Motor vehicle collisions (MVCs) are the second most common cause of injury in older adults. After an MVC, most older adults experience acute musculoskeletal pain and come to the emergency department (ED) for evaluation. After evaluation, the great majority of these older adults are discharged to home. Available evidence indicates that a substantial subset of these independently living older adults develop persistent musculoskeletal pain and associated functional decline. These individuals do not see a physician again for weeks or months after ED discharge. These data, together with evidence that interventions to prevent persistent pain should be initiated in the first few weeks after trauma, suggest that emergency physicians are uniquely positioned to identify older adults at high risk of persistent pain after MVC and link them to early preventive interventions. Unfortunately, this opportunity is currently lost, as contemporary emergency care focuses solely on excluding severe injury in these patients and discharging them to home. No preventive interventions have been developed for older adults experiencing MVC, despite substantial evidence from other settings that such interventions might be very effective. Current barriers to the development of interventions for older adults experiencing MVC include a lack of knowledge regarding the incidence, functional toll, predictors, and etiologic mechanisms of persistent pain in this setting. The candidate for this career development award, Dr. Platts-Mills, is an emergency physician whose career goal is to improve outcomes for older adults evaluated in the ED after MVC. The proposed award will build on the formal training in biostatistics and epidemiology that Dr. Platts-Mills received during his two year institutional KL2 award, and will provide him with advanced training in specific areas necessary for him to achieve his career goals. Specifically, during the award period Dr. Platts-Mills will receive training in analyzing longitudinal data;assessing and interpreting the influence of psychological factors and pain-related cognitions on long-term pain symptoms;assessing physical function in older adults;and designing clinical trials. In addition, Dr. Platts-Mills will perform a prospective study of 200 adlts age 65 or older evaluated in the ED after MVC. These activities will be supported by an outstanding team of mentors and advisors with expertise in key knowledge areas: ED-based longitudinal studies of post-trauma pain (Dr. McLean);geriatric research networks (Dr. Sloane);advanced statistical analyses (Dr. Weaver);psychology of pain (Dr. Keefe);and measures of physical function (Dr. Studenski). By the end of the award period, Dr. Platts-Mills will have the necessary preliminary data and training to obtain and successfully perform a large scale observational R01 study addressing major barriers to the development of interventions which improve pain and functional outcomes among older adults experiencing MVC. Developing such interventions is critical, because it has been estimated that by 2030 25% of drivers will be 65 years of age or older.
This project will identify predictors of persistent pain and associated functional decline among older adults experiencing motor vehicle collision. Additionally, this project will examine the influence of key cognitive and psychological factors during the early recovery period on the development of persistent pain. The results of this work will provide direction for a high-yield large scale observational study of predictors of and mechanisms leading to persistent pain after MVC in older adults which will inform the development of interventions to improve long-term outcomes in these patients.
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