Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma
Background Many older adults with trauma have pre-existing serious illness like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. We hypothesize that baseline pain, depressive symptoms, and unpaid careg...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-03-01
|
| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/1/e001608.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850275761933516800 |
|---|---|
| author | Stuart Lipsitz Christine Ritchie Jolene Wong Zara Cooper Dae Hyun Kim Tamryn Gray Yihan Wang Hiba Dhanani Evan Bollens-Lund Amanda Reich Claire Ankuda |
| author_facet | Stuart Lipsitz Christine Ritchie Jolene Wong Zara Cooper Dae Hyun Kim Tamryn Gray Yihan Wang Hiba Dhanani Evan Bollens-Lund Amanda Reich Claire Ankuda |
| author_sort | Stuart Lipsitz |
| collection | DOAJ |
| description | Background Many older adults with trauma have pre-existing serious illness like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. We hypothesize that baseline pain, depressive symptoms, and unpaid caregiving needs are associated with increased healthcare utilization in the year after trauma admission in seriously ill older adults.Methods Using the Health and Retirement Study (2008–2018) linked to Medicare claims, we identified adults aged ≥66 years admitted for trauma. We assessed pre-admission pain (none/mild vs moderate/severe), depressive symptoms (no—Center for Epidemiologic Studies Depression Scale (CES-D) <3 vs yes—CES-D ≥3) and unpaid caregiving needs (none vs any); and hospital characteristics: trauma center designation and palliative care service. The χ2 tests were used for categorical variables, and t-tests were used for continuous variables. Associations of pain, depressive symptoms, unpaid caregiving needs with healthcare utilization were tested with negative binomial and Poisson regression models.Results Among 1693 older adults with serious illness, a third (35.7%) were older than 85 years, two-thirds were female (67.5%), and almost all were White (88.7%). Before trauma, 36.4% reported moderate/severe pain, 40.2% reported depressive symptoms (CES-D >3), and 34.9% reported any amount of hours/week of unpaid caregiving needs. Adjusted analyses demonstrated that compared with those without depressive symptoms, seriously ill older adults with depressive symptoms were less likely to be alive (incidence rate ratio (IRR) 0.61, 95% CI 0.41 to 0.91), had more emergency room visits (IRR 1.62, 95% CI 1.15 to 2.27), and more hospital visits (IRR 1.48, 95% CI 1.08 to 2.03) in the year after admission. Adjusted analyses of association of pain and caregiving with healthcare utilization were not significant.Conclusions Seriously ill older trauma patients with depressive symptoms have increased healthcare utilization in the year after discharge. Palliative care interventions may improve patient outcomes and reduce postdischarge healthcare utilization.Level of evidence III. |
| format | Article |
| id | doaj-art-c3c3aeb5e3a947edb67f68a699fd07f7 |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-c3c3aeb5e3a947edb67f68a699fd07f72025-08-20T01:50:35ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-03-0110110.1136/tsaco-2024-001608Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for traumaStuart Lipsitz0Christine Ritchie1Jolene Wong2Zara Cooper3Dae Hyun Kim4Tamryn Gray5Yihan Wang6Hiba Dhanani7Evan Bollens-Lund8Amanda Reich9Claire Ankuda10Surgery, Brigham and Women`s Hospital, Boston, Massachusetts, USAPalliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USASurgery, Brigham and Women`s Hospital, Boston, Massachusetts, USASurgery, Brigham and Women`s Hospital, Boston, Massachusetts, USAMedicine, Brigham and Women`s Hospital, Boston, Massachusetts, USAPsychosocial Oncology and Palliative Care, Harvard Medical School, Boston, Massachusetts, USAGeriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USASurgery, Brigham and Women`s Hospital, Boston, Massachusetts, USAGeriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USASurgery, Brigham and Women`s Hospital, Boston, Massachusetts, USAGeriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USABackground Many older adults with trauma have pre-existing serious illness like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. We hypothesize that baseline pain, depressive symptoms, and unpaid caregiving needs are associated with increased healthcare utilization in the year after trauma admission in seriously ill older adults.Methods Using the Health and Retirement Study (2008–2018) linked to Medicare claims, we identified adults aged ≥66 years admitted for trauma. We assessed pre-admission pain (none/mild vs moderate/severe), depressive symptoms (no—Center for Epidemiologic Studies Depression Scale (CES-D) <3 vs yes—CES-D ≥3) and unpaid caregiving needs (none vs any); and hospital characteristics: trauma center designation and palliative care service. The χ2 tests were used for categorical variables, and t-tests were used for continuous variables. Associations of pain, depressive symptoms, unpaid caregiving needs with healthcare utilization were tested with negative binomial and Poisson regression models.Results Among 1693 older adults with serious illness, a third (35.7%) were older than 85 years, two-thirds were female (67.5%), and almost all were White (88.7%). Before trauma, 36.4% reported moderate/severe pain, 40.2% reported depressive symptoms (CES-D >3), and 34.9% reported any amount of hours/week of unpaid caregiving needs. Adjusted analyses demonstrated that compared with those without depressive symptoms, seriously ill older adults with depressive symptoms were less likely to be alive (incidence rate ratio (IRR) 0.61, 95% CI 0.41 to 0.91), had more emergency room visits (IRR 1.62, 95% CI 1.15 to 2.27), and more hospital visits (IRR 1.48, 95% CI 1.08 to 2.03) in the year after admission. Adjusted analyses of association of pain and caregiving with healthcare utilization were not significant.Conclusions Seriously ill older trauma patients with depressive symptoms have increased healthcare utilization in the year after discharge. Palliative care interventions may improve patient outcomes and reduce postdischarge healthcare utilization.Level of evidence III.https://tsaco.bmj.com/content/10/1/e001608.full |
| spellingShingle | Stuart Lipsitz Christine Ritchie Jolene Wong Zara Cooper Dae Hyun Kim Tamryn Gray Yihan Wang Hiba Dhanani Evan Bollens-Lund Amanda Reich Claire Ankuda Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma Trauma Surgery & Acute Care Open |
| title | Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma |
| title_full | Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma |
| title_fullStr | Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma |
| title_full_unstemmed | Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma |
| title_short | Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma |
| title_sort | associations between baseline pain depressive symptoms and unpaid caregiving needs and 1 year postdischarge outcomes among seriously ill older adults admitted for trauma |
| url | https://tsaco.bmj.com/content/10/1/e001608.full |
| work_keys_str_mv | AT stuartlipsitz associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT christineritchie associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT jolenewong associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT zaracooper associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT daehyunkim associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT tamryngray associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT yihanwang associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT hibadhanani associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT evanbollenslund associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT amandareich associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma AT claireankuda associationsbetweenbaselinepaindepressivesymptomsandunpaidcaregivingneedsand1yearpostdischargeoutcomesamongseriouslyillolderadultsadmittedfortrauma |