Skip to main content

Advertisement

SpringerLink
Log in

Geriatric Trauma Patients: What is the Difference?

  • Trauma Surgery (J. Diaz, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Geriatric population is the fastest growing segment of the total population. They represent about 12 % of the US population. By the year 2030 it has been estimated that 19 % of the population will be older than 65 years. Currently elderly are more active and independent that increases the risk of trauma. Elderly are unique in their responses to trauma injury. The age-related physiological changes affect elderly ability to withstand trauma stress and increase the incidence of complications and deaths. Trauma surgeons and staff awareness of age-related changes and challenges will improve trauma-related outcomes in geriatric trauma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Pellicane JV, Byrne K, DeMaria EJ. Preventable complications and death from multiple organ failure among geriatric trauma victims. J Trauma Acute Care Surg. 1992;33(3):440–4.

    Article  CAS  Google Scholar 

  2. Friese R, Wynne J, Joseph B, et al. Age and mortality after injury: is the association linear? Eur J Trauma Emerg Surg. 2014;40(5):567–72.

    Article  CAS  PubMed  Google Scholar 

  3. Stevenson J. When the trauma patient is elderly. J Peri Anesth Nurs. 2004;19(6):392–400.

    Article  Google Scholar 

  4. •• Weir S, Salkever DS, Rivara FP, Jurkovich GJ, Nathens AB, Mackenzie EJ. One-year treatment costs of trauma care in the USA. Expert Rev Pharmacoecon Outcomes Res. 2010;10:187–97. A NSCOT study demonstration the costs of trauma care in USA and estimates treatment costs of care for 12 months following injury to develop a better understanding of the nature of these expenditures for a subgroup of moderately severe and severe injuries.

  5. DeLa’O CM, Kashuk J, Rodriguez A, Zipf J, Dumire RD. The geriatric trauma institute: reducing the increasing burden of senior trauma care. Am J Surg. 2014;208(6):988–94.

    Article  PubMed  Google Scholar 

  6. McGwin G Jr, MacLennan PA, Fife JB, Davis GG, Rue LW III. Preexisting conditions and mortality in older trauma patients. J Trauma Acute Care Surg. 2004;56(6):1291–6.

    Article  Google Scholar 

  7. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76(3):894–901.

    Article  PubMed  Google Scholar 

  8. McCoy G, Johnstone R, Duthie R. Injury to the elderly in road traffic accidents. J Trauma Acute Care Surg. 1989;29(4):494–7.

    Article  CAS  Google Scholar 

  9. Milzman DP, Boulanger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Magnant CM. Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score. J Trauma Acute Care Surg. 1992;32(2):236–44.

    Article  CAS  Google Scholar 

  10. Champion HR, Copes WS, Buyer D, Flanagan ME, Bain L, Sacco WJ. Major trauma in geriatric patients. Am J Public Health. 1989;79(9):1278–82.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Caterino JM, Valasek T, Werman HA. Identification of an age cutoff for increased mortality in patients with elderly trauma. Am J Emerg Med. 2010;28(2):151–8.

    Article  PubMed  Google Scholar 

  12. Barie PS, Hammond JS, Holevar MR, Sinclair KE, Scalea TM, Wahl W. Practice management guidelines for geriatric trauma. J Trauma Acute Care Surg. 2001;54:627–33.

    Google Scholar 

  13. Chang DC, Bass RR, Cornwell EE, MacKenzie EJ. Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008;143(8):776–81.

    Article  PubMed  Google Scholar 

  14. Jokar TO, Rhee PM, Zangbar B, et al. Redefining the association between old age and poor outcomes after trauma: the impact of the frailty syndrome. J Am Coll Surg. 2015;221(4):S83–4.

    Article  Google Scholar 

  15. Joseph B, Pandit V, Zangbar B, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149(8):766–72.

    Article  PubMed  Google Scholar 

  16. De Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, van der Nijhuis Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.

    Article  PubMed  Google Scholar 

  17. •• Joseph B, Pandit V, Zangbar B, et al. Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. J Am Coll Surg. 2014;219(1):10–7. Prospective study showing that the 15-variable Trauma-Specific Frailty Index is an effective tool that can aid clinicians in planning discharge disposition of geriatric trauma patients.

  18. Gillies D. Elderly trauma: they are different. Aust Crit Care. 1999;12(1):24–30.

    Article  CAS  PubMed  Google Scholar 

  19. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.

    Article  CAS  PubMed  Google Scholar 

  20. Lord SR, Sherrington C, Menz HB, Close JC. Falls in older people: risk factors and strategies for prevention. Cambridge: Cambridge University Press; 2007.

    Book  Google Scholar 

  21. Joseph B, Pandit V, Khalil M, et al. Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. J Am Geriatr Soc. 2015;63(4):745–9.

    Article  PubMed  Google Scholar 

  22. Trauma ACoSCo. Advanced trauma life support student course manual. Chicago: American College of Surgeons; 2012.

    Google Scholar 

  23. •• Çevik Y, Doğan NÖ, Daş M, Karakayalı O, Delice O, Kavalcı C. Evaluation of geriatric patients with trauma scores after motor vehicle trauma. Am J Emerg Med. 2013;31(10):1453–6. A cohort study investigating the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision.

  24. Sifrit KJ, Stutts J, Staplin L, Martell C. Intersection crashes among drivers in their 60 s, 70 s and 80 s. Paper presented at proceedings of the human factors and ergonomics society annual meeting. 2010.

  25. Huang S-B, Chang W-H, Huang C-H, Tsai C-H. Management of elderly burn patients. Int J Gerontol. 2008;2(3):91–7.

    Article  Google Scholar 

  26. Jacobs DG, Plaisier BR, Barie PS, et al. Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J Trauma Acute Care Surg. 2003;54(2):391–416.

    Article  Google Scholar 

  27. Evers BM, Townsend C Jr, Thompson J. Organ physiology of aging. Surg Clin N Am. 1994;74(1):23–39.

    CAS  PubMed  Google Scholar 

  28. Scalea TM, Simon HM, Duncan AO, et al. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma Acute Care Surg. 1990;30(2):129–36.

    Article  CAS  Google Scholar 

  29. Stamatos C. Geriatric trauma patients: initial assessment and management of shock. J Trauma Nurs. 1993;1(2):45–54 (Quiz 55–46).

    Google Scholar 

  30. Morris JA, MacKenzie EJ, Edelstein SL. The effect of preexisting conditions on mortality in trauma patients. JAMA. 1990;263(14):1942–6.

    Article  PubMed  Google Scholar 

  31. Bobb JK. Chest trauma in the elderly. Crit Care Nurs Clin N Am. 1993;5(4):735–40.

    CAS  Google Scholar 

  32. Harwood-Nuss A, Wolfson AB, Hendey GW, Ling LJ, Rosen CL. Harwood-Nuss’ clinical practice of emergency medicine. Philadelphia: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  33. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43(1):8–17.

    Article  PubMed  Google Scholar 

  34. Sattler JM, Ryan JJ. Assessment with the WAIS-IV. La Mesa: Jerome M Sattler Publisher; 2009.

    Google Scholar 

  35. Sinha V, Gupta V, Singh DK, Chopra S, Gupta P, Bagaria H. Geriatric head injuries: experience and expectations. Ind J Neurotrauma. 2008;5(2):69–73.

    Article  Google Scholar 

  36. Beynon C, Hertle DN, Unterberg AW, Sakowitz OW. Clinical review: traumatic brain injury in patients receiving antiplatelet medication. Crit Care (Lond Engl). 2012;16(4):228.

    Google Scholar 

  37. Anwar F, Al-Khayer A, Joseph G, Fraser MH, Jigajinni MV, Allan DB. Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J. 2011;20(3):403–7.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Kacey DJ, Perez-Tamayo A. Principles and practice of geriatric surgery. JAMA. 2012;307(18):1981.

    Article  CAS  Google Scholar 

  39. Pandit V, Joseph B, Khalil M, et al. Impact of admission hypothermia on outcomes in severe traumatic brain injury: not so cool! J Am Coll Surg. 2015;221(4):e23.

    Article  Google Scholar 

  40. Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135(6):434.

    PubMed Central  CAS  PubMed  Google Scholar 

  41. Reuter F, Warncke J. Traumatic intracranial hemorrhages in elderly people: head injuries. Berlin: Springer; 1989. p. 43–8.

    Google Scholar 

  42. Cagetti B, Cossu M, Pau A, Rivano C, Viale G. The outcome from acute subdural and epidural intracranial haematomas in very elderly patients. Br J Neurosurg. 1992;6(3):227–31.

    Article  CAS  PubMed  Google Scholar 

  43. •• Joseph B, Pandit V, Aziz H, et al. Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis. J Trauma Acute Care Surg. 2014;76(3):817–20. A study evaluating the clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.

  44. Pennings JL, Bachulis BL, Simons CT, Slazinski T. SUrvival after severe brain injury in the aged. Arch Surg. 1993;128(7):787–94.

    Article  CAS  PubMed  Google Scholar 

  45. Chang W-H, Tsai S-H, Su Y-J, Huang C-H, Chang K-S, Tsai C-H. Trauma mortality factors in the elderly population. Int J Gerontol. 2008;2(1):11–7.

    Article  Google Scholar 

  46. •• Watts HF, Kerem Y, Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emerg Trauma Shock. 2012;5(2):131. A study demonstrating the accuracy of the injury severity score (ISS) and the revised trauma score (RTS) in predicting mortality and hospital length of stay (LOS) in trauma patients over the age of 65.

  47. Carillo E, Richardson J, Malias M, Cryer H, Miller F. Long term outcome of blunt trauma in the elderly. Surg Gynecol Obstet. 1993;176:559–64.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA

    Bellal Joseph & Ahmed Hassan

Authors
  1. Bellal Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bellal Joseph.

Additional information

This article is part of the Topical Collection on Trauma Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joseph, B., Hassan, A. Geriatric Trauma Patients: What is the Difference?. Curr Surg Rep 4, 1 (2016). https://doi.org/10.1007/s40137-015-0123-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-015-0123-0

Keywords

Search

Navigation