Skip to Main Content

KEY POINTS

KEY POINTS

  • For the year 2016, the National Trauma Data Bank noted that 43% of all patients in the registry were 55 years or older and the mortality for this group was 58% of all deaths reported.

  • There is evidence that immune function is significantly attenuated during the aging process and that cytokine response is impaired as well.

  • In the event of hypovolemia secondary to trauma, the “stiffer” heart with atherosclerotic changes in elderly patients may be unable to compensate with tachycardia and an increase in cardiac output.

  • The Trauma-Specific Frailty Index includes reviews of comorbidities, daily activities, health attitude, sexual function, and albumin level.

  • In the National Trauma Triage Protocol, a systolic blood pressure of 110 mm Hg in an injured patient 65 years of age or older is a criterion for transport to a trauma center.

  • When performing rapid sequence intubation in an elderly patient, the doses of induction agents may need to be reduced between 20% and 40% to minimize the risk of cardiovascular depression.

  • Elderly patients on anticoagulants who have had a negative computed tomography (CT) scan of the brain after injury should have a follow-up CT of the brain before discharge from the emergency department, although the time frame for observation is controversial.

  • Many of the falls in older trauma patients are from a standing height but still lead to significant injuries requiring hospitalization.

  • Preexisting conditions such as cirrhosis, congenital coagulopathy, chronic obstructive pulmonary disease, ischemic heart disease, and diabetes mellitus have a significant negative impact on mortality in older trauma patients.

  • Mortality in elderly trauma patients is significantly reduced in an intensivist-model intensive care unit (ICU) as compared to an open-model ICU.

INTRODUCTION

According to census projections, the elderly population in the United States, defined as age more than 65 years, is experiencing the largest growth in history. Members of the post–World War II “baby boom” (75 million people born from 1946 to 1964) were 46 to 64 years old in 2010.1 In 2014, there were more than 40 million elderly Americans (age ≥65 years) representing 14.5% of the US population. By the year 2060, it is projected that the elderly sector of the population will more than double to about 98 million.2

The ever-increasing mobility and active lifestyles of today’s elderly place them at increased risk for serious injury. In fact, data from the National Trauma Data Bank (NTDB) for the year 2016 revealed that 43% of all patients in the registry were 55 years old or older and the mortality for this group was 58% of all deaths reported to the NTDB.3 Injury is now the seventh leading cause of death in the elderly population.4

The elderly have a higher morbidity and mortality, have more preexisting medical problems, and demonstrate a senescent physiologic response to injury when compared to younger individuals. The reasons for the differing ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.