Under-triage of geriatric trauma patients at risk for moderate to severe injury is a major problem and often begins during the pre-hospital assessment. Studies have shown that patients treated at a trauma center have improved outcomes. Other studies found that compared with younger patients with similar injury severity scores (ISS) patients over 70 had a three-fold increase in mortality. Based on these and other studies, the American College of Surgeons’ triage criteria suggests patients age 55 years and above be considered for transport to a trauma center to receive their care. Also, geriatric trauma criteria have been implemented at the state level to address under-triage.
These criteria help identify patients who would be more appropriately transported to a trauma center. Data on the use of geriatric trauma criteria suggest overall outcomes have improved. Pre-hospital providers must maintain a high clinical suspicion for serious injury, regardless of the mechanism of injury.
Elder abuse is under-reported, and the incidence is rising. The prevalence of elder abuse in the United States is estimated to be about 10%. It can present in many ways, for example, physical, emotional, financial, sexual, and neglect. Physicians should maintain a high level of suspicion to identify those at risk. Those in immediate danger should be hospitalized.
Geriatric trauma is on the rise and often presents in sinister ways. Because of advanced age, a decline in organ function and limited reserve, geriatric patients are more likely to die compared to younger people when sustaining the same type of trauma. Thus, assessment and treatment of the geriatric trauma patient must be conducted by taking into consideration their unique physiology and associated co-morbidity. Because geriatric trauma can have diverse presentations, an interprofessional approach is necessary. Often geriatric abuse can present with somatic and neuropsychiatric features, and the key is to be aware of this pathology. Most geriatric patients recover after trauma, but the healing period is long. Many often remain in the hospital for prolonged periods and even when discharged tend to have a residual loss in function. As the care of the geriatric trauma patient improves, it is hoped that the morbidity and mortality will also decrease. Meanwhile, the onus is on healthcare workers to recognize early signs of injury in this very vulnerable population.
References
Fares A. Pharmacological and Non-pharmacological Means for Prevention of Fractures among Elderly. Int J Prev Med. 2018;9:78.
Verhoeff K, Glen P, Taheri A, Min B, Tsang B, Fawcett V, Widder S. Implementation and adoption of advanced care planning in the elderly trauma patient. World J Emerg Surg. 2018;13:40
McGibbon CA, Slayter JT, Yetman L, McColl.um A, McCloskey R, Gionet SG, Oakley H, Jarrett P. An Analysis of Falls and Those who Fall in a Chronic Care Facility. J Am Med Dir Assoc. 2019 Feb;20(2):171-176.