Committee on Trauma

Presents

Geriatri
c
Trauma
Initial Assessment and
Management

Case Scenario
A 79-year-old male is brought to
the ED after he was found at the
base of the stairs by his wife.
Initial vital signs: RR 32; Pulse 64;
BP 110/60; GCS score 12
What issues should you consider in
managing this patient?

Objectives
Describe characteristics of the
elderly patient that affect trauma
management.
Discuss the relevance of
comorbidity and medication.
Explore the potential for elder
abuse.

Special Considerations
What are the special issues to
consider in treating elderly trauma
patients?
Age-related changes in anatomy
and physiology

Preexisting diseases and

comorbidities

Medications
Possibility of elder abuse

The Problem of Elder

Trauma

Increase in proportion of world

population by 2050 will be 20% or

2.5 billion

Increased mortality and morbidity

Majority can return to preinjury
status with appropriate
management

Decline in Function with

Age
Brain mass
Eye disease

Stroke
Diminished hearing

Depth of perception

Sense of smell and taste

Discrimination of colors

Saliva production

Pupillary response

Esophageal activity

Respiratory vital capacity

Renal function

Cardiac stroke volume and

rate

2- to 3-inch loss in height

Heart disease and high

blood pressure

Impaired blood flow to lower

leg(s)

Kidney disease

Degeneration of the joints

Total body water
Nerve damage (peripheral
neuropathy

Gastric secretions
Number of body cells
Elasticity of skin, thinning
of epidermis
15%30% body fat

Unique Characteristics
What are the unique
characteristics of elderly trauma?

Leadin
g
Cause
s of
Injury

Fall
Burn
Alcohol
Pedestrian vs.
vehicle

Motor vehicle
crash

Unique Airway Problems

ABCDE

Priorities are the same

Decreased reserve requires early
intubation

Factors affecting airway

management

Dentition (dentures)
Nasopharyngeal mucosal fragility
Cervical arthritis

Unique Breathing
Problems

Diminished respiratory reserve

Use of supplemental oxygen

COPD
Hypoxemic respiratory drive

Chest injuries poorly tolerated

Minor chest injuries with major
effects

Unique Circulatory
Problems

Decreased cardiovascular
function and reserve

Cautious fluid administration

Increased BP, decreased HR, and

loss of renal function with age

Anticoagulants and other

medications

Pharmacologic effects

Catecholamine effects and

dysrhythmias

Drugs That Affect

Resuscitation

Beta blockers
Antihypertensives
NSAIDS
Anticoagulants

Corticosteroi
ds

Diuretics
Hypoglycemi
cs

Psychotropic
s

Unique Neurologic
Problems

Acute and chronic subdural

hematomas

Altered sensorium secondary to

cerebral atrophy, hypoperfusion,

and medications

Spinal osteoarthritis, leading to

frequent spinal column and cord

injuries

Cervical Spine MRI

Unique Exposure Problems

Abnormal thermoregulatory
mechanism

Increased sensitivity to
hypothermia

Increased risk of infection

Tetanus immunization status

Unique Musculoskeletal
Problems

Most frequent cause of morbidity

Susceptible to certain fractures
Osteoporosis
Preexisting deformities complicate
evaluation

Immobility can lead to

complications

Recognizing Elder Abuse

High index of suspicion

Patterns of injury
Multiple types

Physical
Emotional
Confinement
Intimidation
Poor hygiene

Strategy for Elder Abuse

Dont query in presence of possible

abuser.

If abuse is suspected, remove patient

from abusive environment.
Pitfalls

Failure to recognize and report

End-of-Life Decisions

When is enough, enough?

Advance directives?
Right to self-determination paramount
Treatment only in patients best
interest

Benefits of treatment outweigh

adverse consequences

Summary

Trauma in the elderly is increasing

globally.

Treatment priorities are the same.

Evaluation and management affected
by:

Anatomic and physiologic changes

Comorbid conditions and medications

Consider elder abuse