560 A National Analysis of Discharge Disposition in Older Adults with Burns Estimating Independence at Discharge

Abstract

IntroductionWhereas older age strongly predicts higher burn mortality, the impact of age on discharge disposition is less well defined. Both providers and patients need a better understanding of the likelihood of discharge to non-independent living, as this factor may matter most to older patients. This investigation assesses the relationship between older age and discharge disposition after burns, in a nationally representative sample.MethodsWe queried the 2007-2015 National Trauma Data Bank (NTDB) for burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working age group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area (TBSA), injury mechanism, and race. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression was used to assess the association between older age and discharge to non-independent living, adjusting for covariables.ResultsThere were 25,840 burn hospitalizations in older adults with complete data during the study period. Working-age patients comprised 13,563 (53%) of admissions. Young-old accounted for 7,342 (28%), while middle-old comprised 3,876 (15%), and 1,059 (4%) were classified as old-old. Discharge to non-independent living steadily increased with burn TBSA and older age in survivors (Table). Beginning in the 65-74 age group (young-old), most patients with burns ≥20% TBSA were discharged to non-independent living. After adjusting for patient and injury factors, odd ratios for discharge to non-independent living were 2.1 for young-old, 3.5 for middle-old and 7.6 for old-old patients, when compared to working-age patients (all p< 0.001).ConclusionsOlder age is a strong predictor of discharge to non-independent living after burns. These findings provide a realistic discharge framework for providers and older adults with acute burns.