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GERIATRIC TRAUMA

INTRODUCTION

The ever-increasing
Aging of the population This generation will live mobility and active
is expected to be one of longer than the lifestyles of today’s Injury is now the fifth
the most significant preceding one and will elderly individuals leading cause of death
social transformations have access to high- places them at in the elderly population
of the 21st century. quality health care. increased risk for
serious injury.
FACTORS THAT IMPACTS MORTALITY FROM
GERIATRIC TRAUMA

Senescence of organ systems, both anatomically and physiologically

Preexisting disease states, and frailty all play a part in placing older adults at higher risk from trauma.

Depression

Substance abuse

Maltreatment

Failure to triage
EFFECTS OF AGING

Therefore, aging
is characterized Insults
Declining
by impaired commonly
cellular This condition is
adaptive and tolerated by
function, commonly
homeostatic younger
eventually described as
mechanisms patients can
leading to organ decreased
that cause an lead to
failure, is part of physiologic
increased devastating
the aging reserve.
susceptibility to results in
process.
the stress of elderly patients.
injury.
PREEXISTING CONDITIONS

• Cirrhosis
• Coagulopathy
• chronic obstructive pulmonary disease (COPD)
FIVE PECS THAT •
APPEARED TO INFLUENCE
ischemic heart disease
OUTCOMES IN TRAUMA • diabetes mellitus
PATIENTS:
MECHANISM OF INJURY

MOTOR
PENETRATING
FALLS VEHICLE BURNS
INJURIES
CRASHES
PRIMARY SURVEY WITH RESUSCITATION

As with all trauma patients, the


application of ATLS principles in Clinicians must take into consideration
assessment and management of older the effects of aging on organ systems
adults follows the ABCDE and their implications for care
methodology.
AIRWAY
BREATHING
CIRCULATION
DISABILITY
EXPOSURE AND ENVIRONMENT
SPECIFIC INJURIES

Rib
Fractures

Traumatic
Brain Injury

Pelvic
Fractures
RIB FRACTURES

Elderly patients are at increased risk for rib fractures due to anatomical changes of the chest wall and loss of bone density.

The most common cause of rib fractures is a ground-level fall, followed by motor vehicle crashes.

The primary complication in elderly patients with rib fractures is pneumonia.

Mortality risk increases with each additional rib fractured.

The main objectives of treatment are pain control and pulmonary hygiene. Pain management can include oral medication,
intravenous medications, transdermal medications, or regional anesthetics.

Narcotic administration in elderly patients must be undertaken cautiously and only in the proper environment for close patient
monitoring. Avoiding untoward effects, particularly respiratory depression and delirium, is of paramount importance
TRAUMATIC BRAIN INJURY

The geriatric population is at highest risk for TBI-associated morbidity and mortality.

This increased mortality is not necessarily related to the magnitude of the injury, but rather to the elderly patient’s inability to recover.

Delirium, dementia, and depression can be difficult to distinguish from the signs of brain injury.

Management of elderly patients with TBI who are undergoing anticoagulant and/or antiplatelet therapy is particularly challenging, and the
mortality of these patients is higher

Liberal use of CT scan for diagnosis is particularly important in elderly patients, as preexisting cerebral atrophy, dementia, and cerebral
vascular accidents make the clinical diagnosis of traumatic brain injury difficult.

Additionally, aggressive and early reversal of anticoagulant therapy may improve outcome.

This result may be accomplished rapidly with the use of prothrombin complex concentrate (PCC), plasma, and vitamin K
PELVIC FRACTURES

Pelvic fractures in the elderly population most commonly result from ground-level falls.

As patients age, the incidence of osteoporosis increases linearly; most individuals over the age of 60 have some
degree of osteoporosis.

Mortality from pelvic fracture is four times higher in older patients than in a younger cohort.

The need for blood transfusion, even for seemingly stable fractures, is significantly higher than that seen in a
younger population.

Older adults also have a much longer hospital stay and are less likely to return to an independent lifestyle following
discharge.

Fall prevention is the mainstay of reducing the mortality associated with pelvic fractures.
ELDER MALTREATMENT

When evaluating an injured elderly patient, team members should consider the possibility of maltreatment.

Maltreatment is defined as any willful infliction of injury, unreasonable confinement, intimidation, or cruel
punishment that results in physical harm, pain, mental anguish, or other willful deprivation by a caretaker of
goods or services that are necessary to avoid physical harm, mental anguish, or mental illness.

Maltreatment of the elderly may be as common as child maltreatment.


ELDER MALTREATMENT CAN BE DIVIDED
INTO SIX CATEGORIES
Physical maltreatment

Sexual maltreatment

Neglect

Psychological maltreatment

Financial and material exploitation

Violation of rights