Post-discharge Home Care Services Use, Long-Term Care Placement, and Survival in Older Adults with Major Trauma: a Population-Based Cohort Study from Ontario, Canada.

Background: There are few studies describing health services use and longer-term survival in older adults with major injuries. Our objectives were to characterize the outcomes of older adults experiencing a major injury, and to assess for associations between injury and rates of home-care services use (HCS), long-term care (LTC) placement, and survival. Methods: We conducted a retrospective case-control study including adults 65 years or older admitted for a major injury (trauma survivors) or were uninjured (controls) between 2009 and 2023 in Ontario, Canada. Trauma survivors were matched 1:1 to controls based on age, sex, and number of comorbidities. Primary outcomes were rates of HCS use and LTC admissions for up to five years following discharge. Secondary outcomes were types of HCS use and survival. Multivariate regression was used to compare rates of HCS and LTC use. Cox proportional hazards models were used to assess time to LTC admission or death. Results: The study cohort consisted of 31,508 individuals. Older adult trauma survivors experienced a twofold increased rate of home-care service use (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 2.1-2.4), a 30% increased rate of LTC admissions (OR: 1.3, 95% CI: 1.0-1.6), and a 40% increased rate of death (hazard ratio: 1.4, 95% CI: 1.4-1.5). Conclusions: Compared to controls, older adults surviving trauma use HCS at significantly higher rates, require LTC placement more frequently, and experience a decreased rate of survival.