Special Considerations in the Anesthetic Management of the Polytraumatized Elderly Patient

Abstract

As the elderly population expands rapidly, an increased incidence of geriatric trauma patients, including severely injured elderly patients, is anticipated. Poorer functional outcomes and increased mortality and morbidity rates in these patients compared to their younger counterparts may be inevitable due to the associated pre-existing medical conditions and the reduced physiological reserves and compensatory mechanisms secondary to aging. However, there is evidence that outcomes can be improved when prompt and aggressive treatment is provided in designated trauma centres, with early admission to the ICU and protocols developed especially for this unique patient population. It is, therefore, important to elucidate further the physiologic changes seen during the aging process and the response to injury, and to include these additional parameters during the assessment and the management of the elderly trauma patients, as well as during the evaluation of outcomes. Although the field of geriatric trauma is still in its infancy, research on this topic is ongoing to develop advanced management strategies and improve outcome. Meanwhile, efforts on injury prevention strategies in this trauma population should continue, and trauma and critical care clinicians should not treat these patients as ‘older adults’, but as a special population with special considerations.