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According to U.S. census projections the elderly population, defined as age >65 years, is experiencing the largest growth in history. The post–World War II “baby boom” (75 million people born from 1946 to 1964) was 46–64 years old in 2010. By the year 2030, the elderly population will number 38 million and will usher in the gerentological explosion by 2050 in which 1 in 5 Americans will be elderly.1 The overwhelming evidence of this demographic imperative will result in an elderly population that is active and vital. 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 2008 revealed that 30% of all patients in the registry were 55 years old or older.2 Injury is now the fifth leading cause of death in the elderly population.3

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Older individuals sustaining injury respond differently than younger patients. The elderly have a higher morbidity and mortality, have more preexisting medical problems, and demonstrate a senescent physiologic response to injury when compared with younger individuals. Many of the reasons for the differing response are unknown. The literature, albeit plentiful, can be contradictory in places and there are few prospective randomized trials that focus specifically on the elderly. This is best demonstrated by a lack of consensus on the definition of what age constitutes elderly. Historically geriatric patients were considered to be patients over the age of 65 years. There are a variety of organ-specific injuries that demonstrate rising morbidity and mortality at chronological ages less than 65 years. As such, elderly should be viewed from the vantage of the physiologic response to an injury or injury complex rather than a specific age. Despite these limitations, this chapter will focus on an overview of care for the injured geriatric patient.

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Declining cellular function is part of the aging process. Eventually, this will lead to organ failure. The aging process is characterized by impaired adaptive and homeostatic mechanisms, resulting in increased susceptibility to the stress of injury. This is commonly perceived as decreased physiologic reserve. Insults commonly tolerated by younger patients can lead to devastating results in the elderly patient. Differences in the metabolic response to injury were studied by Frankenfield and colleagues. In their study, they compared injured patients by dividing them into those older than 60 years and those who were younger. These investigators concluded that the metabolic response to injury is significantly attenuated in the elderly population. This was demonstrated by the older group having less fever, less oxygen consumption, more hyperglycemia, and more azotemia.4 This may be driven by the fact that there is evidence that immune function is significantly attenuated during the aging process and that cytokine response is impaired. This immune senescence is, in part, a function of reduced neutrophil function. Butcher et al. investigated a group of patients older than 65 years sustaining mild trauma (hip ...

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