Doha, 21 December 2021: A collaboration between the Trauma Unit in Hamad Medical Corporation (HMC) and the Department of Geriatrics and Long-Term Care, has led to the establishment of a Geriatric Trauma Care Program that facilitates the pro-active triaging of all trauma patients aged 65 and above. The aim is to identify patients that should undergo a Comprehensive Geriatric Assessment (CGA) and enable faster age-appropriate care.
The impetus for the program came from Dr. Hanadi Al Hamad, National Lead for Healthy Ageing in Qatar, Chair of the Geriatric and Long-Term Care Department, and Medical Director of Rumailah Hospital and Qatar Rehabilitation Institute, following evidence of a need for specialised care to be offered to older patients who have been admitted to the trauma unit. On average the Trauma Unit sees approximately two to three geriatric patients every week.
“As patients age, they do not have the same resources or reserves as younger people, and evidence has shown that geriatric patients have unique vulnerabilities in acute illness or trauma. Research indicates that geriatric trauma patients are more likely to sustain significant injuries, even with lower forces of injury, and are therefore served better when they receive specialized age-appropriate care that takes into account various geriatric syndromes that impact on their ability to respond to treatment,” explained Dr. Al Hamad.
Evidence has shown that 80% of geriatric trauma patients have at least one or more chronic diseases, such as hypertension, arthritis, heart disease, pulmonary disease, cancer, diabetes, or history of stroke. When combined with the altered physiology of increased age described later, these illnesses make geriatric trauma patients less able to tolerate the stress of trauma.
Dr. Jorge Passarelli, Consultant in Ortho Geriatrics/Trauma Geriatrics at HMC explained that geriatric patients may experience a range of factors that impact their ability to recover from trauma. “Geriatric trauma patients often experience decreased vision and hearing, have decreased muscle mass and/or strength, reduced bone mineral density and poor balance and impaired motor function leading to falls. In addition, they may have impaired cognitive function and are more likely to experience delirium and are at higher risk of adverse drug events.”
“We consulted with colleagues from the Trauma Unit and agreed to establish a regular process where we triage patients over the age of 65 to determine if they require a comprehensive geriatric assessment that will help identify their particular needs and challenges. The assessment is then reflected in a tailored ongoing treatment plan that takes into account the physical and psychosocial aspects of the patient. Part of the ongoing care includes management of the discharge from the Trauma Step-Down Unit, either to another hospital ward, the rehabilitation hospital or the long-term care unit. Where patients are released home, we also arrange for home healthcare services to ensure the patient recovery is monitored.
Dr Amir Ibrahim Abdalla, Consultant Geriatrician and Director of Acute Geriatrics in the Department of Geriatrics and Long-Term care has been a strong support of the program: “The program was initiated in January this year and so far we have had very favorable feedback from all parties, including our geriatric patients, their families and colleagues in the Trauma unit who have welcomed the specialist support from our department.”
Common reasons for trauma in elderly patients include falls from standing height or from a wheelchair, bed or commode that may have been brought on by the patient’s physical environment inside or outside the home or as a result of a physiological issue, such as dizziness or frailty. Motor vehicle crashes are also among the typical reasons for geriatric patients admittance to the Trauma Intensive Care Unit (TICU).
Dr. Gustav Strandvik, Senior Consultant and Co-Lead Trauma of the Intensive Care Unit (TICU) at Hamad General Hospital expressed his appreciation of the collaboration with the Geriatrics team that has resulted in this program offering valuable benefit to older more vulnerable patients. “Patients who are referred to our Trauma ICU are critically ill patients and our TICU team is experienced in offering high-quality trauma care. However, the same approach for treating adult patients may not always be appropriate for older adults with various geriatric syndromes. We therefore welcomed Dr Hanadi Al Hamad’s suggestion to collaborate on a program of care designed to deliver better outcomes for this cohort of patients.”
“We have been working closely with the Geriatric Trauma team over the course of the year to ensure the implementation of this program according to best practice protocols from the American College of Surgeons. Dr. Jorge Passarelli has also helped provide additional training for our physicians in the specialised care of geriatric trauma patients. We are now working together on developing Geriatric Trauma Management Guidelines for HMC,” added Dr. Strandvik.