Advisor(s)

Russell Griffin

Committee Member(s)

Gerald McGwin
Gerhard Hellemann
Rachel Skains
Zain Hashmi

Document Type

Dissertation

Date of Award

6-18-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Public Health

Department

Epidemiology

Abstract

Adults over the age of 65 are the fastest growing portion of the population and account for a growing percentage of the trauma patient volume at trauma centers around the country. Older adults experience longer length of stays, higher mortality and complication rates than their younger counterparts. As a result, there has recently been an increased focus on models of geriatric trauma care, one of which is the addition of geriatric medicine consults for older trauma patients. The primary objectives of this dissertation were to examine the effect of the consult policy on outcomes using an interrupted time series approach, assess the trajectory of patients’ mental status over the first 30 days of hospitalization, and to identify profiles of geriatric trauma patients using latent class analysis and examine whether outcomes differ by latent class membership. Any adult aged 60 and older admitted between 2013 and 2023 was included in the study population. There was no significant difference in length of stay, repeat hospital visits, or complication rate trends before and after the implementation of geriatric consults; however, there was a significant difference in favorable discharge rates. Sensitivity analysis revealed that geriatric consults were associated with reductions in odds of mortality, but increased odds of complications, repeat visits, and reduced odds of favorable discharge disposition. Delirium prevalence was 21.1% and there were significant differences in trajectory of Nu-DESC scores by age category, head injury severity, and in-hospital mortality. All subgroups examined saw decreases in delirium symptoms over time except those that died in hospital saw an increase in symptoms. Latent class analysis revealed four distinct subgroups of geriatric trauma patients: polytrauma, single/mild injuries, older women with falls, burns among patients in their 60s and 70s. Elevated risk of mortality was observed for the polytrauma group and burn patients only up to 90 days following injury compared to the single injury group; however, for older females mortality risk remained elevated through one year. The rapidly aging trauma patient population highlights the critical importance of identifying optimal models of care and proactively involving geriatricians to improve outcomes for this vulnerable patient population.

Keywords

delirium;epidemiology;geriatric consultations;injuries;trauma

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