Background: There is a rising incidence of trauma in older people in Australia. In the last annual report of the Australia New Zealand Trauma Registry (1 July 2020 – 30 June 2021), 31% of all severe injuries occurred in people aged ≥65 year with a 21% increase over 4 years. Falls have been identified as a significant cause of injury, accounting for 66.9% of all causes of injury in this group. Low falls (from standing height), specifically, are the most common (46%) cause of severe injury in this older cohort of trauma patients. In response to this changing trauma patient demographic, in February 2023, Alfred Health a major trauma centre in Australia, introduced a novel Trauma Geriatrics Service.
Change: Two key process changes have facilitated the delivery of geriatrician-led Comprehensive Geriatric Assessment and optimisation (CGA) for older people admitted under the care of the Alfred Health Trauma Unit. The introduction of the Clinical Frailty Scale (CFS) in the trauma medical admission documentation has provided a common language for the Trauma and Trauma Geriatric Service teams, enabling appropriate referral of older people living with frailty who would benefit from CGA during their acute admission. The iterative construction of a documentation template that operationalises principles of CGA has provided a systematic approach for the Trauma Geriatric Service in their shared-care management of trauma in older people.
Learnings: Principles of CGA: Our experience has shown that CGA is a versatile tool which can be adapted to the acute and perioperative setting for management of trauma in older people. Collaboration and innovation: As previously demonstrated in the orthogeriatrics model of care, the multidisciplinary collaboration between the Trauma Geriatrics Service with the trauma team, other surgical teams, allied health, nursing and discharge coordinators appears to be beneficial in the hospital journey of older patients with trauma. Personal reflections: This unique experience has provided the opportunity for knowledge consolidation and practical experience in clinical governance as a final year geriatric medicine trainee.