The Trauma Dyad: The Role of Informal Caregivers for Older Adults After Traumatic Injury

Claire M. Sokas, Evan Bollens-Lund, Mohammed Husain, Katherine A. Ornstein, Masami T. Kelly, Christina Sheu, Emma Kerr, Molly Jarman, Ali Salim, Amy S. Kelley, Zara Cooper

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To investigate the association between higher injury severity and increased informal caregiving received by injured older adults. Summary of Background Data: Injured older adults experience high rates of functional decline and disability after hospitalization. Little is known about the scope of caregiving received post-discharge, particularly from informal caregivers such as family. Methods: We used the National Health and Aging Trends Study 2011 to 2018 linked to Medicare claims to identify adults ≥65 with hospital admission for traumatic injury and a National Health and Aging Trends Study interview within 12 months pre- and post-trauma. Injury severity was assessed using the injury severity score (ISS, low 0-9; moderate 10-15; severe 16-75). Patients reported the types and hours of formal and informal help received and any unmet care needs. Multi variable logistic regression models examined the association between ISS and increase in informal caregiving hours after discharge. Results: We identified 430 trauma patients. Most were female (67.7%), non-Hispanic White (83.4%) and half were frail. The most common mechanism of injury was fall (80.8%) and median injury severity was low (ISS = 9). Those reporting receiving help with any activity increased post-trauma (49.0% to 72.4%, P < 0.01), and unmet needs nearly doubled (22.8% to 43.0%, P < 0.01). Patients had a median of 2 caregivers and most (75.6%) were informal, often family members. Median weekly hours of care received pre- versus post-injury increased from 8 to 14 (P < 0.01). ISS did not independently predict increase in caregiving hours; pre-trauma frailty predicted an increase in hours ≥8 per week. Conclusions: Injured older adults reported high baseline care needs which increased significantly after hospital discharge and were mostly met by informal caregivers. Injury was associated with increased need for assistance and unmet needs regardless of injury severity. These results can help set expectations for caregivers and facilitate post-acute care transitions.

Original languageEnglish
Pages (from-to)E907-E913
JournalAnnals of Surgery
Issue number4
StatePublished - 1 Apr 2023


  • caregiving
  • family
  • informal caregivers
  • older adults
  • trauma


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