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Frailty ‐ The strongest predictor of 12‐month mortality in minor and major elderly trauma

The proportion of the population aged over 64 years is increasing and is projected to be 20% of the Australian population by the middle of the century. This is reflected in trauma admission, with estimates that those over 64 years of age will comprise 39% of trauma presentations by 2050. The most common mechanism for all trauma admissions is patients aged over 64 years with low falls. Despite the low force of this mechanism, this group has been shown to have poor outcomes, and low falls have been suggested as a predictor of long-term mortality in older trauma patients, independent of Injury Severity Score (ISS), age and comorbidities. A large contributing factor to this may be frailty. Frailty is a loss of physiological reserve that leaves an individual vulnerable to a significant decline from a seemingly minor insult. In major trauma, frailty is associated with increased complications and death, with a study in the United Kingdom showing that frail patients had significantly higher 30-day mortality (frailty score 5–6 odds ratio (OR) 5.68; p < 0.01; frailty score 7–9 OR 10.38; p < 0.01). A study at our institution that aimed to assess the presence and impact of frailty in major trauma found that the prevalence of frailty in major trauma patients aged over 64 years is in fact low, thus the impact of frailty is likely to be greater in minor trauma. A challenge with quantifying the burden of disease in elderly trauma is that data are commonly reported only in major trauma. For instance, the Victorian State Trauma Registry (VSTR), the Australian and New Zealand Trauma Registry and the American National Trauma Data Bank annual reports focus on major trauma. With the ageing population, the incidence of low falls causing minor trauma in the elderly will increase, and therefore, collecting and presenting data on this cohort is vital. Multiple studies in orthogeriatric trauma have shown that multidisciplinary care with surgeons, geriatricians and allied health professionals significantly improves length of stay and 12-month mortality following neck of femur (NOF) fractures. This finding has also been demonstrated in other traumas, where geriatricians assisted with medication changes, pain management, disposition decisions to promote function and decisions around appropriate ceilings of care. This model of care is resource intensive, so identifying those patients who will benefit is crucial as the population ages. The aims of this study were to (1) analyse the frailty of patients aged over 64 years presenting after low falls; (2) compare the morbidity and mortality of low falls compared to all other mechanisms and (3) describe the association between ISS, frailty, age, low fall and mortality. This Australian-based study will provide information that will contribute to current practice by guiding which elderly trauma patients are most at risk of poor outcome, and where intensive multidisciplinary care would be best directed.