This week’s blog is written by Hanna Järbrink, a specialist nurse surgical care, PhD student, and research nurse at the Department of surgery and trauma care, Sahlgrenska University Hospital, Sweden.

The Growing Burden of Trauma in an Aging Population

As the global population ages, the number of older adults requiring trauma care is rising rapidly (1). Falls, road accidents, and other injuries disproportionately affect older individuals, leading to complex medical and care needs. Despite this, older trauma patients often receive suboptimal care, as healthcare systems seldom adapt to their unique requirements (2). Also by being under prioritized places them at higher risk of complications, prolonged hospital stays, and diminished quality of life (3).

Nurses on the Brink: A Workforce in Crisis

Nurses play a critical role in trauma care, yet they are facing an unprecedented crisis. The profession is grappling with severe understaffing, excessive workloads, and burnout, leading many to leave their positions. As a nurse with 13 years of experience, I have witnessed this firsthand, and the situation has worsened significantly in recent years.

The consequences of this migration, I would say, are particularly harmful to older trauma patients, who require consistent, specialised care. When experienced nurses leave, knowledge gaps are created and patient outcomes suffer.

Research has demonstrated a correlation between higher patient-to-nurse ratios and increased rates of patient harm, including higher incidences of medical errors, hospital-acquired infections, and preventable complications (4). Studies have also shown that as the number of patients per nurse increases, so does the likelihood of hospital readmissions and mortality rates (5). Furthermore, this strain of excessive workloads and the resulting moral distress contribute to nurse burnout, which is a significant factor in the high attrition rates within the profession. These findings highlight the urgent need for policies that ensure safer staffing levels to protect both nurses and patients.

The Risk of Missed Nursing Care and Patient Harm

One of the most alarming consequences of the nursing shortage is “missed nursing care”—essential care tasks that go unperformed due to lack of time or resources. For older trauma patients, this can mean delayed pain management, inadequate mobility assistance, or insufficient monitoring for complications. The cumulative effect of these gaps can lead to serious patient harm, increased mortality rates, and unnecessary suffering (6).

A fundamental aspect of nursing care is the “Fundamentals of Care” framework, which ensures that essential physical, psychological, and relational needs are met. When these fundamental aspects, such as hydration, nutrition, hygiene, and emotional support, are neglected, patient recovery is significantly compromised. Addressing these deficits requires a structured approach that prioritizes patient-centered care and adequate staffing to meet these essential needs consistently (7).

The Critical Role of Nurses in Enhancing Recovery

Despite these challenges, nurses continue to strive to improve care for older trauma patients. Evidence-based nursing interventions, such as early mobilization programs, tailored pain management strategies, and comprehensive discharge planning, have been shown to enhance recovery and reduce complications (8, 9). Investing in nurse education, adequate staffing, and better working conditions can ensure that these vital interventions are consistently delivered, while also elevating the priority of nursing care in patient management.

A Call for Action

The increasing number of older trauma patients presents a challenge that cannot be ignored. Addressing the nursing workforce crisis is imperative to safeguard the quality of trauma care for this vulnerable group. Policymakers, healthcare leaders, and institutions must prioritize nurse retention, improve working conditions, and recognize the indispensable role of nurses in trauma recovery. Without urgent action, the risk of inadequate care and patient harm will continue to escalate, along with nursing turnover, with dire consequences for both patients and healthcare systems alike.

References

1. Abrams EM, Akombi B, Alam S, Alcalde-Rabanal JE, Allebeck P, Amini-Rarani M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet (British edition). 2020;396(10258):1204-22.
2. Schuster S, Singler K, Lim S, Machner M, Döbler K, Dormann H. Quality indicators for a geriatric emergency care (GeriQ-ED)-an evidence-based delphi consensus approach to improve the care of geriatric patients in the emergency department. Scandinavian journal of trauma, resuscitation and emergency medicine. 2020;28(1):68-.
3. Wad MS, Laursen T, Fruergaard S, Morgen SS, Dahl B. Survival and health related quality of life after severe trauma − a 15 years follow up study. Injury. 2018;49(2):191-4.
4. Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, et al. Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. International journal of nursing studies. 2018;78:10-5.
5. Aiken LH, Sloane D, Griffiths P, Rafferty AM, Bruyneel L, McHugh M, et al. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ quality & safety. 2017;26(7):559-68.
6. Al-ghraiybah T, Lago L, Fernandez R, Sim J. Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study. International journal of nursing studies. 2024;156:104777-.
7. International Council of Nurses. The fundamentals of care framework 2023 [Available from: https://ilccare.org/the-framework/.]
8. Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377-88.
9. Langhorne P, Holmqvist LW. Early supported discharge after stroke. J Rehabil Med. 2007;39(2):103-8.