Functioning and health-related quality of life following injury in older people : a systematic review

Aim and background There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people. Method A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool. Results There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes. Discussion: The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people. Conclusions Further research is required on older people's postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems.