Early primary care follow-up is associated with improved long-term functional outcomes among injured older adults.

Abstract

Background: Older adults who survive injury frequently experience functional decline, and interventions preventing this decline are needed. We therefore evaluated the association between early primary care physician (PCP) follow-up and nursing home admission or death among injured older adults.

Methods: We performed a retrospective, population-based cohort study of community-dwelling older adults (65 years or older) discharged alive after injury-related hospitalization (2009-2020). The exposure of interest was early PCP visit (within 14 days of discharge). The primary outcome was time to death or nursing home admission in the year after discharge. Cox proportional hazards models were used to evaluate the relationship between early PCP visit and this outcome, adjusting for baseline characteristics.

Results: Among 93,482 patients (63.7% female; mean age, 79.8 years), 24,167 (25.9%) had early follow-up with their own PCP and 6,083 (6.5%) with a different PCP. In the year after discharge, 16,676 patients (17.8%) died or were admitted to a nursing home. After risk adjustment, early follow-up with one's own PCP was associated with a 15% reduction in the hazard of death or nursing home admission relative to no follow-up (hazard ratio, 0.85; 95% confidence interval, 0.83-0.87). Follow-up with a different PCP was not associated with the outcome (hazard ratio, 0.99; 95% confidence interval, 0.95-1.03). These relationships were consistent across all age, sex, frailty, and injury severity strata.

Conclusion: Among injured older adults, early follow-up with their own PCP was associated with increased time alive and at home. These findings suggest strategies to integrate PCPs into postinjury care of older adults should be explored.

Level of evidence: Therapeutic/Care Management; Level III.