Mental Health

Long-term physical, mental, and financial decline after major injury in older adults: A national cohort study with matched controls.

TL;DR

Injury has enduring consequences on the physical, mental, financial, and social health of older patients, and older adults with pre-existing unmet social health needs are particularly vulnerable to poor postinjury long-term outcomes.

Key Findings

Injured older adults required significantly greater assistance with activities of daily living compared to matched non-injured controls.

  • Mean difference in ADL assistance needed: 1.1 (P < .001)
  • Analysis used a difference-in-differences approach with pre- and post-injury data
  • Cohort included 1,754 injured patients and 3,244 non-injured matched controls
  • Patients were aged 65 and older, admitted for injury from 1998 to 2018
  • Data drawn from the nationally representative Health and Retirement Study linked with inpatient Medicare claims

Injured older adults had higher odds of poor or fair self-rated health compared to matched controls.

  • Odds ratio for poor/fair self-rated health: 1.7 (95% CI, 1.1–2.6)
  • Assessed using difference-in-differences analysis of longitudinal survey data
  • Comparison was between 1,754 injured patients and 3,244 non-injured controls

Injury was associated with higher odds of depression among older adults compared to matched controls.

  • Odds ratio for depression: 1.5 (95% CI, 1.2–1.8)
  • Depression was one of multiple mental health outcomes assessed post-injury
  • Findings were derived from difference-in-differences analysis using Health and Retirement Study data

Injured older adults had higher odds of cognitive impairment compared to matched non-injured controls.

  • Odds ratio for cognitive impairment: 1.2 (95% CI, 1.0–1.5)
  • Cognitive impairment was assessed as part of long-term outcome evaluation
  • Analysis used pre- and post-injury longitudinal data from the Health and Retirement Study

Injury was associated with greater odds of having unmet social health needs following the injury event.

  • Odds ratio for unmet social health needs post-injury: 1.7 (95% CI, 1.5–2.0)
  • Social health needs were evaluated as part of a broader assessment of physical, mental, financial, and social outcomes
  • Findings highlight that injury itself contributes to new or worsened social health need

Among injured patients, those with pre-existing unmet social health needs had greater increases in outpatient healthcare utilization compared to injured patients without such needs.

  • Increase in outpatient visits among injured patients with preinjury unmet social health needs: 3.8 visits (95% CI, 1.3–6.7)
  • This comparison was made within the injured cohort, stratified by preinjury social health need status
  • Suggests preinjury social vulnerability leads to greater downstream healthcare engagement or need

Injured older adults with preinjury unmet social health needs had higher odds of poor or fair self-rated health compared to injured patients without such needs.

  • Odds ratio for poor/fair self-rated health: 1.3 (95% CI, 1.1–1.5)
  • Comparison was within the injured cohort only, based on preinjury social health need status
  • Indicates that preinjury social vulnerability compounds postinjury health decline

Injured older adults with preinjury unmet social health needs had higher odds of cognitive impairment compared to injured patients without such needs.

  • Odds ratio for cognitive impairment: 1.4 (95% CI, 1.2–1.8)
  • Analysis was conducted within the injured subgroup, comparing those with and without preinjury unmet social health needs
  • Cognitive impairment was among the long-term outcomes tracked using longitudinal Health and Retirement Study data

Injured older adults with preinjury unmet social health needs experienced increased financial hardship compared to injured patients without such needs.

  • Financial hardship was identified as a distinct outcome domain alongside physical and mental health outcomes
  • Comparison was made within the injured cohort stratified by preinjury social health need status
  • Specific odds ratios or effect sizes for financial hardship were not reported in the abstract

The study cohort was drawn from a nationally representative dataset linking the Health and Retirement Study with inpatient Medicare claims, covering injuries from 1998 to 2018.

  • 1,754 injured patients and 3,244 non-injured matched controls were identified
  • All patients were aged 65 and older and admitted for injury
  • A retrospective difference-in-differences design was used to assess pre- and post-injury changes
  • The Health and Retirement Study provides longitudinal data on older Americans, enabling long-term outcome tracking

What This Means

This research suggests that when older adults (age 65+) are hospitalized for a serious injury, the effects go far beyond the immediate physical harm. Using a large, nationally representative dataset spanning two decades, researchers compared nearly 1,800 injured older adults to more than 3,200 similar people who were not injured. They found that after a major injury, older adults needed significantly more help with everyday tasks like bathing and dressing, were more likely to report poor health, more likely to experience depression and cognitive decline, and more likely to face unmet social needs such as difficulty accessing food, housing, or social support. The study also found that older adults who already had unmet social needs before their injury fared especially poorly afterward. Compared to injured patients without those pre-existing social challenges, they had even higher rates of cognitive impairment, worse self-rated health, more outpatient medical visits, and greater financial hardship following their injury. This suggests that social vulnerabilities — like being isolated, food insecure, or financially strained — make it harder for older adults to recover from serious injuries. This research matters because it highlights that treating an injury in older adults is not just a physical or medical challenge. The long-term consequences affect mental health, daily functioning, finances, and social wellbeing — and these problems are worse for people who were already struggling before they got hurt. The findings suggest that identifying and addressing social health needs, both before and after injury, could be an important part of improving outcomes for older injured patients.

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Citation

Oh E, Sheikh-Khalil N, Sinco B, Hernandez A, Mullens C, Scott J. (2026). Long-term physical, mental, and financial decline after major injury in older adults: A national cohort study with matched controls.. Surgery. https://doi.org/10.1016/j.surg.2026.110169