Trauma in the Elderly Patient

Advanced age is a well-known risk factor for poor outcomes in trauma patients. Older patients can benefit from the intensive monitoring and aggressive management associated with trauma team involvement. Several common topics were chosen for discussion in which the treatment options may differ slightly because of the advanced age of the patient. We discuss the following selected topics: resuscitation of the elderly trauma patient, solid organ injuries, hip fractures, rib fractures, and head injuries. The United States is witnessing a rapid growth of its elderly population. During the last century, the number of persons younger than 65 years tripled while the number of persons older than 65 years increased by a factor of 11. Because the elderly population in this country continues to grow and because elderly persons maintain i ndependent a nd a ctive lifestyles, there will be an increasing number of elderly patients requiring treatment for trauma-related injuries. Increasing age puts a trauma patient into a higher-risk category. Elderly patients sustaining major trauma are known to have higher complication and mortality rates than their younger counterparts. A study of almost 200 000 trauma patients found that there was an increase in mortality starting at the age of 40 years. 1 Many believe that the increase in morbidity and mortality that is seen in elderly trauma patients is partially due to preexisting medical conditions and the diminished physiologic reserves of elderly patients and the inability to compensate for severe injuries. 2,3 Although advanced age is a risk factor for poor outcomes in trauma patients, several articles have demonstrated that older patients can benefit from the intensive monitoring and aggressive management associated with trauma team involvement. 4-6 Because of this, we wanted to outline a few common topics in which the treatment options may differ slightly because of the advanced age of the patient. This is by no means meant to be a comprehensive review of trauma care for elderly patients.We selected the following topics for discussion: resuscitation of the elderly trauma patient, solid organ injuries, hip fractures, rib fractures, and head injuries.