Geriatric Trauma Consultation Service reduces risk of delirium in elderly patients

A first-of-its-kind program at St. Michael's Hospital lowers risk of delirium in elderly patients admitted for trauma and decreases the likelihood they will be discharged to a long-term care facility.

The Geriatric Trauma Consultation Service is a program where every patient over 60 admitted to the trauma service is seen by a member of the geriatric team within 72 hours.

This is a big change from previous practice, where only 4 per cent of elderly patients admitted to trauma were seen by a geriatric team member during their stay in hospital.

"Older patients admitted to trauma are very complex," said Dr. Camilla Wong, a geriatrician in the trauma unit at St. Michael's and the lead physician of the project. "They often have pre-existing health issues, resulting in more in-hospital complications and medical consultations. The traditional model addressed these later, but we felt it was necessary to involve the geriatric team at an earlier point to make sure we're providing the best possible care."

The service provides an in-depth assessment of medical, cognitive, functional and psychosocial conditions.

An evaluation of the program was recently published in Annals of Surgery.

The evaluation looked at 238 elderly patients admitted to hospital for trauma before the Geriatric Trauma Consultation Service was put in place and 248 patients after the service had been implemented.

Dr. Wong and colleagues found that the service reduced the risk of developing delirium in hospital by 10 per cent.

"Seeing a reduction in the risk of developing delirium for these patients was a very significant finding," Dr. Wong said. "Developing delirium in hospital has been associated with morbidity, longer length of hospital stay, increased hospital-acquired complications and permanent cognitive decline, such as developing dementia."

For patients who had originally come to hospital from their home, there was also a significant decline in patients being discharged to a long-term care facility. "In older patients, there's a lot more to consider than just treating their traumatic injuries," Dr. Wong said. "More than 30 per cent of the patients who come to the trauma unit are 60 and older so it's important we have programs like this to properly take into account all their needs."