority. Timely assistance with toileting was a common concern and source of distress, associated with a perception of both lack of empathy and being a low priority for staff, leading to embarrassment and discomfort:

“to be unable to get to the toilet… and then the outcome, of course… if you can't get there… I was really upset” - Family

“you get the feeling that you’re just a damn nuisance… I think that’s worse for you than the ailment” - Patient

3. System Factors in Healthcare

Rehabilitation Access. All participants valued rehabilitation and described it as a positive experience:

“the rehab side of stuff, that led to those good outcomes” - Family

“rehab was fantastic and gives confidence, rehab teaches you what you can do, [through] hydrotherapy, exercise” - Patient

Participants expressed unnecessary delays and difficulties in accessing rehabilitation that aligned with their individuals’ circumstances and abilities:

“it would be good if the rehab came in earlier” - Patient

“I could have done exercises with my arms… because I wasn't doing anything, I was lying on the bed all day, my muscles were wasting away” - Patient

Further, a common theme was one of frustration with rehabilitation scheduling and limited period of availability, being perceived as generic, rather than individualised:

“six weeks’ worth of rehab, then you're left on your own” - Patient

Discharge and Home Support. Discharge that was perceived as “too early” was a common theme:

“[I] fell Friday, operated Saturday, home Tuesday… [it was] too soon” - Patient

“she definitely didn't feel ready and able to go [home]… I think it was too quick” - Family

Participants reported a perception of healthcare staff having limited awareness of the challenges faced by participants following discharge and, in some cases, the “frightening” nature of the first days at home:

“a combination of [feeling] fearful and rushed… what am I going to do type thing” – Patient

Participants collectively recognised the importance of support during the transition to home, although many did not feel they had this adequately available:

“really, you need somebody professional to come in on your first day home” - Patient

“just to check up on me… to see that you are or are alright, mentally… I mean, I'm completely on my own” – Patient

Support systems, including family and friends, financial, and home supports (equipment and assistance) were all identified as important to recovery. Family provided advocacy, guidance, and practical support at home. Funded support, such as transport and home support services, was highly valued:

“to [get to] rehab… they provided taxis… which was great… until I could be able to drive again” - Patient

“there was physio at home and help with showering and whatever I needed really” - Patient

Individualised and Holistic Care. A commonly described theme was poor attention to mental health. Participants described trauma as a distressing and life changing event, yet participants noted a lack of attention to mental health and well-being:

“there was no mention of it the entire time and [the patient] was in the system… for three months or something” – Family

This sentiment sat alongside a common perception that the health system generally “does not work well” for people with complex presentations including mental ill-health, but also for those with complex care, and/or communication needs.

Recommendations from Individuals with Lived Experience of Trauma

Participants recommended five key, inter-related components of an ideal care pathway, to facilitate best possible outcomes for older people following trauma, including care coordination, support for the transition home, extended and flexible rehabilitation options, investment in staff expertise, and a dedicated service.

1. Care coordination for the older trauma patient and family

Participants recommended the establishment of a “guide, liaison or key contact” for older people and their families following trauma. Someone “who can explain things to the patient and the families” (Patient) and is available “throughout care” (Family). Ideally, this would be a person with healthcare knowledge who “understand[s] the needs of the older patient” (Patient) and can provide support in communication, transitions, and advocacy. Several participants had experienced this type of model in other health services and identified it as a potential solution.

2. Support for the transition to home

Participants consistently described the need for “tapering of support” (family) at discharge to home, with increased availability of home hospital services and contact points, providing opportunities to access advice, “trouble shoot” issues at home and support to connect with community services. Supports described included: “more home hospital services, medication checks, phone call checks, advice on what might be helpful [that you] may not have thought of” (group activity worksheet) and “connecting with, for example, My Aged Care, specialist review if needed, GP [timely]access” (group activity worksheet)

3. Extended and flexible rehabilitation options

The most frequently expressed recommendation was for extended and flexible rehabilitation, integrated with support for greater exercise and activity at home and within community programs, allowing participants to continue working towards remaining rehabilitation and recovery goals. Rehabilitation was a strongly positive experience for participants; however perceptions of limited availability or access were equally strong. Participants responded to the question “what [is needed to] support a good outcome” with a resounding response “more rehab”. In addition to improved flexibility and extended rehabilitation options, participants specifically suggested more guided “at home exercise” and rehabilitation integration into “acute and respite” care periods.

4. Investment in Staff Expertise

Participants recommended improved staffing and further training to develop expertise in the care of older people following trauma, including adaptable, responsive communication approaches and with attention to empathy in care.

5. Dedicated service

Participants recommended investment in a dedicated service for older people who have experienced trauma, separate from “the chaos” of the general emergency department and other acute services.

This study explored the perspectives, needs, and preferences of older people and their families following trauma. Participants expressed preferences for improved communication and enhanced empathy in care delivery. Specific recommendations for trauma care services for older people were made, including: a key healthcare professional (liaison); staff with expertise in working with older populations; suitable environments; and flexible, individualised access to rehabilitation and supports, particularly when transitioning to home.

The Importance and Challenge of Empathy in Healthcare Delivery

Older patients and their families have previously reported the importance of being viewed and valued as a person, with a need for respect, individualised care, effective communication, and collaboration with relatives [31–34]. The current study reinforces the recent findings of Kellezi et al. [31], highlighting that concerns of patients and their families often do not relate to a lack of effective clinical care, but the way in which care is delivered and represent an important care quality dimension.

Older people’s experiences of feeling burdensome and perceiving a lack of respect and empathy from healthcare staff is a sentiment that is reflected throughout the literature and must be addressed [31, 32, 35, 36]. In the present study, participants described a perception of high staff workload and time pressures impacting on interpersonal communication and the patient experience, a theme also reported in the broader literature [36–39]. In a review of the role of empathy in health and social care, factors that limited empathy in care included high patient load, time pressure, and lack of education in empathy [36]. These findings affirm participant perceptions in the present study and highlight both the complex challenge of and potential strategies to improve empathy in healthcare.

Attention to Mental Health and Well-being

Participants described trauma as a life-changing experience. They expressed a need for holistic care that focused not only on physical recovery, but also mental health and addressing loss of confidence following trauma. The need for psychosocial support for patients following trauma has been established [18, 40] and reinforced in a recent study of trauma patient experiences [31]. Anxiety and low self-efficacy have been linked with a maladaptive fear of falling [41], which is in itself, associated with negative outcomes for older adults [42]. This underscores the need to provide holistic care, addressing all factors impacting older patients following trauma, including mental health and well-being.

Healthcare Staff Competency, Expert Practitioners, and the Trauma Coordinator Role

Evidence-based geriatric care models which meet the unique and complex needs of older patients require teams of healthcare staff with knowledge of age-related changes and their impacts alongside skilled, responsive communication approaches [43–45]. Healthcare teams with competency in the care of older adults, closely supported by experts such as advanced geriatric care nurses and practitioners, are recognised as delivering improved outcomes for older patients [45–47] and would be well equipped to deliver and promote care that aligns with needs highlighted and recommendations made by participants in this study.

Nurse care coordinator roles are often implemented in the care of higher risk and older populations, including providing input during transitions in care, coordinating between services, and facilitating multi-disciplinary team input, positively impacting patient and health service outcomes [48, 49]. Specialist trauma nurse practitioner roles, including liaison with the patient, families and between teams and coordination of care, have similarly been shown to improve patient outcomes, in addition to supporting staff satisfaction [50]. Collectively, the literature provides evidence for the utility and benefits of a trauma coordinator or “liaison” for older patients and their families, as recommended by our participants.

Building staff competency in the care of older populations through targeted training, the presence of advanced trauma care practitioners, and specialised, nurse led coordination and/or liaison appear to be important ingredients in the delivery of healthcare that meets the needs of older populations.

Early, Flexible, and Individualised Rehabilitation

In contrast with emergency and acute care phases, participants consistently described the rehabilitation period as positive, with patients feeling better and working towards recovery goals. Participants recommended broadening rehabilitation availability to allow earlier and more flexible rehabilitation opportunities. The literature clearly supports early rehabilitation following musculoskeletal trauma for improved outcomes [51], particularly for older patients [52, 53]. Early rehabilitation is recognised as important to mitigate the risk of avoidable functional decline and mortality in older patients [52]. In a review by Kosse et al. [53], older patients who participated in an early multi-disciplinary rehabilitation program demonstrated improved functional levels, reduced length of hospital stay, and reduced likelihood of discharge to residential aged care. The criteria for commencement of rehabilitation for patients following trauma are not clearly defined, however readiness indicators are well discussed in the literature [54]. In a 2017 meta-analysis of published rehabilitation research, improved outcomes were demonstrated through both comprehensive multidisciplinary input and individualised (including inpatient, in-home, and community-based) rehabilitation for older patients [55]. Tele-rehabilitation was not discussed by participants in the current study but is recognised as a complement to rehabilitation services for older people, that is convenient and promotes motivation, self-awareness [56] and supports quality of life [57]. Improved rehabilitation opportunities, as recommended by the participants in the present study, may be provided by models of care that facilitate early rehabilitation access, comprehensive and individualised rehabilitation, and tele-rehabilitation, all of which is well supported in the existing literature.

Supported Discharge / Transition to Home

Participants recommended improved support for the transition from hospital and rehabilitation services to home, with follow up contact and support to connect with community activity groups and services. These recommendations clearly align with established trauma care guidelines and the broader literature which describe improved outcomes for older patients and health services when specialised coordination and liaison roles are adopted [17–19].

Recommendation Summary

Best practice guidelines for the care of older patients following trauma describe care components which align closely with the recommendations made by participants in this study [17–19]. Specifically, guidelines recommend healthcare teams with expertise in the care of older people; clear and timely communication between the healthcare team, the patient, and family; appropriate rehabilitation access, informed by holistic multi-disciplinary assessment; discharge planning including thorough assessment of home service and social support needs; and follow-up post-discharge to assess clinical status and well-being.

Strengths and Limitations

The results of this study must be interpreted with an awareness of the relatively small number of participants (n = 13) over two convened workshops. Within the sample, there is limited diversity in demographics and as such, the perspectives and experiences captured may not reflect that of the broader population of older people following trauma.

A strength of our study is the inclusion of participants with differing levels of health literacy, improving the representativeness of the sample. Health research is often biased towards reflecting the views of individuals with greater health literacy or may not use tools adequate to measure this [58]. This study included participants who reported low confidence in their ability to understand health information however, this measure is not part of a comprehensive conceptual framework.

We captured the perspectives of both patients and their family members, who were recruited by current service clinicians (day rehabilitation and fragility fracture clinics), which is a strength that allowed us timely capture of recent experiences and perspectives that might later have been forgotten if data were collected at a greater retrospective interval.

Implications for Practice

Trauma care teams require staff with a range of expertise in both trauma and geriatric care to meet the specific needs of older trauma patients. A holistic and individualised approach to care across the continuum, facilitated by a coordinator who supports communication and transitions, is important to older trauma patients and their families. Access to flexible rehabilitation and increased support at the time of discharge to home, in addition to the above, requires the attention of health and social care funding bodies.

Insights gained in the present study build on prior research findings, highlighting the need for a health practitioner workforce equipped with competency in working with older populations and specialised geriatric trauma liaison and coordination roles. Recommendations made by participants in this study align with best practice and current guidelines, advocating for a healthcare system that prioritises effective communication, empathy in care, and individualised support, fostering holistic healthcare delivery that positively influences the recovery journey of older adults who have experienced trauma. Extended, flexible rehabilitation access and support at discharge to home were highlighted by participants as healthcare priorities for attention. Consultation with healthcare stakeholders is essential to understand how these recommendations can be sustainably and consistently implemented to support best possible outcomes for older patients following trauma.

EBCD The Experience

Based Co-Design

Ethical approval and consent to participate

Ethical approval was granted by by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 – LNR/23/SAC/101. The participants were informed verbally and in writing about the study’s purpose and were assured that they could withdraw their consent at any time without consequences. All participants gave written consent before the workshop commenced.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during this study will be available from the corresponding author on reasonable request. This study was not pre-registered.

Competing interests

The authors declare no competing interests.

Funding

This work was supported by funding from the Lifetime Support Authority.

Authors contributions

J.W: designed the study, collected data, conducted data analysis, wrote and edited the main manuscript. K.L: designed the study, conducted data analysis, edited the main manuscript and supervised. M.Ch: collected data, conducted data analysis, edited the main manuscript. M.Cr: designed the study and edited the main manuscript. C.E: M.B: J.M: D.L: C.H edited the main manuscript. All authors reviewed the manuscript and read the final version.

Acknowledgements

We would like to thank the participants who contributed their time and expertise to this study.

United Nations. World Population Ageing 2017. ST/ESA/SER.A/408; 2017. Contract No. Department of Economic and Social Affairs, Population Division,.
WHO, Ageing. and health 2022 [ https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
Australian Bureau of Statistics. Population Projections, Australia. ABS; 2017.
Australian Institute of Health and Welfare. Ageing and the health system: challenges, opportunities and adaptions. Canberra AIHW; 2014.
McPake B, Mahal A. Addressing the needs of an aging population in the health system: The Australian case. Health Syst Reform. 2017;3(3):236–47.
Beck B, Cameron P, Lowthian J, Fitzgerald M, Judson R, Gabbe B. Major trauma in older persons. BJS open. 2018;2(5):310–8.
Hill AD, Pinto R, Nathens AB, Fowler RA. Age-related trends in severe injury hospitalization in Canada. J Trauma Acute Care Surg. 2014;77(4):608–13.
Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32(12):911–5.
Shanahan TA, Tonkins M, Bouamra O, Kumar DS, Edwards A, White L et al. The changing major trauma disease burden from low falls in the first two decades of the 21st Century–a longitudinal analysis from the largest European Trauma Registry. medRxiv. 2022.
Barry RG, Wolbert TT, Mozaffari FB, Ray PD, Thompson EC, Gress TW, et al. Comparison of geriatric trauma outcomes when admitted to a medical or surgical service after a fall. J Surg Res. 2019;233:391–6.
Brown K, Cameron ID, Keay L, Coxon K, Ivers R. Functioning and health-related quality of life following injury in older people: a systematic review. Inj Prev. 2017;23(6):403–11.
Rogers A, Rogers F, Bradburn E, Krasne M, Lee J, Wu D, et al. Old and undertriaged: a lethal combination. Am Surg. 2012;78(6):711–5.
Van Vledder MG, Kwakernaak V, Hagenaars T, Van Lieshout EM, Verhofstad MH, South West Netherlands Trauma Region Study Group. Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study. Eur J Trauma Emerg Surg. 2019;45(4):575–83.
Capezuti E, Boltz M, Cline D, Dickson VV, Rosenberg MC, Wagner L, et al. Nurses Improving Care for Healthsystem Elders – a model for optimising the geriatric nursing practice environment. J Clin Nurs. 2012;21(21–22):3117–25.
Ferrah N, Kennedy B, Beck B, Ibrahim J, Gabbe B, Cameron P. A scoping review of models of care for the management of older trauma patients. Injury. 2024;55(2):111200.
Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital elder life program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018;26(10):1015–33.
American College of Surgeons. ACS TQIP Geriatric Trauma Management Guidelines. Chicago2013.
American College of Surgeons. Best Practice Guidelines in Geriatric Trauma Management. Chicago: American College of Surgeons; 2023.
NHS. Pan London Major Trauma System Management of Older Trauma. London: National Health Service,; 2021.
Boddaert J, Cohen-Bittan J, Khiami F, Le Manach Y, Raux M, Beinis J-Y, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS ONE. 2014;9(1):e83795.
Ferrah N, Parker C, Ibrahim J, Gabbe B, Cameron P. A qualitative descriptive study exploring clinicians’ perspectives of the management of older trauma care in rural Australia. BMC Health Serv Res. 2023;23(1):704.
Olufajo OA, Tulebaev S, Javedan H, Gates J, Wang J, Duarte M, et al. Integrating geriatric consults into routine care of older trauma patients: One-year experience of a level I trauma center. J Am Coll Surg. 2016;222(6):1029–35.
Tillou A, Kelley-Quon L, Burruss S, Morley E, Cryer H, Cohen M, et al. Long-term postinjury functional recovery: outcomes of geriatric consultation. JAMA Surg. 2014;149(1):83–9.
Alshibani A, Banerjee J, Lecky F, Coats TJ, Prest R, Mitchell A, et al. A consensus building exercise to determine research priorities for silver trauma. BMC Emerg Med. 2020;20(1):63.
Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13(1):1–22.
Ferris R, Blaum C, Kiwak E, Austin J, Esterson J, Harkless G, et al. Perspectives of patients, clinicians, and health system leaders on changes needed to improve the health care and outcomes of older adults with multiple chronic conditions. J Aging Health. 2018;30(5):778–99.
Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based co-design and healthcare improvement: realizing participatory design in the public sector. Des J. 2015;18(2):227–48.
Gooberman-Hill R. Qualitative approaches to understanding patient preferences. Patient. 2012;5(4):215–23.
Clarke V, Braun V. Thematic analysis: a practical guide. London, England: SAGE; 2021.
Australian Bureau of Statistics. National Health Survey: Health literacy. Canberra: ABS; 2018.
Kellezi B, Earthy S, Sleney J, Beckett K, Barnes J, Christie N, et al. What can trauma patients' experiences and perspectives tell us about the perceived quality of trauma care? a qualitative study set within the UK National Health Service. Injury. 2020;51(5):1231–7.
Mickelson Weldingh N, Kirkevold M. What older people and their relatives say is important during acute hospitalisation: a qualitative study. BMC Health Serv Res. 2022;22(1):578.
Regen E, Phelps K, van Oppen JD, Riley P, Lalseta J, Martin G, et al. Emergency care for older people living with frailty: patient and carer perspectives. Emerg Med J. 2022;39(10):726–32.
van Oppen JD, Keillor L, Mitchell Á, Coats TJ, Conroy SP. What older people want from emergency care: a systematic review. Emerg Med J. 2019;36(12):754–61.
Koskenniemi J, Leino-Kilpi H, Puukka P, Suhonen R. Respect and its associated factors as perceived by older patients. J Clin Nurs. 2019;28(21–22):3848–57.
Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S, editors. The role of empathy in health and social care professionals. Healthcare; 2020.
Alhalal E, Alrashidi LM, Alanazi AN. Predictors of patient-centered care provision among nurses in acute care setting. J Nurs Manag. 2020;28(6):1400–9.
Dierckx de Casterlé B, Mertens E, Steenacker J, Denier Y. Nurses’ experiences of working under time pressure in care for older persons. Nurs Ethics. 2020;27(4):979–90.
Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662–73.
Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: An integrative literature review. Injury. 2013;44(11):1383–90.
Adamczewska N, Nyman SR. A new approach to fear of falls from connections with the posttraumatic stress disorder literature. Gerontol Geriatr Med. 2018;4:2333721418796238.
Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. The association between fear of falling and occurrence of falls: a one-year cohort study. BMC geriatr. 2022;22(1):393.
Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients’ eyes: a qualitative study. BMC Geriatr. 2024;24(1):476.
Bing-Jonsson PC, Bjørk IT, Hofoss D, Kirkevold M, Foss C. Competence in advanced older people nursing: development of ‘Nursing older people–Competence evaluation tool’. Int J Older People Nurs. 2015;10(1):59–72.
Halvachizadeh S, Gröbli L, Berk T, Jensen KO, Hierholzer C, Bischoff-Ferrari HA, et al. The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center. PLoS ONE. 2021;16(1):e0244554.
Henni SH, Kirkevold M, Antypas K, Foss C. The integration of new nurse practitioners into care of older adults: A survey study. J Clin Nurs. 2019;28(15–16):2911–23.
Katrancha ED, Zipf J. Evaluation of a virtual geriatric trauma institute. J Trauma Nurs. 2014;21(6):278–81.
Conway A, O’Donnell C, Yates P. The effectiveness of the nurse care coordinator role on patient-reported and health service outcomes: A systematic review. Eval Health Prof. 2019;42(3):263–96.
Tenison E, James A, Ebenezer L, Henderson EJ. A narrative review of specialist Parkinson’s nurses: Evolution, evidence and expectation. Geriatrics. 2022;7(2):46.
Walter E, Curtis K. The role and impact of the specialist trauma nurse: an integrative review. J Trauma Nurs. 2015;22(3):153–69.
You D, Leighton J, Schneider P. Current concepts in rehabilitation protocols to optimize patient function following musculoskeletal trauma. Injury. 2020;51:S5–9.
Chiu R-H, Tsai K-T, Wang Y-L, Cheng H-H. Early rehabilitation during hospitalization might decrease the Risk of 3-month mortality in older Patients: A retrospective cohort study. Rehabilitation Pract Sci. 2023;2023(1):2.
Kosse NM, Dutmer AL, Dasenbrock L, Bauer JM, Lamoth CJ. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC geriatr. 2013;13(1):1–16.
Kimmel LA, Holland AE, Lannin N, Edwards ER, Page RS, Bucknill A, et al. Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma. Aust Health Rev. 2017;41(2):192–200.
Stott DJ, Quinn TJ. Principles of rehabilitation of older people. Medicine. 2017;45(1):1–5.
Shulver W, Killington M, Morris C, Crotty M. Well, if the kids can do it, I can do it’: older rehabilitation patients' experiences of telerehabilitation. Health Expect. 2017;20(1):120–9.
Velayati F, Ayatollahi H, Hemmat M. A systematic review of the effectiveness of telerehabilitation interventions for therapeutic purposes in the elderly. Methods Inf Med. 2020;59(2–03):104–9.
Pleasant A, McKinney J, Rikard R. Health literacy measurement: a proposed research agenda. J Health Commun. 2011;16:11–21.

No competing interests reported.

Download PDF

Reviews received at journal
30 Sep, 2024
Reviewers agreed at journal
29 Sep, 2024
Reviews received at journal
27 Sep, 2024
Reviewers agreed at journal
23 Sep, 2024
Reviewers agreed at journal
22 Sep, 2024
Reviewers agreed at journal
20 Sep, 2024
Reviewers agreed at journal
20 Sep, 2024
Reviewers agreed at journal
20 Sep, 2024
Reviews received at journal
13 Sep, 2024
Reviewers agreed at journal
13 Sep, 2024
Reviewers invited by journal
13 Sep, 2024
Editor invited by journal
22 Aug, 2024
Editor assigned by journal
22 Aug, 2024
Submission checks completed at journal
22 Aug, 2024
First submitted to journal
20 Aug, 2024

You are reading this latest preprint version

Exploring the needs and preferences of older trauma patients: A qualitative study

Status:

Version 1

Abstract

Background

Methods

Study design

Participants

Study procedures

Data analysis

Results

1. Shock and fear

2. Uncertainty

3. Decreased confidence

4. Feeling burdensome

1. Regaining independence & “full” recovery hopes

2. Moving and exercise

3. Social connection

1. Communication

2. Empathy and Interpersonal Skills in Care

3. System Factors in Healthcare

Recommendations from Individuals with Lived Experience of Trauma

1. Care coordination for the older trauma patient and family

2. Support for the transition to home

3. Extended and flexible rehabilitation options

4. Investment in Staff Expertise

5. Dedicated service

Discussion

The Importance and Challenge of Empathy in Healthcare Delivery

Attention to Mental Health and Well-being

Healthcare Staff Competency, Expert Practitioners, and the Trauma Coordinator Role

Early, Flexible, and Individualised Rehabilitation

Supported Discharge / Transition to Home

Recommendation Summary

Strengths and Limitations

Implications for Practice

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1