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TRAUMA IN
THE
ELDERLY
trauma in the elderly 18-1
Overview
 Pathophysiology of aging
 Assessment of the elderly patient
 Management of the elderly patient
trauma in the elderly 18-2
Geriatric Population
 Geriatric patients:
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Respond less favorably to trauma.
More likely to have a fatal outcome.
Being older than 55 is more consistently
associated with bad outcome.
trauma in the elderly 18-3
Pathophysiology
of Aging
 Decreased sight and hearing
»
Problems communicating with the patient
 Decreased Mobility
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Mobility aids: Walkers, canes, wheelchairs
 Tooth and gum disease common
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»
Bridges and dentures may cause airway
obstruction.
Diseased teeth may be easily knocked loose
during intubation.
trauma in the elderly 18-4
Pathophysiology
of Aging
 Respiratory
Decreased vital capacity
» COPD more common
» Hypoxia more likely after chest
injury
»
trauma in the elderly 18-5
Pathophysiology of
Aging
 Cardiovascular
Decreased circulation to vital organs
» Decreased cardiac output
 Poor reserve
» Poor tolerance of
 Hypovolemia
 Hypoxia
» Underlying cardiovascular disease
»
trauma in the elderly 18-6
Pathophysiology of
Aging
 Renal
Often have decreased renal function
» Kidneys may not tolerate hypoxia
» May not be able to excrete a fluid
overload
 Increased risk of CHF
»
trauma in the elderly 18-7
Pathophysiology of
Aging
 Neurological
Atrophy of brain increases chance
of subdural hematoma after trauma.
» Decreased cerebral circulation.
» Poor cerebral tolerance to hypoxia,
hypotension, or shock.
» Poor balance and coordination
increase risk of injury.
»
trauma in the elderly 18-8
Pathophysiology of
Aging
 Musculoskeletal
» Osteoporosis
 Increased risk of
fracture with minimal
trauma (hip, wrist,
compression fractures
of spine )
» Kyphosis of spine
 Difficulty packaging
on backboard
 Difficulty intubating
trauma in the elderly 18-9
Pathophysiology of
Aging
 Thermoregulation
More susceptible to:
 Hypothermia
 Heat illness
» When possible, document patient
temperature.
»
trauma in the elderly 18-10
Pathophysiology of
Aging
 General
Medications often interfere with
compensation for injury.
» Elderly more prone to accidents due
to decreased sight, hearing, balance,
and coordination.
» Elderly may have an acute medical
problem (MI or Stroke) that causes
accident or fall.
»
trauma in the elderly 18-11
Assessment of the
Elderly
»
Does the patient live alone?
Does the patient appear to be able to care
for himself/herself?
What medications does the patient take?
»
Signs of abuse or neglect?
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trauma in the elderly 18-12
Assessment
 Initial Assessment
 Rapid Trauma Survey or Focused Exam
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Check for dentures or bridges.
Be alert for signs of COPD.
Observe for hypoxia and hypoventilation.
 Check blood glucose
Remember to check for Medical Alert tags.
trauma in the elderly 18-13
Critical Interventions
 Elderly patients have poor
compensatory mechanisms.
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Treat hypoxia and shock early.
Be careful when IV fluids have been
prescribed .
 Can precipitate pulmonary edema.
Keep the patient warm.
trauma in the elderly 18-14
Detailed Exam
History is extremely important.
 S - Elderly may not be aware of pain.
 A - Allergies.
 M - Bring medications if available.
 P - Past medical history very important.
 L - When was last meal?
 E - Events prior to the injury.
» Chest pain or syncope prior to an accident?
» Be alert to medical problems.
trauma in the elderly 18-15
Patients with Altered
Mental Status
 Ask about patient’s usual cognitive
state.
 Is this a change from usual state?
 Check blood glucose.
 Look for underlying causes of altered
cognitive state
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Could patient have overdosed on his
medications?
trauma in the elderly 18-16
Summary
 Elderly patients have:
Different response to trauma
» High risk of underlying disease
» Decreased compensatory
mechanisms
»
 Get a good history.
 Anticipate potential problems.
trauma in the elderly 18-17
Questions?
trauma in the elderly 18-18