Persistent gaps in health-related quality of life measures for older adult trauma patients: A systematic review

BACKGROUND: Older adults experience persistent functional and psychosocial consequences after trauma, but it remains unclear whether commonly used health-related quality of life (HRQoL) instruments adequately measure recovery in this population. This systematic review appraised psychometric evidence and risk of bias for HRQoL instruments used in United States trauma cohorts that included adults aged 65 years or older. METHODS: MEDLINE, EMBASE, and CINAHL were searched from inception through January 28, 2026. Two reviewers independently screened studies and extracted data. Risk of bias was evaluated using an adapted Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment. Studies evaluating an HRQoL instrument as the target measure underwent Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias assessment for each reported measurement property. Results were rated as sufficient, insufficient, or indeterminate and synthesized by instrument. RESULTS: Of 17,195 records, 19 studies were included. Studies most often examined isolated orthopedic trauma (n=7, 36.8%), spinal cord injury (n=6, 31.6%), other injury populations (n=3, 15.8%), polytrauma or systemic injury (n=2, 10.5%), and burns (n=1, 5.3%). Frequently evaluated domains included physical functioning (n=16), emotional or mental health (n=13), overall life satisfaction (n=13), social functioning (n=11), and physical symptoms (n=10). Although all studies used at least one previously developed patient-reported measure, none explicitly adapted or comprehensively validated an eligible HRQoL instrument for older adult trauma patients. Ten studies evaluated a target HRQoL instrument, contributing 33 COSMIN measurement property assessments: 19 sufficient, 10 indeterminate, and 4 insufficient. Overall risk of bias was low in six studies, moderate in eight, serious in three, and unclear in two. CONCLUSIONS: Existing studies show that HRQoL instruments have been used in trauma cohorts including older adults, but they do not establish validity for older adult trauma patients specifically. Future studies should evaluate promising instruments in cohorts designed around older adults’ recovery priorities and clinical characteristics after trauma. LEVEL OF EVIDENCE: Systematic Review; Level III.