Functional Decline and Loss of Independence After Traumatic Injury in Older Adults With Dementia

BACKGROUND: Older adult patients with dementia experience higher rates of traumatic injury, yet little is known about long-term recovery trajectories in this population. This multi-center retrospective cohort study examined differences in long-term patient-reported outcomes after traumatic injury in older adults with and without dementia. STUDY DESIGN: Secondary analysis of trauma patients ≥ 65 years with moderate or severe trauma (Injury Severity Score > 9) admitted to three Level I trauma centers and interviewed 6-12 months post-injury. Primary outcomes were loss of community living and activities of daily living (ADL) impairment. Multivariable logistic and linear regression adjusted for age, sex, educational level, and injury mechanism. RESULTS: Among 3210 older adult trauma patients, 291 (9.1%) had dementia before injury. Dementia patients presented with similar injury severity compared to those without dementia (mean ISS 12.1 (5.7) vs. 12.8 (6.2), p = 0.076); however, they had a greater number of new ADL limitations post-injury (1.86 (2.07) vs. 1.0 (1.55), p < 0.001). Among patients living at home pre-injury, 16.5% with dementia were discharged to institutionalized settings, compared to 4.9% without dementia (p = 0.185). Older women with dementia had significantly higher odds of losing community living status compared to older women without dementia (OR = 2.12 [1.17, 3.84], p = 0.013). CONCLUSION: Older adults with dementia who sustain traumatic injuries face a substantial risk of functional deterioration and loss of independence in the critical 6-12 months post-injury. These findings highlight the need for interventions aimed at preserving autonomy and minimizing premature transitions to long-term care.