Long-term physical, mental, and financial decline after major injury in older adults: A national cohort study with matched controls.

BACKGROUND: The incidence of injury among older adults is rising in the United States, yet long-term outcomes after injury and their relationship to social health needs remain undescribed at a national level. The purpose of this study was to evaluate long-term physical, mental, financial, and social health outcomes among injured older adults, using matched controls.

METHODS: We conducted a retrospective analysis of the nationally representative Health and Retirement Study linked with inpatient Medicare claims. Our cohort included individuals aged 65 and older who were admitted for injury from 1998 to 2018. Changes following injury were assessed using a difference-in-differences analysis using pre-/postinjury data in the Health and Retirement Study.

RESULTS: We identified 1,754 injured patients and 3,244 non-injured controls. Injured patients required greater assistance with activities of daily living (mean difference: 1.1; P < .001), had higher odds of poor/fair self-rated health (odds ratio [OR], 1.7; 95% CI, 1.1-2.6), depression (OR, 1.5; 95% CI, 1.2-1.8), and cognitive impairment (OR, 1.2; 95% CI, 1.0-1.5). Injury was associated with greater odds of having unmet social health needs (OR, 1.7; 95% CI: 1.5-2.0). Among injured patients, those with preinjury unmet social health needs reported greater increases in outpatient visits (3.8 visits; 95% CI, 1.3-6.7), higher odds of poor/fair self-rated health (OR, 1.3; 95% CI 1.1-1.5) and cognitive impairment (OR, 1.4; 95% CI 1.2-1.8), and increased financial hardship compared with injured patients without unmet social health needs.

CONCLUSIONS: Injury has enduring consequences on the physical, mental, financial, and social health of older patients Older adults with pre-existing unmet SHNs are particularly vulnerable to poor postinjury long-term outcomes.