Uncertainty and unmet needs in older high-risk blunt trauma survivors and their caregivers: a multi-centre mixed methods study

Quality-of-life is reduced in older patients surviving major blunt trauma. Pre-injury frailty, chronic illness, low falls, or head injury, increase the risk of unplanned healthcare utilization and post-discharge mortality. However, post-hospitalization needs and experiences of patients and caregivers from this high-risk group are not well-understood. This mixed-methods longitudinal study aims to understand participants’ perspectives on needs, prognosis, quality-of-life and end-of-life planning, during the post-injury trajectory. High-risk patients > 55-years-old, and their caregivers, were recruited from three hospitals after surviving blunt trauma. All participants allowed the study team access to medical records, including unplanned readmission and death, for 36 months. Participants who consented to longitudinal follow-up were assessed for quality-of-life and caregiver burden at regular intervals. If unplanned readmission or death occurred, the longitudinal group participants were contacted for a semi-structured interview. Out of 155 participants recruited, 71 patients experienced > = 1 unplanned readmission and 33 died. Twelve semi-structured interviews were conducted after unplanned readmission or death. Five unmet needs were extrapolated from qualitative interviews: uncertainty of prognosis; access to financial support; unaddressed social needs; inconsistent access to healthcare and inadequate structural support. Qualitative findings corroborated with and provided context for the quantitative analysis. Patients with high (> = 2) unplanned readmissions, higher co-morbidities or poorer function had lower quality-of-life. For caregiver burden, high-readmission caregivers experienced increasing financial stress over time, but other domain trajectories were similar between high- and low-readmission groups. The study was limited by recruitment and access difficulties caused by the COVID-19 pandemic, and over-representation of the ethnic majority. Older high-risk blunt trauma survivors and caregivers need better support to mitigate uncertainties in their disease trajectory. Future directions include a system-level prompt to identify at-risk patients at discharge, offering access to designated care teams at different time-points to support the patients and caregivers to navigate the many uncertainties in their healthcare journeys.