For older adults, the potential for decline in the ability to carry out daily tasks after even minor injuries is a concern. Knowing what might predict a functional decline after a minor injury could help identify those older individuals at greatest risk, and enable efforts aimed at decreasing the likelihood of such decline, or at least ensure that individuals likely to experience such declines are able to get the assistance they need. To examine this issue, a Canadian study followed 355 older adults who were admitted to emergency departments (EDs) for minor injuries to see how many of these individuals experienced a functional decline three or six months later, and to determine which factors were associated with a higher likelihood of such a decline. All of the older adults studied were over 65 and were independent in basic activities of daily living at the time that they were admitted to the ED with minor injuries. None of these individuals required hospitalization for the injuries that led them to report to the ED. Eighty percent of these injuries were due to falls, and the types of injuries treated were mild traumatic brain injury (24 percent), contusions (64 percent), lacerations (25 percent), sprains (22 percent), and fractures (29 percent). For these individuals, functional decline three or six months later was defined as a loss of 2 or more points out of 28 on the Older Americans Resources Services (OARS) scale. This scale includes questions about activities of daily living (ADLs; for example eating, grooming, bathing, and walking), independent activities of daily living (IADLs; for example meal preparation, shopping, and managing money or medications).
The range of OARS scores at the time of discharge for the individuals in this study ranged from 18 to a perfect 28, with all individuals scoring a perfect score of 14 on the subscale on ADLs. Three months following their hospital visit, 15 percent of these individuals had lost 2 or more points from their original OARs score. By six months, 17 percent had OARS scores that declined by 2 points or more. This observed decline occurred mostly in four ADLs: walking, transferring, bathing, and dressing. Of the IADLs, the most common declines came in activities related to mobility.
Some background characteristics most strongly associated with functional decline were being over 85, having five or more co-morbidities, and having a greater number of visits to a family doctor prior to the original injury. Going out fewer than five times a week, occasional use of a walking aid, and needing help with IADLs prior to injury were also significantly associated with a greater likelihood of functional decline. Of the parts of an examination made by researchers at the time of the ED visit, taking longer than 10 seconds on the Timed Up and Go (TUG) test, low scores on self-efficacy, and having anxiety symptoms all also significantly correlated with functional decline. The emergency physician’s assessment of risk of the patient’s functional decline was also significantly associated with decline measured three months later. Interestingly, the type of minor injury treated in the ED was not significantly associated with later functional decline.
The findings from this study can help with the identification of older individuals at risk of functional decline during medical consultations for minor injuries, and the authors of this study conclude that this study also confirms the need to improve risk assessment and the management of older adults with minor injuries.
Sirois M-J, Émond M, Ouellet M-C, et al. Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department. Journal of the American Geriatrics Society (2013); 61: 1661–1668.