Trauma in Geriatrics

Abstract

As the populations age the geriatric population grows. Trauma in the elderly is responsible for a significant number of visits to ED and will continue to increase. Knowledge of the physiologic changes associated with aging, the impact of coexistent acute and chronic medical conditions and an understanding of the unique patterns of injury in geriatric trauma patients is critical to maximizing outcome. Older patients tend to injure themselves most often after falls. Even falls from standing can result in significant fractures and head injury. Geriatric trauma victims demand aggressive management, a high index of suspicion for occult instability and a low threshold for laboratory and radiographic investigation to delineate injuries. Advanced age alone should not be used as the sole criterion for denying or limiting care in these patients. With the exception of patients who are refusing treatment on arrival, if the initial aggressive approach was pursued, the majority will return home and up to 85% will return to independent function. The elderly often require greater health care resources than younger patients who have similar injuries. Assessing the cost/benefit ratios of aggressive testing and interventions can be much more difficult in this group. Subsequent quality of life is also a key factor in decision making. Ultimately, trauma in the elderly should be addressed not just in the ED and hospital, but also from a public health perspective with emphasis on services and prevention. Research that addresses the different and public health research on prevention will help further enlighten emergency physicians on how to best treat geriatric trauma patients to help them maintain high functional status.