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. 2018 Mar 2;97(9):e0034. doi: 10.1097/MD.0000000000010034

Physical and nutrition statuses of geriatric patients after trauma-related hospitalization

Data from the Korean National Health and Nutrition Examination Survey 2013–2015

Hang Joo Cho 1, Tae Hwa Hong 1, Maru Kim 1,∗
Editor: Goran Augustin1
PMCID: PMC5851728  PMID: 29489652

Abstract

Population aging is associated with increasing numbers of geriatric trauma patients, and various studies have evaluated their short-term outcomes, assessment, and treatment. However, there is insufficient information regarding their long-term outcomes. This study evaluated the physical and nutritional statuses of geriatric patients after trauma-related hospitalization.

Data regarding physical and nutritional status were obtained from the Korean National Health and Nutrition Examination Survey VI (2013–2015).

A total of 21,069 individuals participated in the survey, including 5650 geriatric individuals. After excluding individuals with missing data, 3731 cases were included in the analyses. The average age was 68 years, and most individuals were women (n = 2055, 55.08%). There were 94 patients had been hospitalized because of trauma. Trauma-related hospitalization among geriatric patients was significantly associated with reduced strength exercise (23.56% vs 12.99%, P = .043), activity limitations caused by joint pain (0.65% vs 3.31%, P = .028), self-care problems (8.00% vs 16.77%, P = .008), pain or discomfort (29.48% vs 40.51%, P = .024), hypercholesterolemia (27.37% vs 39.36%, P = .037), and mastication discomfort (39.98% vs 57.85% P = .005). The adjusted analyses revealed that trauma-related hospitalization was independently associated with activity limitations caused by joint pain (odds ratio [OR]: 5.04, 95% confidence interval [CI]: 1.29–19.67, P = .020), self-care problems (OR: 2.24, 95% CI: 1.11–4.53, P = .025), pain or discomfort (OR: 1.77, 95% CI: 1.08–2.89, P = .023), and mastication discomfort (OR: 2.06, 95% CI: 1.22–3.46, P = .007).

Medical staff should be aware that geriatric patients have relatively poor physical and nutritional statuses after trauma-related hospitalization, and manage these patients accordingly.

Keywords: geriatric, nutrition, quality of life, trauma

1. Introduction

Trauma is a leading cause of disability,[1] although advances in trauma surgery have recently improved the prognosis of patients with trauma. In addition, military surgeons have returned from several wars during the 20th century and used their experience to improve trauma treatments and systems.[2,3] For example, their experience has been used to develop rapid transport and triage systems, as well as surgical treatments that have improved outcomes among the general population. However, aging societies have trauma patients with constantly changing characteristics, and the National Trauma Data Bank has indicated that the proportion of ≥65-year-old trauma patients at Levels I–II trauma centers had increased from 23% in 2003 to 30% in 2009. It is also estimated that >80 million Americans will be ≥65 years old in 2050, which is approximately double the population from 2012.[4] Moreover, the UK Trauma Audit Research Network has revealed that the mean age of major trauma patients has increased from 36.1 years in 1990 to 53.8 years in 2013.[5] During that period, the proportion of patients with major trauma who were >75 years increased from 8.1% to 26.9%, and the UK population of ≥65-year-old individuals is expected to double by 2030.[6]

Geriatric trauma patients have relatively poor morbidity and mortality outcomes,[6–8] which may be related to their diminished physiological reserve.[9,10] Furthermore, aging is associated with declines in cardiac, pulmonary, and renal functioning, as well as hypertension, diabetes, and treatment using antiplatelet and anticoagulant drugs.[9] Therefore, geriatric patients are vulnerable to trauma and have relatively poor trauma-related outcomes. However, there is insufficient evidence regarding the health-related quality of life, nutritional status, and physical status of geriatric patients after trauma, although many studies have evaluated their short-term outcomes. The present study aimed to determine whether geriatric patients might experience reduced quality of life, nutritional status, and physical status after trauma-related hospitalization (vs the general population of geriatric individuals), based on data from the Korean National Health and Nutrition Examination Survey (KNHANES).

2. Methods

2.1. Data collection

Data were obtained from the KNHANES VI survey (2013–2015), which is an annual population-based cross-sectional survey that is conducted by Korean Centers for Disease Control and Prevention. The multistage stratified survey collects information regarding various characteristics, including age, sex, and socioeconomic status. Participants are asked to complete a four-part questionnaire regarding their health, health-related behaviors, medical history, and nutritional status. The participants also complete health examinations, laboratory testing, and anthropometric and dental evaluations. Body weight and height are measured while the participants are only wearing light indoor clothes. All data were collected by trained medical staff after obtaining written informed consent from all participants. Approval was obtained from our institutional review board to evaluate data from all geriatric individuals (≥60 years old) who participated in the KNHANES VI survey.

The present study evaluated data regarding age, sex, individual income, and household income. Furthermore, cases that involved trauma-related hospitalization were evaluated to obtain information regarding the trauma mechanism and intentionality. Furthermore, data were collected regarding quality of life parameters and physical status, such as performing strength exercises (push-ups, sit-ups, chin-ups, and dumbbell or barbell exercises on at least 2 days per week), activity limitations and causes, knee joint pain, and hip joint pain. The participants also completed the EuroQol five-dimensions questionnaire (EQ-5D) regarding mobility, self-care, activities of daily living, pain or discomfort, and anxiety/depression, after receiving approval from the EuroQol Group. Body mass index (BMI, kg/m2) was used to identify participants with a BMI of <18.5 kg/m2 (underweight) or ≥25 kg/m2 (obese). The upper limit of normal for glycated hemoglobin (HbA1c) was defined as 6.5%. Anemia was considered present for female patients with a hemoglobin level of <12.0 g/dL and male patients with a hemoglobin level of <13.0 g/dL. Hypercholesterolemia was considered present for patients who were receiving cholesterol-lowering medication or who had a total cholesterol level of ≥240 mg/dL. Complaints of mastication discomfort or toothache were also recorded. Individuals with missing data were excluded from the analysis.

2.2. Data analysis

The physical and nutritional statuses were compared between individuals with and without trauma-related hospitalization. Categorical data were reported as number (percent) and analyzed using the Rao-Scott chi-square test. Continuous data were reported mean ± standard deviation and analyzed using the t-test. Univariate and multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for various outcomes. The regression analyses were adjusted for age, sex, individual income, and household income. All statistical analyses were performed using SAS software (version 9.4; SAS Institute Inc., Cary, NC). P values of <.05 were considered statistically significant.

3. Results

A total of 21,069 individuals participated in the KNHANES VI survey, including 5650 geriatric individuals. After excluding individuals with missing data, 3731 cases were included in the analyses. The average age was 68 years, and most individuals were women (n = 2055, 55.08%). Ninety-four patients were hospitalized because of trauma, and these cases generally involved blunt injuries that were caused by slips and falls. All patients reported that the trauma was accidental. The geriatric individuals’ baseline characteristics are shown in Table 1.

Table 1.

Baseline characteristics of analyzed geriatrics.

3.

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Geriatric patients with trauma-related hospitalization experienced decreased quality of life in several dimensions, compared to their non-hospitalized counterparts (Table 2). For example, these patients were significantly less likely to perform strength exercises (23.56% vs 12.99%, P = .043), more likely to experience activity limitations because of joint pain (0.65% vs 3.31%, P = .028), more likely to have self-care problems (somewhat agree: 8.00% vs 16.77%; strongly agree: 0.55% vs 1.29%, P = .008), and more likely to experience pain or discomfort (somewhat agree: 29.48% vs 40.51%; strongly agree: 1.65% vs 3.58%, P = .024). Trauma-related hospitalization was also associated with hypercholesterolemia (27.37% vs 39.36%, P = .037), and mastication discomfort (39.98% vs 57.85%, P = .005)

Table 2.

Physical and nutritional status of geriatric patient after trauma-related hopitalization.

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The univariate and multivariate regression analysis results are shown in Table 3. Trauma-related hospitalization was associated with a lower likelihood of performing strength exercises (OR: 0.49, 95% CI: 0.24–0.99, P = .048) and a higher likelihood of activity imitations because of joint pain (OR: 5.11, 95% CI: 1.24–21.00, P = .024). Trauma-related hospitalization was also associated with increased risks of self-care problems (OR: 2.34, 95% CI: 1.20–4.55, P = .012), pain or discomfort (OR: 1.78, 95% CI: 1.09–2.91, P = .021), hypercholesterolemia (OR: 1.72, 95% CI: 1.03–2.89, P = .040), and mastication discomfort (OR: 2.06, 95% CI: 1.23–3.44, P = .0058). The adjusted analyses revealed that trauma-related hospitalization was independently associated with activity limitations caused by joint pain (OR: 5.04, 95% CI: 1.29–19.67, P = .020), self-care problems (OR: 2.24, 95% CI: 1.11–4.53, P = .025), pain or discomfort (OR: 1.77, 95% CI: 1.08–2.89, P = .023), and mastication discomfort (OR: 2.06, 95% CI: 1.22–3.46, P = .007).

Table 3.

Univariate and multivariate regression analysis of physical and nutritional factors.

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4. Discussion

Many studies have revealed poor outcomes among geriatric trauma patients,[6–8] which led to the development of tools to predict their outcomes and improve their treatment.[8,11,12] However, to the best of our knowledge, the present study is the first to evaluate the health-related quality of life, nutritional status, and physical status of geriatric trauma patients, and we identified several problems related to their physical and nutritional statuses after trauma-related hospitalization. They had more risk for activity limitations caused by joint pain, self-care problems, pain or discomfort and mastication discomfort. Additionally trauma-related hospitalization was also associated with non-significant increases in mobility problems, activities of daily living problems, and anxiety or depression. Furthermore, patients with trauma-related hospitalization were more likely to experience changes in their weight, anemia, HbA1c levels of ≥6.5%. Therefore, it is important to consider these patients’ quality of life, as well as their mortality or morbidity. A collaborative approach should be developed to combine the expertise of surgeons, intensivists, physiatrists, nutritionists, nurses, and social workers.

Only a small proportion of geriatric patients were hospitalized because of trauma (2.5% of the eligible individuals), compared to 6.7% of individuals who had experienced an injury in a previous KNHANES survey (797 of 11,837 individuals).[13] Furthermore, a previous study has revealed that the incidences of trauma-related hospitalization were 2.3% among men and 1.7% among women.[14] Thus, the low incidence of trauma-related hospitalization indicates that big-data studies may be needed to identify significant differences in the physical and nutritional statuses of geriatric trauma patients.

The EuroQol group developed the EQ-5D tool to rapidly assess health-related quality of life[15] using five questions regarding mobility, self-care, activities of daily living, pain/discomfort, and anxiety/depression. This tool has been used to evaluate patients’ overall health status and health-related quality of life in cases that involved cardiac arrest, burns, critical illnesses, and geriatric patients.[15–19] In the present study, the EQ-5D tool identified several significant decreases in the health-related quality of life of geriatric trauma patients.

It is interesting that geriatric trauma patients had an increased risk of mastication discomfort, as we did not limit our analysis to patients who had experienced oromaxillary trauma. A recent study has revealed that masseter muscle cross-sectional area predicted mortality among elderly blunt trauma patients,[20] and decreased chewing ability is associated with impaired activities of daily living, cognitive function, depression, and food insufficiency among geriatric patients.[21] Therefore, further studies are needed to understand mastication rehabilitation and nutritional challenges among geriatric trauma patients.

The present study has several potential limitations. For example, there was limited information regarding the patients’ admission parameters and ward (e.g., the intensive care unit), and we could only identify patients who were or were not hospitalized because of trauma. In addition, case severity can be evaluated using the injury severity score, SOFA score, or APACHE score, although these tools are not used in the KNHANES surveys, which are performed to obtain general information for the Korean Centers for Disease Control and Prevention. This approach facilitates long-term analysis, although specific and sophisticate analysis may not be possible. However, the Korean Trauma Data Base includes information regarding trauma cases’ injury severity score, abbreviated injury score, trauma and injury severity score, intensive care unit admission, morbidity, and mortality. Thus, combination of that database with KNHANES data might facilitate more comprehensive analyses, and it would also be useful to evaluate methods to improve these patients’ health-related quality of life. Furthermore, evaluating data regarding intensive care unit admission might provide additional information regarding post-intensive care syndrome.[22]

Among geriatric patients, trauma-related hospitalization was associated with reduced strength exercise, activity limitations caused by joint pain, self-care problems, pain or discomfort, hypercholesterolemia, and mastication discomfort. Therefore, trauma surgeons, nurses, physiatrists, nutritionists, and social workers should collaborate to improve the physical and nutritional statuses of these patients. In addition, further studies are needed to elucidate the long-term prognosis of geriatric trauma patients.

Acknowledgments

We thank Professor Hyun Woo Im and his co-investigator Jin Young Huh for providing statistical assistance.

Footnotes

Abbreviations: BMI = body mass index, CI = confidence interval, EQ-5D = EuroQol five-dimensions questionnaire, HbA1c = glycated hemoglobin, KNHANES = Korean National Health and Nutrition Examination Survey, OR = odds ratio.

The authors report no conflicts of interest.

References

  • [1].Hoffman K, Cole E, Playford ED, et al. Health outcome after major trauma: what are we measuring? PLoS One 2014;9:e103082. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [2].Adams SD, Holcomb JB. Geriatric trauma. Curr Opin Crit Care 2015;21:520–6. [DOI] [PubMed] [Google Scholar]
  • [3].Mullins RJ. A historical perspective of trauma system development in the United States. J Trauma 1999;47:S8–14. [DOI] [PubMed] [Google Scholar]
  • [4].Brown CV, Rix K, Klein AL, et al. A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients. Am Surg 2016;82:1055–62. [PubMed] [Google Scholar]
  • [5].Kehoe A, Smith JE, Edwards A, et al. The changing face of major trauma in the UK. Emerg Med J 2015;32:911–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [6].Clement ND, Aitken S, Duckworth AD, et al. Multiple fractures in the elderly. J Bone Joint Surg Br 2012;94:231–6. [DOI] [PubMed] [Google Scholar]
  • [7].Hwabejire JO, Nembhard CE, Oyetunji TA, et al. Age-related mortality in blunt traumatic hemorrhagic shock: the killers and the life savers. J Surg Res 2017;213:199–206. [DOI] [PubMed] [Google Scholar]
  • [8].Llompart-Pou JA, Perez-Barcena J, Chico-Fernandez M, et al. Severe trauma in the geriatric population. World J Crit Care Med 2017;6:99–106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [9].Giannoudis PV, Harwood PJ, Court-Brown C, et al. Severe and multiple trauma in older patients; incidence and mortality. Injury 2009;40:362–7. [DOI] [PubMed] [Google Scholar]
  • [10].Braun BJ, Holstein J, Fritz T, et al. Polytrauma in the elderly: a review. EFORT Open Rev 2016;1:146–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [11].Calland JF, Ingraham AM, Martin N, et al. Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73:S345–50. [DOI] [PubMed] [Google Scholar]
  • [12].Newgard CD, Holmes JF, Haukoos JS, et al. Improving early identification of the high-risk elderly trauma patient by emergency medical services. Injury 2016;47:19–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [13].Kim SK, Kim H, Lee K, et al. The relationship between injury and socioeconomic status in reference to the fourth Korean National Health and Nutrition Examination Survey. Ann Occup Environ Med 2014;26:1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [14].Paek KW, Chun KH, Cho JP. Risk factors influencing the occurrence of injuries in Koreans requiring hospitalization. Yonsei Med J 2007;48:164–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [15].Lutomski JE, Krabbe PF, Bleijenberg N, et al. Measurement properties of the EQ-5D across four major geriatric conditions: Findings from TOPICS-MDS. Health Qual Life Outcomes 2017;15:45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [16].Helvik AS, Corazzini K, Selbaek G, et al. Health-related quality of life in older depressed psychogeriatric patients: one year follow-up. BMC Geriatr 2016;16:131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [17].Solverson KJ, Grant C, Doig CJ. Assessment and predictors of physical functioning post-hospital discharge in survivors of critical illness. Ann Intensive Care 2016;6:92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [18].Andrew E, Nehme Z, Bernard S, et al. Comparison of health-related quality of life and functional recovery measurement tools in out-of-hospital cardiac arrest survivors. Resuscitation 2016;107:57–64. [DOI] [PubMed] [Google Scholar]
  • [19].Druery M, Newcombe PA, Cameron CM, et al. Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol. BMJ Open 2017;7:e017545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Wallace JD, Calvo RY, Lewis PR, et al. Sarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography. J Trauma Acute Care Surg 2017;82:65–72. [DOI] [PubMed] [Google Scholar]
  • [21].Kimura Y, Ogawa H, Yoshihara A, et al. Evaluation of chewing ability and its relationship with activities of daily living, depression, cognitive status and food intake in the community-dwelling elderly. Geriatr Gerontol Int 2013;13:718–25. [DOI] [PubMed] [Google Scholar]
  • [22].Rawal G, Yadav S, Kumar R. Post-intensive Care Syndrome: an overview. J Transl Int Med 2017;5:90–2. [DOI] [PMC free article] [PubMed] [Google Scholar]

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