The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.

Abstract

The number of older adults (>60 years) in Sub-Saharan Africa (SSA) is expected to double by 2050. This demographic shift has led to a rise in traumatic injuries among this population, with one in ten trauma patients in Tanzania being an older adult. Yet, geriatric specialization remains largely absent in many low- and middle-income countries (LMICs), including Tanzania. To inform strategies for optimizing care in this vulnerable group, we conducted a cross-sectional secondary analysis using data from the adult trauma registry at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital serving over 15 million people in northern Tanzania. The study included all injured adults (>18 years) from 2020 to 2024. We compared socio-demographic, clinical characteristics, injury patterns, and in-hospital outcomes between older (≥60 years) and younger adults. The main outcomes were length of hospital stay and in-hospital mortality. A total of 3,296 adult trauma patients were included, of whom 13.3% were older adults. Older adults took 4 hours longer to reach care (p < 0.001) and were more likely to be injured by falls (56% vs. 17%), while younger adults were more commonly involved in road traffic crashes (67% vs. 33%) (p < 0.001). Although most older adults sustained mild injuries (86%), they were more often hospitalized (91%) and required surgery (66%) compared to younger adults (85%, 58%) (p = 0.002). Comorbidities were more prevalent in older adults, notably diabetes (12%) and hypertension (26%) (p < 0.001). Older adults also experienced 4 days longer hospital stays and higher in-hospital mortality (9% vs. 4%) than younger adults (p < 0.001).Our study demonstrates significant differences between the injured older adult patients and the younger adult patients, highlighting the differences in care required for older adult trauma patients and providing evidence to support the next steps of adoption and implementation of older adult-specific clinical practice guidelines to improve outcomes.