Palliative Care for the Elderly Trauma Patient: Models for Early Screening and Intervention (TH300)

Abstract

•Describe the unmet palliative care needs and patient-centered quality outcomes in the elderly trauma patient.•Identify screening criteria or “triggers” for assessment of palliative care needs in the elderly trauma patient.•Describe models of proactive palliative care assessment and interventions for the elderly trauma patient in the emergency department and Surgical ICU. Trauma is a sudden, often catastrophic, event that has a significant impact on the patient. The injured patient’s family is also unprepared and often has to deal with the challenge of making complex decisions in the face of uncertain outcomes. The elderly have significantly worse outcomes after trauma and are much more likely to be hospitalized and less likely to return to independent function or return to an acceptable quality of life. The injured elderly also face the added burden of being frail and having multiple preexisting comorbidities. Engagement of palliative care in the elderly trauma patient is rare and often occurs too late in the disease process to make a real difference. We will discuss the emerging literature on geriatric trauma and palliative care. We will describe the “screening criteria or triggers” for early palliative care consultations in the elderly trauma patient that we have developed. These “triggers” include preexisting functional status, delirium, and Palliative Performance Scale as well as injury severity scores and injury patterns in the elderly. Models of proactive palliative care assessment and intervention in the emergency department and the surgical intensive care unit (ICU) will be described. We will also discuss how we have established an institutional culture of collaborative trauma palliative care in the emergency department and surgical ICU. The interdisciplinary panel will highlight the collaborative shared decision-making approach that includes early assessment and communication in order to support patients and families in the surgical ICU, particularly during transitions of care.