Exploring the needs and preferences of older trauma patients: A qualitative study

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Despite existing guidelines for trauma care of older populations, adoption is limited and undertreatment persists. This study aimed to explore the needs and preferences of older people and their families following traumatic injuries and define key components of a trauma care model for older populations. Methods: This research adopted participatory design principles, engaging older people and their families, who had interacted with local healthcare services, to participate in a workshop which included structured activities and questions designed to facilitate discussion of the participants’ experiences of trauma and subsequent healthcare. Qualitative data were collected, coded, and analyzed using thematic analysis. Results: Seven patients and six family members attended one of two workshops. Most patient participants were women, with a mean age of 82 years. Participants reported negative feelings following trauma, including uncertainty, shock and fear, decreased confidence, and feeling burdensome. Recovery goals were focused on regaining independence, participating in movement and exercise, and maximizing social connection. Communication, empathy and interpersonal skills in care, and system-related factors were identified as key factors impacting care and recovery experience following trauma. To improve trauma care, participants recommended care coordination, improved access to home support and rehabilitation, investment in staff expertise and training, and a dedicated trauma service for older adults. Conclusions: This study underscores the importance of a comprehensive and person-centered approach to trauma care for older people, offering valuable insights for healthcare providers and policymakers striving to enhance the quality of care and improve outcomes for this vulnerable population. healthcare experience falls rehabilitation critical pathways recovery pathway care model older adults trauma Background Demographic projections indicate a worldwide proportional rise in the population of older adults [ 1 , 2 ]. In Australia, the number of people aged 85 years and over is projected to double by 2042 [ 3 ], with a consequent increased demand on healthcare services. Policy makers and healthcare providers are being urged to develop systems that effectively meet the needs of our growing, ageing population [ 4 , 5 ]. The number of older adults hospitalised for trauma in Western countries is rapidly growing [ 6 – 8 ]. In Australia, the proportion of older patients in the major trauma population has increased, with an older person falling from standing height being the most common type of trauma [ 6 ]. Older patients frequently present with a clinical picture of major trauma, through a relatively minor or low energy injury mechanism [ 8 , 9 ]. The presence of frailty or comorbidities contribute to a more severe consequence of trauma than in a younger person with equivalent injury severity, including a trajectory of functional decline, loss of independence, poorer quality of life, increased complications, and mortality [ 10 – 13 ]. Health systems need to develop specialised trauma care models and systems to effectively meet the needs of older patients [ 7 , 14 – 16 ]. Trauma care of older people is supported by guidelines [ 17 – 19 ] and several targeted models of care, such as geriatric co-management and consultation, and have demonstrated potential for reduction of adverse outcomes for older patients following trauma [ 20 – 23 ]. Despite this, older patients remain under-triaged and undertreated, with health services lacking comprehensive adoption of recommended standards [ 21 , 24 ]. Experts in emergency and geriatric care have identified research priorities as a need to 1. understand older people’s preferred goals of trauma care and 2. identify what combination of trauma and geriatric care is needed [ 24 ]. Engaging consumers can support the understanding of their needs and preferences [ 25 , 26 ] and subsequently, assist in developing acceptable models of trauma care for older people. The primary objective of this study was to understand the needs and preferences for healthcare and recovery from the perspective of older patients and their families following trauma. The secondary objective was to define components and attributes of a model of trauma care recommended by consumers. Methods Study design The nature of this research warranted adoption of principles for participatory design methodology. The Experience-Based Co-Design (EBCD) cycle is commonly used as a healthcare quality improvement tool [ 27 ], engaging patients, carers, and staff to collaboratively identify improvement priorities, design and implement changes, and jointly reflect on their achievements. In this research, we sought to gather information about consumer (patients and family/carers) needs and preferences that are expected to form part of a larger program of research relating to trauma care for older people. A workshop was designed, aimed at fostering participant ownership over workshop outcomes, as recommended by Donetto et al [ 27 ]. The workshops involved structured activities and facilitated discussions, guided by The Field Guide to Human Centred Design (IDEO.org, 2015), exploring participant experiences, perceptions, needs, and preferences and generating qualitative data addressing the research question. Ethical approval was granted by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 – LNR/23/SAC/101. Participants Older people (65 + years) who had experienced trauma requiring emergency care and their families were invited to participate in one of two workshops. All patient participants accessed healthcare through the Southern Adelaide Local Health Network (SALHN) in South Australia and were identified through subacute and community services. Eligibility criteria included living at home, without a diagnosis of dementia, able to provide informed consent, and able to independently access and participate in workshop activities. A short pre-workshop demographic and background information survey was developed, including participant reported age, gender, country of birth (or year of arrival in Australia), language spoken at home, level of confidence in understanding health information [ 3 ], and questions relating to health services accessed through their trauma healthcare experience. Study procedures Clinical staff identified potential participants, based on the eligibility criteria, and provided provisional study information. The project team provided further information and sought consent from potential participants. Prior to attending the workshop, participants completed the pre-workshop survey via telephone. Consumer workshops were facilitated by researchers experienced in qualitative research and held in a community hub. Participants attended one of two workshops and were provided with a $ 70AUD gift card honorarium. Data analysis Participant demographic and characteristics data were entered into a Microsoft Excel spreadsheet. Workshop group discussions were audio recorded and professionally transcribed. Data coding and analysis of qualitative data were conducted by two members of the research team (JW and MCh), with the adoption of grounded theory principles, in which the systematic and iterative process of data coding and analysis provides insights into the factors, processes, and interactions that influence the experience, needs, and preferences of consumers. This approach is well suited to the pursuit of understanding health consumer experiences and perspectives [ 28 ] and was enacted through a process of reflexive thematic analysis [ 29 ]. Coding was conducted using NVivo 1.7.1 software. To ensure coherence across themes, the researchers conducted a shared review of data against minor and major themes. Final definitions, naming of themes, and report planning included review by a third, senior qualitative researcher (KL). Results Between August and November 2023, 13 participants attended the workshops, including “patients” who had experienced trauma (n = 7) and “family members” who had supported the patient following trauma (n = 6). All patients presented to the emergency department following a fall (via ambulance n = 6 and directly n = 1) and were admitted to acute wards. Most had surgical interventions (n = 5) and inpatient rehabilitation (n = 6). Hospital-in-the-home services were accessed by 3 patient participants. All had accessed outpatient healthcare services (rehabilitation, physiotherapy, and/or group exercise such as hydrotherapy). Community-based exercise groups were accessed by four patient participants at the time of the workshop, with others intending to access when available. Health literacy confidence varied within both patient and family participant groups, indicated by responses in Table 1 to the statement ‘I always understand health information well enough to know what to do’ [ 30 ]. Table 1 Participant characteristics (N = 13) Variable ‘Patient’ participants n = 7 (53.8%) ‘Family’ participants n = 6 (46.1%) Sex Male, n 1 4 Female, n 6 2 Age, years Min-max 80–87 42–87 Median (mean) 80 (82) 71 (67.3) Country of birth Australia, n 4 5 England, n Netherlands, n Northern Ireland, n 1 1 1 1 Health literacy 1 Strongly agree, n 0 3 Somewhat agree, n 5 2 Neither agree, nor disagree, n 1 0 Somewhat disagreed, n 0 1 Disagree, n 1 0 1 Response to: “it is always easy for me to understand health information well enough to know what to do”question from the Australian Bureau of Statistics National Health Survey: Health literacy. During the workshops, participants shared their experiences of trauma, and it’s impacts, of health system interactions and perceptions and perspectives related to the needs and preferences of older trauma patients. This led to the emergence of key themes related to; (1) negative feelings post trauma, (2) goals for recovery, (3) factors influencing the experience of care and recovery following trauma, and (4) recommendations to improve the experience of care following trauma, each with associated subthemes (Table 2 ). Table 2 summary of the identified themes and subthemes Theme Subtheme Negative feelings post trauma Shock and fear Uncertainty Decreased confidence Feeling burdensome Recovery goals Regaining independence and a “full” recovery Movement and exercise Social connection Factors Influencing the Older Patient’s Experience of Care and Recovery Following Trauma Communication Empathy and interpersonal skills in care System-related factors in healthcare Participant recommendations Care coordination for the older trauma patient and family Support for the transition to home Extended and flexible rehabilitation options Investment in staff expertise Dedicated service Negative feelings post trauma 1. Shock and fear At the time of injury, all participants experienced distress, expressed as feelings of shock, closely followed by fear: “I… couldn’t believe it was happening to me… how was I going to get help?” - Patient 2. Uncertainty Participants expressed considerable uncertainty during recovery and when returning home: “[I was] fearful…I was not ready to go home” – Patient “you feel as though you could go home when you're in hospital, but once you get home, it's a different… entirely different, you don't feel as capable as what you do when you're in hospital” – Patient 3. Decreased confidence Participants expressed a loss of confidence, frequently related to mobility and fear of falling: “I [lost] my confidence in walking, [fearful] that I might have another fall ……. every time you fall, your confidence goes down.” - Patient “[such] a long time before I got my confidence back”- Patient 4. Feeling burdensome Participants consistently reported feeling “burdensome” for both health service staff and family: “managing all the medications, lots of pills, trying to be nurse, doctor etc, going home quickly helped me but not [my husband]” – Patient Recovery Goals 1. Regaining independence & “full” recovery hopes Universal goals for participants were to regain independence, particularly relating to mobility, activities of daily living, and driving. Participants valued returning to social and family activities, and hobbies such as gardening: “getting [back] to normal household activities again too, that's a big thing” - Patient “being able to get out into it” - Family Participants agreed that an ideal outcome would be complete recovery, but that for some, this was not necessarily realistic or not yet attained: “to get back to 100 percent… it's been a little bit disappointing” - Patient “I thought I did all the right things, but [I still need to use] a walker” - Patient 2. Moving and exercise Moving and exercising with confidence was a common goal. All patient participants sought to join community exercise groups upon discharge: I've had [exercises] with my legs and just been not able to... and [anticipating] the joy of being able to get up and do it again. 3. Social connection Reconnecting socially with family and friends was a priority recovery goal for all participants: “getting out… going to people's houses or having them come to your house” - Patient “It makes so much difference…[resuming a] social life, yeah.” - Family Factors Influencing the Older Patients Experience of Care Following Trauma 1. Communication Information sharing with patient and family. At initial interaction with health services, participants described a “blur” of “quick” actions that were not always well-communicated, nor understood by the patient and family. Several participants described the interaction as a period in which they felt “uninformed”, with “no communication” relating to assessments, diagnoses, and plans for management, creating a distressing experience: “just to be… told nothing really, not given any information is off-putting… it’s frustrating” - Patient Communication between staff and services. Poor communication between healthcare staff, services, and consumers, particularly during transitions in care, was a source of concern: “When she was given the information, it was never followed through with… they said she'd be going to this ward, she's going to that ward… she never went anywhere” – Family Effective communication after discharge. Communication with patients and families following discharge was collectively important to participants, providing “checking-in” opportunities and facilitating coordination of follow-up appointments and services. Supports to connect with community services for longer term recovery progress was important and sometimes lacking: “there’s that gap after rehab when you go home, when there’s no-one helping you find exercise in the community or at home after that, so there’s no follow up”- Family “you sort of feel ignored” – Patient 2. Empathy and Interpersonal Skills in Care Impact of staff workload. Patients and their families emphasized the profound impact of empathy during healthcare interactions. Participants shared the view that empathy and subsequently, quality of care was impacted when healthcare staff faced high workloads: “if you meet somebody who's rushed off their feet and has too many people to look after, they won't have the time to look after you” - Patient Positive and valued experiences. Empathy and dignity were demonstrated in the manner that health and care needs were met, particularly when staff extended this beyond the essentials of clinical care, and provided attention to patient comfort and dignity: “those small acts of kindness” – Patient “just those small, dignified things” - Family Negative and distressing experiences. Several participants described distressing experiences, linked with both a perceived lack of healthcare staff empathy and poor interpersonal skills. This manifested in situations where patients felt dismissed, with timely pain management potentially impacted: “[the healthcare staff] made it quite clear I was just a pest” - Patient “they sort of didn't believe you… the pain you're in… [they] didn’t take it seriously” - Patient Perception of being a low priority. Timely assistance with toileting was a common concern and source of distress, associated with a perception of both lack of empathy and being a low priority for staff, leading to embarrassment and discomfort: “to be unable to get to the toilet… and then the outcome, of course… if you can't get there… I was really upset” - Family “you get the feeling that you’re just a damn nuisance… I think that’s worse for you than the ailment” - Patient 3. System Factors in Healthcare Rehabilitation Access. All participants valued rehabilitation and described it as a positive experience: “the rehab side of stuff, that led to those good outcomes” - Family “rehab was fantastic and gives confidence, rehab teaches you what you can do, [through] hydrotherapy, exercise” - Patient Participants expressed unnecessary delays and difficulties in accessing rehabilitation that aligned with their individuals’ circumstances and abilities: “it would be good if the rehab came in earlier” - Patient “I could have done exercises with my arms… because I wasn't doing anything, I was lying on the bed all day, my muscles were wasting away” - Patient Further, a common theme was one of frustration with rehabilitation scheduling and limited period of availability, being perceived as generic, rather than individualised: “six weeks’ worth of rehab, then you're left on your own” - Patient Discharge and Home Support. Discharge that was perceived as “too early” was a common theme: “[I] fell Friday, operated Saturday, home Tuesday… [it was] too soon” - Patient “she definitely didn't feel ready and able to go [home]… I think it was too quick” - Family Participants reported a perception of healthcare staff having limited awareness of the challenges faced by participants following discharge and, in some cases, the “ frightening ” nature of the first days at home: “a combination of [feeling] fearful and rushed… what am I going to do type thing” – Patient Participants collectively recognised the importance of support during the transition to home, although many did not feel they had this adequately available: “ really, you need somebody professional to come in on your first day home” - Patient “just to check up on me… to see that you are or are alright, mentally… I mean, I'm completely on my own” – Patient Support systems, including family and friends, financial, and home supports (equipment and assistance) were all identified as important to recovery. Family provided advocacy, guidance, and practical support at home. Funded support, such as transport and home support services, was highly valued: “to [get to] rehab… they provided taxis… which was great… until I could be able to drive again” - Patient “there was physio at home and help with showering and whatever I needed really” - Patient Individualised and Holistic Care. A commonly described theme was poor attention to mental health. Participants described trauma as a distressing and life changing event, yet participants noted a lack of attention to mental health and well-being: “there was no mention of it the entire time and [the patient] was in the system… for three months or something” – Family This sentiment sat alongside a common perception that the health system generally “does not work well” for people with complex presentations including mental ill-health, but also for those with complex care, and/or communication needs. Recommendations from Individuals with Lived Experience of Trauma Participants recommended five key, inter-related components of an ideal care pathway, to facilitate best possible outcomes for older people following trauma, including care coordination, support for the transition home, extended and flexible rehabilitation options, investment in staff expertise, and a dedicated service. 1. Care coordination for the older trauma patient and family Participants recommended the establishment of a “guide, liaison or key contact” for older people and their families following trauma. Someone “who can explain things to the patient and the families” (Patient) and is available “throughout care” (Family). Ideally, this would be a person with healthcare knowledge who “understand[s] the needs of the older patient” (Patient) and can provide support in communication, transitions, and advocacy. Several participants had experienced this type of model in other health services and identified it as a potential solution. 2. Support for the transition to home Participants consistently described the need for “ tapering of support” (family) at discharge to home, with increased availability of home hospital services and contact points, providing opportunities to access advice, “trouble shoot” issues at home and support to connect with community services. Supports described included: “more home hospital services, medication checks, phone call checks, advice on what might be helpful [that you] may not have thought of” (group activity worksheet) and “connecting with, for example, My Aged Care, specialist review if needed, GP [timely]access” (group activity worksheet) 3. Extended and flexible rehabilitation options The most frequently expressed recommendation was for extended and flexible rehabilitation, integrated with support for greater exercise and activity at home and within community programs, allowing participants to continue working towards remaining rehabilitation and recovery goals. Rehabilitation was a strongly positive experience for participants; however perceptions of limited availability or access were equally strong. Participants responded to the question “what [is needed to] support a good outcome” with a resounding response “more rehab” . In addition to improved flexibility and extended rehabilitation options, participants specifically suggested more guided “at home exercise” and rehabilitation integration into “ acute and respite” care periods. 4. Investment in Staff Expertise Participants recommended improved staffing and further training to develop expertise in the care of older people following trauma, including adaptable, responsive communication approaches and with attention to empathy in care. 5. Dedicated service Participants recommended investment in a dedicated service for older people who have experienced trauma, separate from “the chaos” of the general emergency department and other acute services. Discussion This study explored the perspectives, needs, and preferences of older people and their families following trauma. Participants expressed preferences for improved communication and enhanced empathy in care delivery. Specific recommendations for trauma care services for older people were made, including: a key healthcare professional (liaison); staff with expertise in working with older populations; suitable environments; and flexible, individualised access to rehabilitation and supports, particularly when transitioning to home. The Importance and Challenge of Empathy in Healthcare Delivery Older patients and their families have previously reported the importance of being viewed and valued as a person, with a need for respect, individualised care, effective communication, and collaboration with relatives [ 31 – 34 ]. The current study reinforces the recent findings of Kellezi et al. [ 31 ], highlighting that concerns of patients and their families often do not relate to a lack of effective clinical care, but the way in which care is delivered and represent an important care quality dimension. Older people’s experiences of feeling burdensome and perceiving a lack of respect and empathy from healthcare staff is a sentiment that is reflected throughout the literature and must be addressed [ 31 , 32 , 35 , 36 ]. In the present study, participants described a perception of high staff workload and time pressures impacting on interpersonal communication and the patient experience, a theme also reported in the broader literature [ 36 – 39 ]. In a review of the role of empathy in health and social care, factors that limited empathy in care included high patient load, time pressure, and lack of education in empathy [ 36 ]. These findings affirm participant perceptions in the present study and highlight both the complex challenge of and potential strategies to improve empathy in healthcare. Attention to Mental Health and Well-being Participants described trauma as a life-changing experience. They expressed a need for holistic care that focused not only on physical recovery, but also mental health and addressing loss of confidence following trauma. The need for psychosocial support for patients following trauma has been established [ 18 , 40 ] and reinforced in a recent study of trauma patient experiences [ 31 ]. Anxiety and low self-efficacy have been linked with a maladaptive fear of falling [ 41 ], which is in itself, associated with negative outcomes for older adults [ 42 ]. This underscores the need to provide holistic care, addressing all factors impacting older patients following trauma, including mental health and well-being. Healthcare Staff Competency, Expert Practitioners, and the Trauma Coordinator Role Evidence-based geriatric care models which meet the unique and complex needs of older patients require teams of healthcare staff with knowledge of age-related changes and their impacts alongside skilled, responsive communication approaches [ 43 – 45 ]. Healthcare teams with competency in the care of older adults, closely supported by experts such as advanced geriatric care nurses and practitioners, are recognised as delivering improved outcomes for older patients [ 45 – 47 ] and would be well equipped to deliver and promote care that aligns with needs highlighted and recommendations made by participants in this study. Nurse care coordinator roles are often implemented in the care of higher risk and older populations, including providing input during transitions in care, coordinating between services, and facilitating multi-disciplinary team input, positively impacting patient and health service outcomes [ 48 , 49 ]. Specialist trauma nurse practitioner roles, including liaison with the patient, families and between teams and coordination of care, have similarly been shown to improve patient outcomes, in addition to supporting staff satisfaction [ 50 ]. Collectively, the literature provides evidence for the utility and benefits of a trauma coordinator or “liaison” for older patients and their families, as recommended by our participants. Building staff competency in the care of older populations through targeted training, the presence of advanced trauma care practitioners, and specialised, nurse led coordination and/or liaison appear to be important ingredients in the delivery of healthcare that meets the needs of older populations. Early, Flexible, and Individualised Rehabilitation In contrast with emergency and acute care phases, participants consistently described the rehabilitation period as positive, with patients feeling better and working towards recovery goals. Participants recommended broadening rehabilitation availability to allow earlier and more flexible rehabilitation opportunities. The literature clearly supports early rehabilitation following musculoskeletal trauma for improved outcomes [ 51 ], particularly for older patients [ 52 , 53 ]. Early rehabilitation is recognised as important to mitigate the risk of avoidable functional decline and mortality in older patients [ 52 ]. In a review by Kosse et al. [ 53 ], older patients who participated in an early multi-disciplinary rehabilitation program demonstrated improved functional levels, reduced length of hospital stay, and reduced likelihood of discharge to residential aged care. The criteria for commencement of rehabilitation for patients following trauma are not clearly defined, however readiness indicators are well discussed in the literature [ 54 ]. In a 2017 meta-analysis of published rehabilitation research, improved outcomes were demonstrated through both comprehensive multidisciplinary input and individualised (including inpatient, in-home, and community-based) rehabilitation for older patients [ 55 ]. Tele-rehabilitation was not discussed by participants in the current study but is recognised as a complement to rehabilitation services for older people, that is convenient and promotes motivation, self-awareness [ 56 ] and supports quality of life [ 57 ]. Improved rehabilitation opportunities, as recommended by the participants in the present study, may be provided by models of care that facilitate early rehabilitation access, comprehensive and individualised rehabilitation, and tele-rehabilitation, all of which is well supported in the existing literature. Supported Discharge / Transition to Home Participants recommended improved support for the transition from hospital and rehabilitation services to home, with follow up contact and support to connect with community activity groups and services. These recommendations clearly align with established trauma care guidelines and the broader literature which describe improved outcomes for older patients and health services when specialised coordination and liaison roles are adopted [ 17 – 19 ]. Recommendation Summary Best practice guidelines for the care of older patients following trauma describe care components which align closely with the recommendations made by participants in this study [ 17 – 19 ]. Specifically, guidelines recommend healthcare teams with expertise in the care of older people; clear and timely communication between the healthcare team, the patient, and family; appropriate rehabilitation access, informed by holistic multi-disciplinary assessment; discharge planning including thorough assessment of home service and social support needs; and follow-up post-discharge to assess clinical status and well-being. Strengths and Limitations The results of this study must be interpreted with an awareness of the relatively small number of participants (n = 13) over two convened workshops. Within the sample, there is limited diversity in demographics and as such, the perspectives and experiences captured may not reflect that of the broader population of older people following trauma. A strength of our study is the inclusion of participants with differing levels of health literacy, improving the representativeness of the sample. Health research is often biased towards reflecting the views of individuals with greater health literacy or may not use tools adequate to measure this [ 58 ]. This study included participants who reported low confidence in their ability to understand health information however, this measure is not part of a comprehensive conceptual framework. We captured the perspectives of both patients and their family members, who were recruited by current service clinicians (day rehabilitation and fragility fracture clinics), which is a strength that allowed us timely capture of recent experiences and perspectives that might later have been forgotten if data were collected at a greater retrospective interval. Implications for Practice Trauma care teams require staff with a range of expertise in both trauma and geriatric care to meet the specific needs of older trauma patients. A holistic and individualised approach to care across the continuum, facilitated by a coordinator who supports communication and transitions, is important to older trauma patients and their families. Access to flexible rehabilitation and increased support at the time of discharge to home, in addition to the above, requires the attention of health and social care funding bodies. Conclusions Insights gained in the present study build on prior research findings, highlighting the need for a health practitioner workforce equipped with competency in working with older populations and specialised geriatric trauma liaison and coordination roles. Recommendations made by participants in this study align with best practice and current guidelines, advocating for a healthcare system that prioritises effective communication, empathy in care, and individualised support, fostering holistic healthcare delivery that positively influences the recovery journey of older adults who have experienced trauma. Extended, flexible rehabilitation access and support at discharge to home were highlighted by participants as healthcare priorities for attention. Consultation with healthcare stakeholders is essential to understand how these recommendations can be sustainably and consistently implemented to support best possible outcomes for older patients following trauma. Abbreviations EBCD The Experience Based Co-Design Declarations Ethical approval and consent to participate Ethical approval was granted by by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 – LNR/23/SAC/101. The participants were informed verbally and in writing about the study’s purpose and were assured that they could withdraw their consent at any time without consequences. All participants gave written consent before the workshop commenced. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during this study will be available from the corresponding author on reasonable request. This study was not pre-registered. Competing interests The authors declare no competing interests. Funding This work was supported by funding from the Lifetime Support Authority. Authors contributions J.W: designed the study, collected data, conducted data analysis, wrote and edited the main manuscript. 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What older people and their relatives say is important during acute hospitalisation: a qualitative study. BMC Health Serv Res. 2022;22(1):578. Regen E, Phelps K, van Oppen JD, Riley P, Lalseta J, Martin G, et al. Emergency care for older people living with frailty: patient and carer perspectives. Emerg Med J. 2022;39(10):726–32. van Oppen JD, Keillor L, Mitchell Á, Coats TJ, Conroy SP. What older people want from emergency care: a systematic review. Emerg Med J. 2019;36(12):754–61. Koskenniemi J, Leino-Kilpi H, Puukka P, Suhonen R. Respect and its associated factors as perceived by older patients. J Clin Nurs. 2019;28(21–22):3848–57. Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S, editors. The role of empathy in health and social care professionals. Healthcare; 2020. Alhalal E, Alrashidi LM, Alanazi AN. Predictors of patient-centered care provision among nurses in acute care setting. J Nurs Manag. 2020;28(6):1400–9. Dierckx de Casterlé B, Mertens E, Steenacker J, Denier Y. Nurses’ experiences of working under time pressure in care for older persons. Nurs Ethics. 2020;27(4):979–90. Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662–73. Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: An integrative literature review. Injury. 2013;44(11):1383–90. Adamczewska N, Nyman SR. A new approach to fear of falls from connections with the posttraumatic stress disorder literature. Gerontol Geriatr Med. 2018;4:2333721418796238. Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. The association between fear of falling and occurrence of falls: a one-year cohort study. BMC geriatr. 2022;22(1):393. Molendijk-van Nieuwenhuyzen K, Belt-van Opstal R, Hakvoort L, Dikken J. Exploring geriatric trauma unit experiences through patients’ eyes: a qualitative study. BMC Geriatr. 2024;24(1):476. Bing-Jonsson PC, Bjørk IT, Hofoss D, Kirkevold M, Foss C. Competence in advanced older people nursing: development of ‘Nursing older people–Competence evaluation tool’. Int J Older People Nurs. 2015;10(1):59–72. Halvachizadeh S, Gröbli L, Berk T, Jensen KO, Hierholzer C, Bischoff-Ferrari HA, et al. The effect of geriatric comanagement (GC) in geriatric trauma patients treated in a level 1 trauma setting: A comparison of data before and after the implementation of a certified geriatric trauma center. PLoS ONE. 2021;16(1):e0244554. Henni SH, Kirkevold M, Antypas K, Foss C. The integration of new nurse practitioners into care of older adults: A survey study. J Clin Nurs. 2019;28(15–16):2911–23. Katrancha ED, Zipf J. Evaluation of a virtual geriatric trauma institute. J Trauma Nurs. 2014;21(6):278–81. Conway A, O’Donnell C, Yates P. The effectiveness of the nurse care coordinator role on patient-reported and health service outcomes: A systematic review. Eval Health Prof. 2019;42(3):263–96. Tenison E, James A, Ebenezer L, Henderson EJ. A narrative review of specialist Parkinson’s nurses: Evolution, evidence and expectation. Geriatrics. 2022;7(2):46. Walter E, Curtis K. The role and impact of the specialist trauma nurse: an integrative review. J Trauma Nurs. 2015;22(3):153–69. You D, Leighton J, Schneider P. Current concepts in rehabilitation protocols to optimize patient function following musculoskeletal trauma. Injury. 2020;51:S5–9. Chiu R-H, Tsai K-T, Wang Y-L, Cheng H-H. Early rehabilitation during hospitalization might decrease the Risk of 3-month mortality in older Patients: A retrospective cohort study. Rehabilitation Pract Sci. 2023;2023(1):2. Kosse NM, Dutmer AL, Dasenbrock L, Bauer JM, Lamoth CJ. Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review. BMC geriatr. 2013;13(1):1–16. Kimmel LA, Holland AE, Lannin N, Edwards ER, Page RS, Bucknill A, et al. Clinicians’ perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma. Aust Health Rev. 2017;41(2):192–200. Stott DJ, Quinn TJ. Principles of rehabilitation of older people. Medicine. 2017;45(1):1–5. Shulver W, Killington M, Morris C, Crotty M. Well, if the kids can do it, I can do it’: older rehabilitation patients' experiences of telerehabilitation. Health Expect. 2017;20(1):120–9. Velayati F, Ayatollahi H, Hemmat M. A systematic review of the effectiveness of telerehabilitation interventions for therapeutic purposes in the elderly. Methods Inf Med. 2020;59(2–03):104–9. Pleasant A, McKinney J, Rikard R. Health literacy measurement: a proposed research agenda. J Health Commun. 2011;16:11–21. Additional Declarations No competing interests reported. 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In Australia, the number of people aged 85 years and over is projected to double by 2042 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], with a consequent increased demand on healthcare services. Policy makers and healthcare providers are being urged to develop systems that effectively meet the needs of our growing, ageing population [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe number of older adults hospitalised for trauma in Western countries is rapidly growing [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Australia, the proportion of older patients in the major trauma population has increased, with an older person falling from standing height being the most common type of trauma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Older patients frequently present with a clinical picture of major trauma, through a relatively minor or low energy injury mechanism [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The presence of frailty or comorbidities contribute to a more severe consequence of trauma than in a younger person with equivalent injury severity, including a trajectory of functional decline, loss of independence, poorer quality of life, increased complications, and mortality [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Health systems need to develop specialised trauma care models and systems to effectively meet the needs of older patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTrauma care of older people is supported by guidelines [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and several targeted models of care, such as geriatric co-management and consultation, and have demonstrated potential for reduction of adverse outcomes for older patients following trauma [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Despite this, older patients remain under-triaged and undertreated, with health services lacking comprehensive adoption of recommended standards [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Experts in emergency and geriatric care have identified research priorities as a need to 1. understand older people\u0026rsquo;s preferred goals of trauma care and 2. identify what combination of trauma and geriatric care is needed [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEngaging consumers can support the understanding of their needs and preferences [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and subsequently, assist in developing acceptable models of trauma care for older people.\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to understand the needs and preferences for healthcare and recovery from the perspective of older patients and their families following trauma.\u003c/p\u003e \u003cp\u003eThe secondary objective was to define components and attributes of a model of trauma care recommended by consumers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003e The nature of this research warranted adoption of principles for participatory design methodology. The Experience-Based Co-Design (EBCD) cycle is commonly used as a healthcare quality improvement tool [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], engaging patients, carers, and staff to collaboratively identify improvement priorities, design and implement changes, and jointly reflect on their achievements. In this research, we sought to gather information about consumer (patients and family/carers) needs and preferences that are expected to form part of a larger program of research relating to trauma care for older people.\u003c/p\u003e \u003cp\u003eA workshop was designed, aimed at fostering participant ownership over workshop outcomes, as recommended by Donetto et al [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The workshops involved structured activities and facilitated discussions, guided by The Field Guide to Human Centred Design (IDEO.org, 2015), exploring participant experiences, perceptions, needs, and preferences and generating qualitative data addressing the research question.\u003c/p\u003e \u003cp\u003eEthical approval was granted by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 \u0026ndash; LNR/23/SAC/101.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eOlder people (65\u0026thinsp;+\u0026thinsp;years) who had experienced trauma requiring emergency care and their families were invited to participate in one of two workshops. All patient participants accessed healthcare through the Southern Adelaide Local Health Network (SALHN) in South Australia and were identified through subacute and community services. Eligibility criteria included living at home, without a diagnosis of dementia, able to provide informed consent, and able to independently access and participate in workshop activities.\u003c/p\u003e \u003cp\u003eA short pre-workshop demographic and background information survey was developed, including participant reported age, gender, country of birth (or year of arrival in Australia), language spoken at home, level of confidence in understanding health information [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and questions relating to health services accessed through their trauma healthcare experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy procedures\u003c/h2\u003e \u003cp\u003eClinical staff identified potential participants, based on the eligibility criteria, and provided provisional study information. The project team provided further information and sought consent from potential participants. Prior to attending the workshop, participants completed the pre-workshop survey via telephone.\u003c/p\u003e \u003cp\u003eConsumer workshops were facilitated by researchers experienced in qualitative research and held in a community hub. Participants attended one of two workshops and were provided with a \u003cspan\u003e$\u003c/span\u003e70AUD gift card honorarium.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eParticipant demographic and characteristics data were entered into a Microsoft Excel spreadsheet. Workshop group discussions were audio recorded and professionally transcribed.\u003c/p\u003e \u003cp\u003eData coding and analysis of qualitative data were conducted by two members of the research team (JW and MCh), with the adoption of grounded theory principles, in which the systematic and iterative process of data coding and analysis provides insights into the factors, processes, and interactions that influence the experience, needs, and preferences of consumers. This approach is well suited to the pursuit of understanding health consumer experiences and perspectives [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and was enacted through a process of reflexive thematic analysis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCoding was conducted using NVivo 1.7.1 software. To ensure coherence across themes, the researchers conducted a shared review of data against minor and major themes. Final definitions, naming of themes, and report planning included review by a third, senior qualitative researcher (KL).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBetween August and November 2023, 13 participants attended the workshops, including \u0026ldquo;patients\u0026rdquo; who had experienced trauma (n\u0026thinsp;=\u0026thinsp;7) and \u0026ldquo;family members\u0026rdquo; who had supported the patient following trauma (n\u0026thinsp;=\u0026thinsp;6). All patients presented to the emergency department following a fall (via ambulance n\u0026thinsp;=\u0026thinsp;6 and directly n\u0026thinsp;=\u0026thinsp;1) and were admitted to acute wards. Most had surgical interventions (n\u0026thinsp;=\u0026thinsp;5) and inpatient rehabilitation (n\u0026thinsp;=\u0026thinsp;6). Hospital-in-the-home services were accessed by 3 patient participants. All had accessed outpatient healthcare services (rehabilitation, physiotherapy, and/or group exercise such as hydrotherapy). Community-based exercise groups were accessed by four patient participants at the time of the workshop, with others intending to access when available. Health literacy confidence varied within both patient and family participant groups, indicated by responses in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e to the statement \u0026lsquo;I always understand health information well enough to know what to do\u0026rsquo; [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eParticipant characteristics (N\u0026thinsp;=\u0026thinsp;13)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;Patient\u0026rsquo; participants\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;7 (53.8%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;Family\u0026rsquo; participants\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;6 (46.1%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMin-max\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u0026ndash;87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMedian (mean)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (67.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCountry of birth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAustralia, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEngland, n\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eNetherlands, n\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eNorthern Ireland, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eHealth literacy \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStrongly agree, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSomewhat agree, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNeither agree, nor disagree, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSomewhat disagreed, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDisagree, n\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e \u003cem\u003e1\u003c/em\u003e \u003c/sup\u003e \u003cem\u003eResponse to: \u0026ldquo;it is always easy for me to understand health information well enough to know what to do\u0026rdquo;question from the Australian Bureau of Statistics National Health Survey: Health literacy.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eDuring the workshops, participants shared their experiences of trauma, and it\u0026rsquo;s impacts, of health system interactions and perceptions and perspectives related to the needs and preferences of older trauma patients. This led to the emergence of key themes related to; (1) negative feelings post trauma, (2) goals for recovery, (3) factors influencing the experience of care and recovery following trauma, and (4) recommendations to improve the experience of care following trauma, each with associated subthemes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003esummary of the identified themes and subthemes\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNegative feelings post trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShock and fear\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncertainty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased confidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeeling burdensome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eRecovery goals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegaining independence and a \u0026ldquo;full\u0026rdquo; recovery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMovement and exercise\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial connection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eFactors Influencing the Older Patient\u0026rsquo;s Experience of Care and Recovery Following Trauma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpathy and interpersonal skills in care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystem-related factors in healthcare\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eParticipant recommendations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCare coordination for the older trauma patient and family\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport for the transition to home\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtended and flexible rehabilitation options\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInvestment in staff expertise\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDedicated service\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eNegative feelings post trauma\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1. Shock and fear\u003c/h2\u003e \u003cp\u003eAt the time of injury, all participants experienced distress, expressed as feelings of shock, closely followed by fear:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I\u0026hellip; couldn\u0026rsquo;t believe it was happening to me\u0026hellip; how was I going to get help?\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2. Uncertainty\u003c/h2\u003e \u003cp\u003eParticipants expressed considerable uncertainty during recovery and when returning home:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;[I was] fearful\u0026hellip;I was not ready to go home\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;you feel as though you could go home when you're in hospital, but once you get home, it's a different\u0026hellip; entirely different, you don't feel as capable as what you do when you're in hospital\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3. Decreased confidence\u003c/h2\u003e \u003cp\u003eParticipants expressed a loss of confidence, frequently related to mobility and fear of falling:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I [lost] my confidence in walking, [fearful] that I might have another fall \u0026hellip;\u0026hellip;. every time you fall, your confidence goes down.\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;[such] a long time before I got my confidence back\u0026rdquo;- Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4. Feeling burdensome\u003c/h2\u003e \u003cp\u003eParticipants consistently reported feeling \u0026ldquo;burdensome\u0026rdquo; for both health service staff and family:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;managing all the medications, lots of pills, trying to be nurse, doctor etc, going home quickly helped me but not [my husband]\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecovery Goals\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e1. Regaining independence \u0026amp; \u0026ldquo;full\u0026rdquo; recovery hopes\u003c/h2\u003e \u003cp\u003eUniversal goals for participants were to regain independence, particularly relating to mobility, activities of daily living, and driving. Participants valued returning to social and family activities, and hobbies such as gardening:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;getting [back] to normal household activities again too, that's a big thing\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;being able to get out into it\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants agreed that an ideal outcome would be complete recovery, but that for some, this was not necessarily realistic or not yet attained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;to get back to 100 percent\u0026hellip; it's been a little bit disappointing\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I thought I did all the right things, but [I still need to use] a walker\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2. Moving and exercise\u003c/h2\u003e \u003cp\u003eMoving and exercising with confidence was a common goal. All patient participants sought to join community exercise groups upon discharge:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI've had [exercises] with my legs and just been not able to... and [anticipating] the joy of being able to get up and do it again.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3. Social connection\u003c/h2\u003e \u003cp\u003eReconnecting socially with family and friends was a priority recovery goal for all participants:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;getting out\u0026hellip; going to people's houses or having them come to your house\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It makes so much difference\u0026hellip;[resuming a] social life, yeah.\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors Influencing the Older Patients Experience of Care Following Trauma\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1. Communication\u003c/h2\u003e \u003cp\u003e\u003cb\u003eInformation sharing with patient and family.\u003c/b\u003e At initial interaction with health services, participants described a \u0026ldquo;blur\u0026rdquo; of \u0026ldquo;quick\u0026rdquo; actions that were not always well-communicated, nor understood by the patient and family. Several participants described the interaction as a period in which they felt \u0026ldquo;uninformed\u0026rdquo;, with \u0026ldquo;no communication\u0026rdquo; relating to assessments, diagnoses, and plans for management, creating a distressing experience:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;just to be\u0026hellip; told nothing really, not given any information is off-putting\u0026hellip; it\u0026rsquo;s frustrating\u0026rdquo; - Patient\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eCommunication between staff and services.\u003c/b\u003e Poor communication between healthcare staff, services, and consumers, particularly during transitions in care, was a source of concern:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;When she was given the information, it was never followed through with\u0026hellip; they said she'd be going to this ward, she's going to that ward\u0026hellip; she never went anywhere\u0026rdquo;\u003c/em\u003e \u0026ndash; \u003cem\u003eFamily\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEffective communication after discharge.\u003c/b\u003e Communication with patients and families following discharge was collectively important to participants, providing \u003cem\u003e\u0026ldquo;checking-in\u0026rdquo;\u003c/em\u003e opportunities and facilitating coordination of follow-up appointments and services. Supports to connect with community services for longer term recovery progress was important and sometimes lacking:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;there\u0026rsquo;s that gap after rehab when you go home, when there\u0026rsquo;s no-one helping you find exercise in the community or at home after that, so there\u0026rsquo;s no follow up\u0026rdquo;- Family\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;you sort of feel ignored\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2. Empathy and Interpersonal Skills in Care\u003c/h2\u003e \u003cp\u003e \u003cb\u003eImpact of staff workload.\u003c/b\u003e Patients and their families emphasized the profound impact of empathy during healthcare interactions. Participants shared the view that empathy and subsequently, quality of care was impacted when healthcare staff faced high workloads:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;if you meet somebody who's rushed off their feet and has too many people to look after, they won't have the time to look after you\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003ePositive and valued experiences.\u003c/b\u003e Empathy and dignity were demonstrated in the manner that health and care needs were met, particularly when staff extended this beyond the essentials of clinical care, and provided attention to patient comfort and dignity:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;those small acts of kindness\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;just those small, dignified things\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eNegative and distressing experiences.\u003c/b\u003e Several participants described distressing experiences, linked with both a perceived lack of healthcare staff empathy and poor interpersonal skills. This manifested in situations where patients felt dismissed, with timely pain management potentially impacted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;[the healthcare staff] made it quite clear I was just a pest\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;they sort of didn't believe you\u0026hellip; the pain you're in\u0026hellip; [they] didn\u0026rsquo;t take it seriously\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003ePerception of being a low priority.\u003c/b\u003e Timely assistance with toileting was a common concern and source of distress, associated with a perception of both lack of empathy and being a low priority for staff, leading to embarrassment and discomfort:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;to be unable to get to the toilet\u0026hellip; and then the outcome, of course\u0026hellip; if you can't get there\u0026hellip; I was really upset\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;you get the feeling that you\u0026rsquo;re just a damn nuisance\u0026hellip; I think that\u0026rsquo;s worse for you than the ailment\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3. System Factors in Healthcare\u003c/h2\u003e \u003cp\u003e \u003cb\u003eRehabilitation Access.\u003c/b\u003e All participants valued rehabilitation and described it as a positive experience:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;the rehab side of stuff, that led to those good outcomes\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;rehab was fantastic and gives confidence, rehab teaches you what you can do, [through] hydrotherapy, exercise\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants expressed unnecessary delays and difficulties in accessing rehabilitation that aligned with their individuals\u0026rsquo; circumstances and abilities:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;it would be good if the rehab came in earlier\u0026rdquo; - Patient\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I could have done exercises with my arms\u0026hellip; because I wasn't doing anything, I was lying on the bed all day, my muscles were wasting away\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurther, a common theme was one of frustration with rehabilitation scheduling and limited period of availability, being perceived as generic, rather than individualised:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;six weeks\u0026rsquo; worth of rehab, then you're left on your own\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eDischarge and Home Support.\u003c/b\u003e Discharge that was perceived as \u0026ldquo;too early\u0026rdquo; was a common theme:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;[I] fell Friday, operated Saturday, home Tuesday\u0026hellip; [it was] too soon\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;she definitely didn't feel ready and able to go [home]\u0026hellip; I think it was too quick\u0026rdquo; - Family\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants reported a perception of healthcare staff having limited awareness of the challenges faced by participants following discharge and, in some cases, the \u0026ldquo;\u003cem\u003efrightening\u003c/em\u003e\u0026rdquo; nature of the first days at home:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;a combination of [feeling] fearful and rushed\u0026hellip; what am I going to do type thing\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants collectively recognised the importance of support during the transition to home, although many did not feel they had this adequately available:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003ereally, you need somebody professional to come in on your first day home\u0026rdquo; - Patient\u003c/em\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;just to check up on me\u0026hellip; to see that you are or are alright, mentally\u0026hellip; I mean, I'm completely on my own\u0026rdquo; \u0026ndash; Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSupport systems, including family and friends, financial, and home supports (equipment and assistance) were all identified as important to recovery. Family provided advocacy, guidance, and practical support at home. Funded support, such as transport and home support services, was highly valued:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;to [get to] rehab\u0026hellip; they provided taxis\u0026hellip; which was great\u0026hellip; until I could be able to drive again\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;there was physio at home and help with showering and whatever I needed really\u0026rdquo; - Patient\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndividualised and Holistic Care.\u003c/b\u003e A commonly described theme was poor attention to mental health. Participants described trauma as a distressing and life changing event, yet participants noted a lack of attention to mental health and well-being:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;there was no mention of it the entire time and [the patient] was in the system\u0026hellip; for three months or something\u0026rdquo; \u0026ndash; Family\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis sentiment sat alongside a common perception that the health system generally \u0026ldquo;does not work well\u0026rdquo; for people with complex presentations including mental ill-health, but also for those with complex care, and/or communication needs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations from Individuals with Lived Experience of Trauma\u003c/h2\u003e \u003cp\u003eParticipants recommended five key, inter-related components of an ideal care pathway, to facilitate best possible outcomes for older people following trauma, including care coordination, support for the transition home, extended and flexible rehabilitation options, investment in staff expertise, and a dedicated service.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e1. Care coordination for the older trauma patient and family\u003c/h2\u003e \u003cp\u003eParticipants recommended the establishment of a \u003cem\u003e\u0026ldquo;guide, liaison or key contact\u0026rdquo;\u003c/em\u003e for older people and their families following trauma. Someone \u003cem\u003e\u0026ldquo;who can explain things to the patient and the families\u0026rdquo; (Patient)\u003c/em\u003e and is available \u003cem\u003e\u0026ldquo;throughout care\u0026rdquo; (Family).\u003c/em\u003e Ideally, this would be a person with healthcare knowledge who \u003cem\u003e\u0026ldquo;understand[s] the needs of the older patient\u0026rdquo; (Patient)\u003c/em\u003e and can provide support in communication, transitions, and advocacy. Several participants had experienced this type of model in other health services and identified it as a potential solution.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e2. Support for the transition to home\u003c/h2\u003e \u003cp\u003eParticipants consistently described the need for \u0026ldquo;\u003cem\u003etapering of support\u0026rdquo; (family)\u003c/em\u003e at discharge to home, with increased availability of home hospital services and contact points, providing opportunities to access advice, \u0026ldquo;trouble shoot\u0026rdquo; issues at home and support to connect with community services. Supports described included: \u003cem\u003e\u0026ldquo;more home hospital services, medication checks, phone call checks, advice on what might be helpful [that you] may not have thought of\u0026rdquo; (group activity worksheet)\u003c/em\u003e and \u003cem\u003e\u0026ldquo;connecting with, for example, My Aged Care, specialist review if needed, GP [timely]access\u0026rdquo; (group activity worksheet)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e3. Extended and flexible rehabilitation options\u003c/h2\u003e \u003cp\u003eThe most frequently expressed recommendation was for extended and flexible rehabilitation, integrated with support for greater exercise and activity at home and within community programs, allowing participants to continue working towards remaining rehabilitation and recovery goals. Rehabilitation was a strongly positive experience for participants; however perceptions of limited availability or access were equally strong. Participants responded to the question \u0026ldquo;what [is needed to] support a good outcome\u0026rdquo; with a resounding response \u003cem\u003e\u0026ldquo;more rehab\u0026rdquo;\u003c/em\u003e. In addition to improved flexibility and extended rehabilitation options, participants specifically suggested more guided \u0026ldquo;at home exercise\u0026rdquo; and rehabilitation integration into \u0026ldquo;\u003cem\u003eacute and respite\u0026rdquo;\u003c/em\u003e care periods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4. Investment in Staff Expertise\u003c/h2\u003e \u003cp\u003eParticipants recommended improved staffing and further training to develop expertise in the care of older people following trauma, including adaptable, responsive communication approaches and with attention to empathy in care.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e5. Dedicated service\u003c/h2\u003e \u003cp\u003eParticipants recommended investment in a dedicated service for older people who have experienced trauma, separate from \u0026ldquo;the chaos\u0026rdquo; of the general emergency department and other acute services.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the perspectives, needs, and preferences of older people and their families following trauma. Participants expressed preferences for improved communication and enhanced empathy in care delivery. Specific recommendations for trauma care services for older people were made, including: a key healthcare professional (liaison); staff with expertise in working with older populations; suitable environments; and flexible, individualised access to rehabilitation and supports, particularly when transitioning to home.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eThe Importance and Challenge of Empathy in Healthcare Delivery\u003c/h2\u003e \u003cp\u003eOlder patients and their families have previously reported the importance of being viewed and valued as a person, with a need for respect, individualised care, effective communication, and collaboration with relatives [\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The current study reinforces the recent findings of Kellezi et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], highlighting that concerns of patients and their families often do not relate to a lack of effective clinical care, but the way in which care is delivered and represent an important care quality dimension.\u003c/p\u003e \u003cp\u003eOlder people\u0026rsquo;s experiences of feeling burdensome and perceiving a lack of respect and empathy from healthcare staff is a sentiment that is reflected throughout the literature and must be addressed [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In the present study, participants described a perception of high staff workload and time pressures impacting on interpersonal communication and the patient experience, a theme also reported in the broader literature [\u003cspan additionalcitationids=\"CR37 CR38\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In a review of the role of empathy in health and social care, factors that limited empathy in care included high patient load, time pressure, and lack of education in empathy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These findings affirm participant perceptions in the present study and highlight both the complex challenge of and potential strategies to improve empathy in healthcare.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eAttention to Mental Health and Well-being\u003c/h2\u003e \u003cp\u003eParticipants described trauma as a life-changing experience. They expressed a need for holistic care that focused not only on physical recovery, but also mental health and addressing loss of confidence following trauma. The need for psychosocial support for patients following trauma has been established [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and reinforced in a recent study of trauma patient experiences [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Anxiety and low self-efficacy have been linked with a maladaptive fear of falling [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], which is in itself, associated with negative outcomes for older adults [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This underscores the need to provide holistic care, addressing all factors impacting older patients following trauma, including mental health and well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eHealthcare Staff Competency, Expert Practitioners, and the Trauma Coordinator Role\u003c/h2\u003e \u003cp\u003eEvidence-based geriatric care models which meet the unique and complex needs of older patients require teams of healthcare staff with knowledge of age-related changes and their impacts alongside skilled, responsive communication approaches [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Healthcare teams with competency in the care of older adults, closely supported by experts such as advanced geriatric care nurses and practitioners, are recognised as delivering improved outcomes for older patients [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and would be well equipped to deliver and promote care that aligns with needs highlighted and recommendations made by participants in this study.\u003c/p\u003e \u003cp\u003eNurse care coordinator roles are often implemented in the care of higher risk and older populations, including providing input during transitions in care, coordinating between services, and facilitating multi-disciplinary team input, positively impacting patient and health service outcomes [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Specialist trauma nurse practitioner roles, including liaison with the patient, families and between teams and coordination of care, have similarly been shown to improve patient outcomes, in addition to supporting staff satisfaction [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Collectively, the literature provides evidence for the utility and benefits of a trauma coordinator or \u0026ldquo;liaison\u0026rdquo; for older patients and their families, as recommended by our participants.\u003c/p\u003e \u003cp\u003eBuilding staff competency in the care of older populations through targeted training, the presence of advanced trauma care practitioners, and specialised, nurse led coordination and/or liaison appear to be important ingredients in the delivery of healthcare that meets the needs of older populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eEarly, Flexible, and Individualised Rehabilitation\u003c/h2\u003e \u003cp\u003eIn contrast with emergency and acute care phases, participants consistently described the rehabilitation period as positive, with patients feeling better and working towards recovery goals. Participants recommended broadening rehabilitation availability to allow earlier and more flexible rehabilitation opportunities. The literature clearly supports early rehabilitation following musculoskeletal trauma for improved outcomes [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], particularly for older patients [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Early rehabilitation is recognised as important to mitigate the risk of avoidable functional decline and mortality in older patients [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In a review by Kosse et al. [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], older patients who participated in an early multi-disciplinary rehabilitation program demonstrated improved functional levels, reduced length of hospital stay, and reduced likelihood of discharge to residential aged care. The criteria for commencement of rehabilitation for patients following trauma are not clearly defined, however readiness indicators are well discussed in the literature [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In a 2017 meta-analysis of published rehabilitation research, improved outcomes were demonstrated through both comprehensive multidisciplinary input and individualised (including inpatient, in-home, and community-based) rehabilitation for older patients [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Tele-rehabilitation was not discussed by participants in the current study but is recognised as a complement to rehabilitation services for older people, that is convenient and promotes motivation, self-awareness [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] and supports quality of life [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Improved rehabilitation opportunities, as recommended by the participants in the present study, may be provided by models of care that facilitate early rehabilitation access, comprehensive and individualised rehabilitation, and tele-rehabilitation, all of which is well supported in the existing literature.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSupported Discharge / Transition to Home\u003c/h2\u003e \u003cp\u003eParticipants recommended improved support for the transition from hospital and rehabilitation services to home, with follow up contact and support to connect with community activity groups and services. These recommendations clearly align with established trauma care guidelines and the broader literature which describe improved outcomes for older patients and health services when specialised coordination and liaison roles are adopted [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecommendation Summary\u003c/h3\u003e\n\u003cp\u003eBest practice guidelines for the care of older patients following trauma describe care components which align closely with the recommendations made by participants in this study [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Specifically, guidelines recommend healthcare teams with expertise in the care of older people; clear and timely communication between the healthcare team, the patient, and family; appropriate rehabilitation access, informed by holistic multi-disciplinary assessment; discharge planning including thorough assessment of home service and social support needs; and follow-up post-discharge to assess clinical status and well-being.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe results of this study must be interpreted with an awareness of the relatively small number of participants (n\u0026thinsp;=\u0026thinsp;13) over two convened workshops. Within the sample, there is limited diversity in demographics and as such, the perspectives and experiences captured may not reflect that of the broader population of older people following trauma.\u003c/p\u003e \u003cp\u003eA strength of our study is the inclusion of participants with differing levels of health literacy, improving the representativeness of the sample. Health research is often biased towards reflecting the views of individuals with greater health literacy or may not use tools adequate to measure this [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. This study included participants who reported low confidence in their ability to understand health information however, this measure is not part of a comprehensive conceptual framework.\u003c/p\u003e \u003cp\u003eWe captured the perspectives of both patients and their family members, who were recruited by current service clinicians (day rehabilitation and fragility fracture clinics), which is a strength that allowed us timely capture of recent experiences and perspectives that might later have been forgotten if data were collected at a greater retrospective interval.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eTrauma care teams require staff with a range of expertise in both \u003cem\u003etrauma and geriatric\u003c/em\u003e care to meet the specific needs of older trauma patients. A holistic and individualised approach to care across the continuum, facilitated by a coordinator who supports communication and transitions, is important to older trauma patients and their families. Access to flexible rehabilitation and increased support at the time of discharge to home, in addition to the above, requires the attention of health and social care funding bodies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInsights gained in the present study build on prior research findings, highlighting the need for a health practitioner workforce equipped with competency in working with older populations and specialised geriatric trauma liaison and coordination roles. Recommendations made by participants in this study align with best practice and current guidelines, advocating for a healthcare system that prioritises effective communication, empathy in care, and individualised support, fostering holistic healthcare delivery that positively influences the recovery journey of older adults who have experienced trauma. Extended, flexible rehabilitation access and support at discharge to home were highlighted by participants as healthcare priorities for attention. Consultation with healthcare stakeholders is essential to understand how these recommendations can be sustainably and consistently implemented to support best possible outcomes for older patients following trauma.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBCD The Experience\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBased Co-Design\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by\u0026nbsp;by The Southern Adelaide Clinical Human Research Ethics Committee, reference 101.23 \u0026ndash; LNR/23/SAC/101. The participants were informed verbally and in writing about the study\u0026rsquo;s purpose and were assured that they could withdraw their consent at any time without consequences. All participants gave written consent before the workshop commenced.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during this study will be available from the corresponding author on reasonable request. This study was not pre-registered.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported by funding from the Lifetime Support Authority.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors contributions\u003c/p\u003e\n\u003cp\u003eJ.W: designed the study, collected data, conducted data analysis, wrote and edited the main manuscript. K.L: designed the study, conducted data analysis, edited the main manuscript and supervised. M.Ch: collected data, conducted data analysis, edited the main manuscript. M.Cr: designed the study and edited the main manuscript. C.E: M.B: J.M: D.L: C.H edited the main manuscript. All authors reviewed the manuscript and read the final version.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to thank the participants who contributed their time and expertise to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited Nations. World Population Ageing 2017. ST/ESA/SER.A/408; 2017. Contract No. Department of Economic and Social Affairs, Population Division,.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO, Ageing. and health 2022 [ \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/ageing-and-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/ageing-and-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics. 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A systematic review of the effectiveness of telerehabilitation interventions for therapeutic purposes in the elderly. Methods Inf Med. 2020;59(2\u0026ndash;03):104\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePleasant A, McKinney J, Rikard R. Health literacy measurement: a proposed research agenda. J Health Commun. 2011;16:11\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"healthcare experience, falls, rehabilitation, critical pathways, recovery pathway, care model, older adults, trauma","lastPublishedDoi":"10.21203/rs.3.rs-4942016/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4942016/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Trauma in older people is emerging as a major health issue, with falls being the most common cause. Despite existing guidelines for trauma care of older populations, adoption is limited and undertreatment persists. This study aimed to explore the needs and preferences of older people and their families following traumatic injuries and define key components of a trauma care model for older populations.\u003c/p\u003e\n\u003cp\u003eMethods: This research adopted participatory design principles, engaging older people and their families, who had interacted with local healthcare services, to participate in a workshop which included structured activities and questions designed to facilitate discussion of the participants’ experiences of trauma and subsequent healthcare. Qualitative data were collected, coded, and analyzed using thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSeven patients and six family members attended one of two workshops. Most patient participants were women, with a mean age of 82 years. Participants reported negative feelings following trauma, including uncertainty, shock and fear, decreased confidence, and feeling burdensome. Recovery goals were focused on regaining independence, participating in movement and exercise, and maximizing social connection. Communication, empathy and interpersonal skills in care, and system-related factors were identified as key factors impacting care and recovery experience following trauma. To improve trauma care, participants recommended care coordination, improved access to home support and rehabilitation, investment in staff expertise and training, and a dedicated trauma service for older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study underscores the importance of a comprehensive and person-centered approach to trauma care for older people, offering valuable insights for healthcare providers and policymakers striving to enhance the quality of care and improve outcomes for this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Exploring the needs and preferences of older trauma patients: A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-23 06:22:52","doi":"10.21203/rs.3.rs-4942016/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-18T11:54:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-30T20:35:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200721490856204368781146722108124954387","date":"2024-09-29T13:00:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-27T17:55:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98481819279390074963393677920572801804","date":"2024-09-23T14:01:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180323388992085079802537686119869207900","date":"2024-09-22T14:17:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290201905335711861188602055334736653758","date":"2024-09-20T19:52:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64886502548673918135104914014959144800","date":"2024-09-20T13:15:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24111742820162594216676090926677924107","date":"2024-09-20T04:58:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-13T14:40:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134941257518829788685675692053293946328","date":"2024-09-13T12:20:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-13T09:29:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-22T18:31:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-22T06:07:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-22T06:06:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-08-20T04:38:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e79dd92-097b-455b-93e7-0e54f0113c3c","owner":[],"postedDate":"September 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T15:59:33+00:00","versionOfRecord":{"articleIdentity":"rs-4942016","link":"https://doi.org/10.1186/s12877-025-06801-z","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-11-26 15:57:01","publishedOnDateReadable":"November 26th, 2025"},"versionCreatedAt":"2024-09-23 06:22:52","video":"","vorDoi":"10.1186/s12877-025-06801-z","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06801-z","workflowStages":[]},"version":"v1","identity":"rs-4942016","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4942016","identity":"rs-4942016","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}