Maryland Older Drivers Psychosocial Factors and Injury Outcomes of - - PowerPoint PPT Presentation

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Maryland Older Drivers Psychosocial Factors and Injury Outcomes of - - PowerPoint PPT Presentation

Oct 18, 2023 184 likes •590 views

TH E C H A R LE S M C C . M A TH I A S , JR . N A TI O N A L S TU D Y C E N TE R FO R TR A U M A A N D E M S Maryland Older Drivers Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants

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TH E C H A R LE S “M C C .” M A TH I A S , JR . N A TI O N A L S TU D Y C E N TE R FO R TR A U M A A N D E M S

Maryland Older Drivers

Psychosocial Factors and Injury Outcomes

  • f Motor Vehicle Occupants Over Age 65

Kathle hleen en Read, d, MSW, , LCSW SW-C kread@som.umaryland.edu

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SLIDE 2

National Study Center CIREN Colleagues

Patricia Dischinger, PhD Timothy Kerns, MS Joseph Kufera, MA Cynthia Burch, MPH Shiu Ho, MS Abree Johnson, BA

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 3
  • Review incidence, severity and type of injuries
  • f older and younger MVC occupants
  • Discuss pre-injury occupant and crash

characteristics

  • Post-trauma outcomes and psychosocial

consequences of injury

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 4

44 38 34 30 16 16 23 35 10 20 30 40 50 16-34 35-64 65-74 75+ % Age (Year) Brain Injury Incidence Brain Injury Max. AIS 4+

Incidence and Severity of Brain Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .01

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 5

23 31 44 45 4 7 7 6 10 20 30 40 50 16-34 35-64 65-74 75+ % Age (Year) Thoracic Injury Incidence Thoracic Injury Max. AIS 4+

Incidence and Severity of Thoracic Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .01

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 6

16 15 13 12 15 11 7 12 10 20 16-34 35-64 65-74 75+ % Age (Year) Abdomen Injury Incidence Abdomen Injury Max. AIS 4+

Incidence and Severity of Abdomen Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .01

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 7

22 25 22 19 6 7 6 9 10 20 30 16-34 35-64 65-74 75+ % Age (Year) Spinal Injury Incidence Spinal Injury Max. AIS 3+

Incidence and Severity of Spinal Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .04

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 8

30 28 27 26 49 54 57 54 10 20 30 40 50 60 16-34 35-64 65-74 75+ % Age (Year) Upper Extremity Injury Incidence Upper Extremity Injury Max. AIS 2+

Incidence and Severity of Upper Extremity Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .01

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 9

36 34 33 34 66 69 70 69 10 20 30 40 50 60 70 80 16-34 35-64 65-74 75+ % Age (Year) Lower Extremity Injury Incidence Lower Extemity Injury Max. AIS 2+

Incidence and Severity of Lower Extremity Injury By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010 p < .01 p < .04

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 10

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 11

Incidence of Injury By Age

34 44 13 22 27 33 30 45 12 19 26 34

5 10 15 20 25 30 35 40 45 50

Brain Injury Incidence Thoracic Injury Incidence Abdomen Injury Incidence Spinal Injury Incidence Upper Extremity Injury Incidence Lower Extremity Injury Incidence % 65-74 75+

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

n= 2,143 n= 2,322

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SLIDE 12

Incidence of Severe Injury By Age

23 7 7 6 57 70 35 6 12 9 54 69

10 20 30 40 50 60 70 80

Brain Injury Max. AIS 4+ Thoracic Injury

  • Max. AIS 4+

Abdomen Injury

  • Max. AIS 4+

Spinal Injury Max. AIS 3+ Upper Extremity Injury Max. AIS 2+ Lower Extemity Injury Max. AIS 2+ %

65-74 75+

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

n= 712 n= 686 n= 938 n=1047 n= 267 n= 261 n= 464 n= 437 n= 577 n= 610 n= 711 n= 781

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16-34 35-64 65-74 75+ Deceased 1 1 4 7 Rehad 2 3 6 10 Other Facility 4 7 13 23 Home 92 89 77 61 25 50 75 100 %

Hospital Discharge Status By Age

Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

n= 14,242 n= 12,940 n= 1,986 n= 2,155

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SLIDE 14

Multidimensional Model

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 15

Psychosocial Dimensions of Vehicular Injury

  • Employment/Occupation/Education
  • Pre-Injury History/Trauma
  • Payor Sources, costs, impact
  • Co-morbidity
  • Physical/Cognitive/Emotional Outcomes
  • Litigation
  • Role of Alcohol and Drugs

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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Standardized Measurements Psychosocial Outcomes

  • 1. SF 36 - Short Form Health Survey (MOS)
  • 2. CAGE - Alcohol and Drugs
  • 3. AUDIT - Alcohol
  • 4. NRS - Numerical Rating Scale for Pain
  • 5. Depression Screening
  • 6. Cognitive Functioning
  • 7. PTSD - Post Traumatic Stress Disorder

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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Physical Component Mental Component

SF-36

Physical Function Role Physical Bodily Pain General Health Mental Health Role Emotional Social Function Vitality

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SF36 Norms by Age Group

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

Physical Function Role Physical Bodily Pain General Health Vitality Social Function Role Emotional Mental Health

PHYSICAL EMOTIONAL

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Patient Characteristics

Under 65 (n=480) Over 65 (n=82) Marital Status: Married 50% 63% Divorced/Separated 12 4 Widowed 3 30 Gender (Female) 55 62 Average Age (42) 36 74 Smoker 35 7 Household Income < $50,000 38 19

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Occupant / Crash Characteristics

Under 65 (n=480) Over 65 (n=82) Driver 84% 72% Culpability 61 70 Restraint Use: Seat Belt & Air Bag 63 70 Air Bag Only 18 10 Seat Belt Only 13 9 Additional Family Member Injured/Killed in Crash 19 43

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Occupant / Crash Characteristics

Under 65 (n=480) Over 65 (n=82) GCS 15 80% 79% LOC / Altered Mental Status

Medical Record/Pt. Reported

32/49 34/55 GCS 13-14 10 13 GCS <12 11 7

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Occupant / Crash Characteristics

Under 65 (n=480) Over 65 (n=82) Substance-Related Crash 29% 4% Alcohol on Admission (BAC) 18 Cage 2+ 22 5

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Pre-injury Characteristics

Under 65 (n=480) Over 65 (n=82) Co-morbidity 53% 95% Hypertension 17 70 Diabetes 6 24 Heart 4 28 Cancer 3 29 Co-morbidity – 2 or more 24 83 Co-morbidity – 3 or more 10 43 Depression history 31 21 Depression current 28 22

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Pre-injury Characteristics

Under 65 (n=480) Over 65 (n=82) HX of prior injury MVC 31% 23% Assault 10 1 Prior Trauma History 23 10 Moving Violations 36 13 History of DWI/DUI 14 4 Stressful life crisis within 6mo of crash 47 33

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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Median Costs

Under 65 (n=480) Over 65 (n=82) Hospital 49,504 41,469 Professional 11,569 12,078 Rehab 21,000 25,390 Total 87,142 93,780

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012

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SLIDE 26

Post Trauma Outcomes

Under 65 Over 65 6 mo. 1 yr. 6 mo. 1 yr. Return to driving 68% 81% 57% 70% Legal/Litigation 59 38 42 18 Disrupting Pain 48 47 35 52 Spirituality/Recovery 51 52 77 75 Severe Financial Impact 28 26 10 9

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012, “N” may vary due to loss of follow up

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SLIDE 27

Psychological Post Trauma Outcomes

Depression PTSD Symptoms Cognitive Behavioral < 65 65+ < 65 65+ < 65 65+ < 65 65+ 52% 41% 27% 16% 41% 25% 33% 17% 43% 38% 23% 13% 39% 13% 24% 13%

6mo 1yr

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012, “N” may vary due to loss of follow up

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91 100 72 9 28 25 50 75 100 <65 65-69 70+ % Age (Year) Home (Alone or with Family) Other

Living Situation 6 Months Post Crash By Age

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012, “N” may vary due to loss of follow up

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SLIDE 29

82 18

<65

92 8

65-69

65 35

70+

No or Not due to Injury Yes, Injury Related

Change in Living Situation 6 Months Post Crash By Age

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012, “N” may vary due to loss of follow up

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SLIDE 30

99 1

<65

92 8

65-69

93 7

70+

No Change due to Crash Yes, Widowed

Change in Marital Status 6 Months Post Crash By Age

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

CIREN Psychosocial Database – 1998-05/2012, “N” may vary due to loss of follow up

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91.4 74.2 70.9 66.8 78 80.3 59.1 45.3 53.4 50.7 65.6 66.4 74.7 63.1 64.5 60 72 73.6 10 20 30 40 50 60 70 80 90 100 18-64 65+ 18-64 65+ 18-64 65+ Baseline 6 Months 12 Months

SF-36 Outcome Measures Stratified by Age

Physical Functioning Vitality Mental Health Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

Anderson, D., Ryb, G., Dischinger, P., Kufera, J. & Read, K. (2010). Self-reported health indicators in the year following a motor vehicle crash: a comparison of younger versus older subjects. Association for the Advancement

  • f Automotive Medicine, 54, 359-67.
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SLIDE 32

CIREN Case Summary

  • Case vehicle:

2006 Toyota Prius

  • General crash type:

Frontal

  • V2 / Object struck:

Guardrail end

  • Seat Position:

Driver

  • Gender / Age:

Male / 87

  • Ht./ Wt./ BMI:

5’10” / 140lbs. / 20.1

  • Restraint Use:

3-point Lap & Shoulder

  • Air Bag Deployment:

Frontal Air Bag deployed

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SLIDE 33

Pre-Injury

  • 87 year old married male
  • Returning home from lunch outing
  • Independent in activities of daily living with no major

medical comorbidities, but mild dementia noted

  • Slow unstable gait with recent falls and 3 non-injury

crashes in recent months

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 34
  • Length of stay - 6 days
  • Non-weight bearing on the left lower extremity
  • Weight bearing as tolerated on the right lower

extremity

  • Discharged to in-patient rehab and remained there for

2 months, then home with full-time aid

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

At Discharge

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SLIDE 35
  • Injury necessitated relocation into an assisted living

facility with full health and social services

  • Patient ambulates with walker
  • Further decline in cognitive functioning
  • Struggling to adjust to new living environment
  • Costs:

– Hospital & Professional: $25,152 – Re-habilitation: approx. $26,000 – Home Care: $9,000

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

Post-Trauma

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SLIDE 36
  • Measures any limitations in physical

activities from bathing and dressing to the most rigorous activity. PHYSICAL FUNCTIONING (PF)

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

  • Extent physical or emotional

health interferes with social activity SOCIAL FUNCTIONING (SF)

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SLIDE 37

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

20 40 60 80 100

PF RP BP GH VT SF RE MH

Pre-Injury 6 Months Post Crash 12 Months Post Crash Norm

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Summary

  • Older drivers…

– Are less likely to be discharged home – Are more likely to have a change in living situation – Are more likely to require rehab services

  • Older patients require rehab focusing on physical domains while

younger patients may require more mental/emotional support

  • Age itself is not a significant predictor of the potential for recovery

especially when other age associated conditions are considered.

  • Pre-injury functional status has a major influence on recovery

following vehicular trauma

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+

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SLIDE 39

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+