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

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 Over Age 65 Kathle hleen en Read, d, MSW, , LCSW SW-C kread@som.umaryland.edu

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ National Study Center CIREN Colleagues Patricia Dischinger, PhD Cynthia Burch, MPH Timothy Kerns, MS Shiu Ho, MS Joseph Kufera, MA Abree Johnson, BA

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ • Review incidence, severity and type of injuries of 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+ Incidence and Severity of Brain Injury By Age Brain Injury Incidence Brain Injury Max. AIS 4+ p < .01 p < .01 50 44 38 40 35 34 30 30 23 % 20 16 16 10 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence and Severity of Thoracic Injury By Age Thoracic Injury Incidence Thoracic Injury Max. AIS 4+ p < .01 p < .01 50 45 44 40 31 30 23 % 20 10 7 7 6 4 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence and Severity of Abdomen Injury By Age Abdomen Injury Incidence Abdomen Injury Max. AIS 4+ p < .01 p < .01 20 16 15 15 13 12 12 10 % 11 7 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence and Severity of Spinal Injury By Age Spinal Injury Incidence Spinal Injury Max. AIS 3+ p < .01 p < .04 30 25 22 22 20 19 % 9 10 7 6 6 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence and Severity of Upper Extremity Injury By Age Upper Extremity Injury Incidence Upper Extremity Injury Max. AIS 2+ p < .01 p < .01 60 57 54 54 50 49 40 30 28 30 % 27 26 20 10 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence and Severity of Lower Extremity Injury By Age Lower Extremity Injury Incidence Lower Extemity Injury Max. AIS 2+ p < .01 p < .04 80 70 69 69 70 66 60 50 40 % 36 34 33 34 30 20 10 0 16-34 35-64 65-74 75+ Age (Year) Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

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

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence of Injury By Age 65-74 75+ n= 2,143 n= 2,322 50 45 44 45 40 34 34 33 35 30 30 27 26 % 25 22 19 20 13 15 12 10 5 0 Brain Injury Thoracic Injury Abdomen Injury Spinal Injury Upper Extremity Lower Extremity Incidence Incidence Incidence Incidence Injury Incidence Injury Incidence Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Incidence of Severe Injury By Age 65-74 75+ 80 70 69 70 57 60 54 50 % 40 35 30 23 20 12 9 7 7 10 6 6 n= 712 n= 686 n= 938 n=1047 n= 267 n= 261 n= 464 n= 437 n= 577 n= 610 n= 711 n= 781 0 Brain Injury Max. Thoracic Injury Abdomen Injury Spinal Injury Max. Upper Extremity Lower Extemity AIS 4+ Max. AIS 4+ Max. AIS 4+ AIS 3+ Injury Max. AIS 2+ Injury Max. AIS 2+ Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Hospital Discharge Status By Age 100 75 50 % 25 n= 14,242 n= 12,940 n= 1,986 n= 2,155 0 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 Maryland Codes – Inpatient File, MVC, Drivers Only, 2001-2010

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

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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+ 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+ Physical Mental SF-36 Component Component Physical Function Mental Health Role Physical Role Emotional Bodily Pain Social Function General Health Vitality

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ SF36 Norms by Age Group Physical Role Bodily General Vitality Social Role Mental Function Physical Pain Health Function Emotional Health PHYSICAL EMOTIONAL

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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 CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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 19 43 Injured/Killed in Crash CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Occupant / Crash Characteristics Under 65 (n=480) Over 65 (n=82) GCS 15 80% 79% LOC / Altered Mental Status 32/49 34/55 Medical Record/Pt. Reported GCS 13-14 10 13 GCS <12 11 7 CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Occupant / Crash Characteristics Under 65 (n=480) Over 65 (n=82) Substance-Related Crash 29% 4% Alcohol on Admission (BAC) 18 0 Cage 2+ 22 5 CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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 CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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 47 33 6mo of crash CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ 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 CIREN Psychosocial Database – 1998-05/2012

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Post Trauma Outcomes Under 65 Over 65 6 mo. 6 mo. 1 yr. 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 CIREN Psychosocial Database – 1998- 05/2012, “N” may vary due to loss of follow up

Maryland Older Divers- Psychosocial Factors and Injury Outcomes of Motor Vehicle Occupants 65+ Psychological Post Trauma Outcomes PTSD Depression Cognitive Behavioral Symptoms < 65 65+ < 65 < 65 65+ < 65 65+ 65+ 6mo 52% 41% 27% 16% 41% 25% 33% 17% 1yr 43% 38% 23% 13% 39% 13% 24% 13% CIREN Psychosocial Database – 1998- 05/2012, “N” may vary due to loss of follow up