Functional Decline and Loss of Independence After Traumatic Injury in Older Adults With Dementia

Background Older adult patients with dementia experience higher rates of traumatic injury, yet little is known about long‐term recovery trajectories in this population. This multi‐center retrospective cohort study examined differences in long‐term patient‐reported outcomes after traumatic injury in older adults with and without dementia. Study Design Secondary analysis of trauma patients ≥ 65 years with moderate or severe trauma (Injury Severity Score > 9) admitted to three Level I trauma centers and interviewed 6–12 months post‐injury. Primary outcomes were loss of community living and activities of daily living (ADL) impairment. Multivariable logistic and linear regression adjusted for age, sex, educational level, and injury mechanism. Results Among 3210 older adult trauma patients, 291 (9.1%) had dementia before injury. Dementia patients presented with similar injury severity compared to those without dementia (mean ISS 12.1 (5.7) vs. 12.8 (6.2), p = 0.076); however, they had a greater number of new ADL limitations post‐injury (1.86 (2.07) vs. 1.0 (1.55), p < 0.001). Among patients living at home pre‐injury, 16.5% with dementia were discharged to institutionalized settings, compared to 4.9% without dementia ( p = 0.185). Older women with dementia had significantly higher odds of losing community living status compared to older women without dementia (OR = 2.12 [1.17, 3.84], p = 0.013). Conclusion Older adults with dementia who sustain traumatic injuries face a substantial risk of functional deterioration and loss of independence in the critical 6–12 months post‐injury. These findings highlight the need for interventions aimed at preserving autonomy and minimizing premature transitions to long‐term care.