Preventable harm in trauma care for older adults: a retrospective study of nurse-sensitive adverse events

Abstract Introduction Older adults are particularly vulnerable to nurse-sensitive adverse events (NSAEs) during hospitalization due to frailty, comorbidities, and complex care needs. These events—such as infections, pressure ulcers, and medication-related injuries—are often preventable and linked to missed nursing care. This study aimed to investigate the prevalence and characteristics of NSAEs among trauma patients aged ≥65 years and examine differences in clinical vulnerability factors between those with and without NSAEs. Method A retrospective chart review was conducted at a level one trauma centre in Sweden. The sample included 270 patients aged ≥65 years hospitalized due to physical trauma between 2019 and 2024. NSAEs were identified using a trigger tool protocol. Group comparisons were performed using non-parametric tests. Result A total of 81 patients (30%) experienced at least one NSAE. The most common events were healthcare-associated infections (19%), overdistended bladder (11%), pressure ulcers (6%), and malnutrition (5%). Patients with NSAEs were significantly older (p = .005), frailer (p < .001) and had higher injury severity score (p = .005) than those without. The overall mean length of stay (LOS) was 9 days. Patients with NSAEs had a mean LOS of 17 days, compared to 6 days for those without (p < .001). No significant differences were observed for gender or Glasgow Coma Scale. Discussion NSAEs were frequent among older trauma patients and were associated with higher age, frailty, injury severity, and longer hospitalization, consistent with previous research. These findings highlight the need for targeted nursing care and system-level interventions to reduce preventable harm in this vulnerable group.