Associations Between Baseline Pain, Depression, and Caregiving and One-Year Post-Discharge Outcomes Among Seriously Ill Older Adults Admitted for Trauma (Sch411)

{Outcomes 1. Understand how pain, depression, and caregiving in seriously ill trauma patients impacts healthcare utilization costs 1 year after discharge. 2. Conceptualize how palliative care intervention targeting pain, depression, and caregiving in seriously ill trauma patients may improve healthcare outcomes 1-year post discharge. Introduction Many older trauma patients have preexisting serious illness (SI) like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. However, there are few data about targets for palliative care in these patients. We hypothesized that older SI adults with pain, depression, and caregiving needs before trauma admission have higher 1-year postdischarge healthcare utilization compared to trauma patients without SI. Methods Using data from the Health and Retirement Study (2008-2018) linked to Medicare claims, we identified seriously ill adults over 66 years old and assessed patient characteristics including demographics, comorbidity, baseline pain (none/mild versus moderate/severe), depression (CES-D ≥3) and caregiving needs (≥30 hours/month), as well as hospital characteristics including trauma center designation and palliative care service. Comparisons between pain, depression, caregiving, and SI were reported using chi square tests. Differences in healthcare utilization between groups with palliative care, pain, depression, and caregiving were reported using t-tests. Results The study cohort included 513. Mean age was 82.1 years (SD 8.1), 73.1% were female, and 84.1% were non-Hispanic white. Most (70.5%) were admitted to a trauma center and (88.8%) hospital with a palliative care service. Compared to those without preexisting pain, depression, and caregiving needs, SI older trauma patients with these conditions were less likely to be alive a year after discharge (71.2% vs 81.6%