This proposal presents a five-year research career development program focused on describing the comprehensive long-term experience of trauma from the perspective of older adults and their family caregivers. The candidate is currently an Assistant Professor of Surgery at Duke University and acute and critical care trauma surgeon, with previous research experience in trauma-related outcomes and healthcare disparities, and has now chosen to focus on aging research, qualitative analysis, and health-related quality of life (HRQoL) research with a diverse mentoring committee of investigators with expertise in geriatrics, gerontology, surgery, critical care, and qualitative research. The proposed experiments and didactic training will provide the candidate with a unique set of skills that will help her transition to independence as a surgeon-scientist and enable her to fill a significant ?experience gap? in the field of research dedicated to the older adult trauma patient population. Traumatic injury currently effects 5.4 million older adults each year in the United States representing 23% of all trauma admissions, and these numbers are projected to climb as the population ages. The consequences resulting from trauma to older adults are magnified when compared to younger age groups. Older adults have an increased likelihood of death as a result of trauma, with one-third of patients with presenting with multisystem trauma dying prior to leaving the hospital. Indeed, trauma is the 5th leading cause of death in older adult patients. Recent research suggests that the impact of trauma on older patients, their family members, and health care systems is dramatic. Despite these findings, very few high-quality studies have been conducted to describe the long-term experience of trauma from the perspective of these patients and their respective caregivers. Indeed, very little is known from the patient perspective regarding post-discharge trajectories through care facilities, the impact of functional limitations, and what factors are associated with poor outcomes. Compounding this problem is that it remains unknown which existing quality of life measurement instruments may be optimal for older adult trauma patients. These gaps in knowledge regarding this patient population serve to make the process of informed, shared decision making about goals of care challenging for older patients, their family caregivers, and clinicians. This proposal will characterize the one-year patient healthcare experience of older adult trauma patients and their family caregivers using a concurrent nested mixed-methods study design, using both qualitative and quantitative methods consisting of a survey and concept elicitation interviews. Specifically, the work of this proposal will 1) identify aspects of quality of life (QoL) among older adult trauma patients and how these change over time, 2) characterize the caregivers experience over one year, and 3) identify a core set of both patient- and caregiver-reported HRQOL measures that address key domains identified through the interviews, and determine which measures are most effective at different time points post-trauma.
The consequences resulting from trauma to older adults are magnified when compared to younger age groups, however very few high-quality studies have been conducted to describe the long-term experience of trauma from the perspective of these patients and their respective caregivers. This study will characterize the experience of older adult trauma patients and their family caregivers using a qualitative approach through concept elicitation interviews over time. The results from this study will lead to innovative intervention strategies designed to improve quality of life for older adults with traumatic injury.
