Catastrophic injury and illness in the elderly

Abstract

This study examined characteristics of elderly veterans who had suffered disability subsequent to catastrophic injury or illness, identified variables common to those who maintained rehabilitative gains, and developed a theoretical model that may be useful for description and explanation of the experience. The results of six preliminary studies laid the foundation for the theoretical model contained in the study. The Geriatric Rehabilitation Intervention Program (GRIP) was developed from themes gathered from a grounded theory study of elders who had recently suffered catastrophic disability. Targeted toward assisting elders with the transition to the community after discharge from geriatric rehabilitation, GRIP includes components of Adjusting to Disability, Coping with Loss, Life after Rehabilitation, and Maintaining Motivation. Those patients that participated in GRIP had significantly greater improvement in functional status, health-related quality of life (HRQOL), and self-efficacy. Qualitative and quantitative data were triangulated to form latent variables to reflect the nature of the experience from the perspective of the patient. The latent variable model demonstrated appropriate fit with this data set; however a confirmatory study is needed. Predictors of rehabilitative gain are desired by stakeholders in an effort to maximize rehabilitative programs and control health care costs. The confidence with which patients were able to manage the symptoms secondary to their catastrophic injury or illness was identified as a predictor of functional gain. This area provides a target for which to aim nursing interventions. In addition, the ability to plan for survival and information gained from the GRIP program were identified as predictors of increased general health one month after discharge to the community. This study explored client, intervention, and context characteristics of catastrophic disability in the elderly. Personal and social factors not yet identified in the literature were examined for their influence on rehabilitative outcomes and a theoretical model was developed. Further research is needed to refine and test the model.