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Functioning and health-related quality of life following injury in older people: a systematic review
  1. Katherine Brown1,
  2. Ian D Cameron2,
  3. Lisa Keay1,
  4. Kristy Coxon1,3,
  5. Rebecca Ivers1
  1. 1The George Institute for Global Health, Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
  2. 2John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, the University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  3. 3School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia
  1. Correspondence to Katherine Brown, The George Institute for Global Health, Sydney Medical School, the University of Sydney, PO Box M201, Missenden Rd, Sydney, NSW 2050, Australia; kbrown{at}


Aim and background There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people.

Method A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool.

Results There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes.

Discussion The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people.

Conclusions Further research is required on older people's postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems.

  • Injury Diagnosis

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  • Contributors KB carried out the systematic review. RI and KB were responsible for planning the review. KB and KC independently reviewed potentially eligible publications and resolved any discrepancies found. KC assisted with both risk of bias assessment and data extraction for the summary of findings table. RI, LK and IC provided y input and feedback on the review document. All authors reviewed and approved the final manuscript.

  • Funding KB is a current PhD student at The George Institute for Global Health, Sydney Medical School, the University of Sydney, and is the recipient of an Australian Postgraduate Award scholarship with additional support from the New South Wales State Insurance Regulatory Authority.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.