People ages 65 and older have high rates of injury, and traumatic injury in this age group is associated with worse outcomes than in younger populations. A case-control study assessed whether implementation of a multidisciplinary geriatric clinical care pathway improved delirium and length of stay at a trauma center in older adults who had a traumatic injury.

Adults ages 65 or older who were admitted to the trauma service but didn't have surgery were eligible for the study. A multidisciplinary team developed a care pathway based on geriatric best practices.

Of the 712 patients (mean age, 81.4 years; 394 were women) included in the study, 442 were in the baseline group and 270 were in the postimplementation group. The mechanism of injury was similar in the two groups, with falls experienced by 247 patients in the baseline group and 162 patients in the postimplementation group. Injuries were mild or moderate in both groups.

Delirium occurred significantly less frequently in the postimplementation group than in the baseline group (18.5% versus 28.3%). Significant reductions in delirium were observed in women, in those who experienced a fall, and in those who had an Injury Severity Score of less than 15, which indicates a minor or moderate injury. Non-English speakers didn't experience significant reductions in delirium. There were no significant differences in mean length of stay and time to mobilization in the baseline and postimplementation groups. Goals of care metrics improved significantly after implementation with regard to documented goals of care notes and a shortened time to discussion from presenting to the ED.

Coordinated care is needed to achieve optimal results in older adults after traumatic injury, the authors conclude.

One limitation of this study is that the study population-the majority of patients were White and English speaking-may not reflect the demographic characteristics of other trauma centers. Additionally, comparing some baseline and postimplementation metrics was challenging, according to the authors, who also noted that they relied on nurse-documented delirium scores, which reflect screening rather than confirmed delirium diagnoses.