A.S. Karpe1, S. Martinez Ugarte1, M.O. Fajemisin1, D.E. Meyer1, G.E. Hatton1, G. Khraish1, L.S. Kao1, T.J. Puzio1 1McGovern Medical School at UTHealth Houston, Trauma And Acute Care Surgery, Houston, TX, USA
Introduction:
Code status discussions (CSDs) held with injured older adults are recommended by the American College of Surgeons at time of admission to provide high-quality patient care and uphold patient autonomy. Preconceived unrealistic expectations of CPR have been identified in other populations as a barrier to effective CSDs, but data among injured older adults are limited. We hypothesized that injured older adults and their families have a poor understanding of CPR and code status at hospital discharge.
Methods:
Injured older adults (≥65) or surrogate decision makers for those incapacitated at a level I trauma center were surveyed at time of discharge to obtain a baseline assessment of current code status and CPR discussions by the medical team. The primary outcome was the percentage of patients who received discussions to determine life sustaining care during hospitalization. Secondary outcomes included presence of a prehospital advanced directive, knowledge of CPR and code status, and desire for more information regarding code status. Responses from patients and family members of incapacitated patients were compared with univariate analysis.
Results:
A total of 76 patients and 16 separate surrogate decision makers for incapacitated patients were surveyed. Of patients surveyed, median age was 83, with 55% (N =42) female, 68% (N=52) white and 59% (N=45) having a high school level of education. Of surrogates surveyed, median age was 61, with 81% (N=13) female, 56% (N=9) white and 63% (N=10) having a bachelor’s degree as highest level of education. Approximately half, (51%, N=47) of all patients had a living will and 52% (N = 48) had talked to loved ones about their desire for CPR prior to hospitalization. A similar number of patients (74%, N = 56) and surrogates (75%, N =12) over-estimated the successfulness of CPR (P = 0.91). A majority of patients (84%, N = 63) and surrogates (75%, N = 12) reported not discussing CPR with a provider (P = 0.31) while more patients (78%, N = 59) than surrogates (25%, N=4) were unsure of code status (P<0.01).
Conclusion:
In this population of older adults admitted after injury and surrogates for those incapacitated, there was a demonstrated poor understanding of code status and CPR. Our study highlights the need for effective educational interventions to improve CSDs in this population.