Age is an issue of mind over matter. If you don't mind, it doesn't matter.

1. Presentation
Special consideration in geriatrics
trauma
Dr Abdul rub
Mem pgy2

2. Definitions
 Elderly >65 years
 Young old and Old old
 Chronological age is actual years lived
 Physiologic age is actual functional capacity of patient’s organ
systems

3. Sensory Related Changes
 Vision
cataracts cause blurring of vision
 Hearing
 decreased hearing
 diminished sense of balance
 Touch
neuropathies cause decreased sensitivity to tactile senses

4. Musculoskeletal system:
 fat decreases relative to body weight
 cartilage loses its adaptive capabilities, becoming less flexible and
more likely to break when stressed.
 Osteopenia & osteoporosis: bones become prone to fracture

5. Central Nervous System
 Subdurals - Most common
 Atrophy
 Delayed accumulation of blood/pressure symptoms
 Warfarin
 Pre-existing dementia or strokes makes evaluation and recovery
difficult
 Peripheral nerves: Elderly people may lose the ability to feel pain,
meaning a minor complaint of "it hurts a little" may represent the
only symptom of a significant fracture or other injury

6.  Respiratory :
weak muscles
reduced vital capacity & pao2
 Cardiovascular:
reduced cardiac output
increases SVR
Normotension in the usually hypertensive patient may be
indicator of haemorrhage.

7. AIRWAY & BREATHING
 Airway management may be difficult in elders
 Cachectic or edentulous patients may be difficult to ventilate with
bag, valve,and mask.
 Decreased mouth opening and limited neck mobility
 Drugs :neuromuscular blocking agents
 Dosing of drugs

9. Mechanisms
 Falls 40%
 Motor Vehicle Crashes (MVC)20 -59%
 Pedestrian vs. Motor Vehicle 9-25%
 Burns
 Assaults

10. Falls
 Most common injury - 40% elderly trauma
 25% who fall sustain “serious injury”
 Falls M=F but females are more likely to be injured
 Postural instability, vision and hearing, reaction time, meds
 Standing height falls

11. Burns in the Elderly
 1000 die each year from home fires
 People over 60 have higher mortality rate
from burns
 Increased morbidity/mortality due to
preexisting disease, skin changes (thinning &
slower healing time), altered nutrition,
increased risk to infection, decreased reaction
time to move away from source

12. Elder Abuse
 May occur in home or institutional setting
 Abuse
 any physical injury, sexual abuse or mental injury inflicted on a
person, aged 60 or older, other than by accidental means
 Neglect
 failure to provide adequate medical or personal care or
maintenance in which failure results in physical or mental injury
or deterioration of condition

13. Trauma score
In the emergency department, the two most useful scores are
the Trauma Score (TS) and Revised Trauma Score (RTS).
The TS assesses blood pressure, respiratory rate, respiratory
effort, Glasgow Coma Score (GCS), and
capillary refill to produce a minimum score of zero and
maximum score of 16.
The RTS is similar, but does not account for respiratory
effort or capillary refill (scores 0–8).

14. consideration
 elderly with a head injury can present with a minor abrasion or
hematoma on their scalp, but internally they may have significant
intracranial bleeding.
 elderly with only vague complaints ƒ weakness, dizziness, diffuse
pain or a family member says they are "just not acting right."
However, these complaints may be symptoms of a life-threatening
injury.
 the elderly patient with untreated hypertension may be in shock
when their blood pressure reaches the lower limits of normal.

15. Specific questions must be
considered:
 How the car accident occur:
?patient failed to react in time/ transient ischemic attack?
 Decreased sensory distal to the arm fracture pre- and post-
immobilization be trusted since the patient has insulin-dependent
diabetes mellitus?
 When confronted with an elderly patient, it is fairly safe to assume
the trauma (e.g., dislocated hip, fracture, hematoma) won’t be the
only medical issue.

16.  Making a Connection
communication may be difficult to impossible. Even if they speak the
same language, your interaction may require involving others (e.g., family
members, neighbours) to gain understanding and to solicit answers.

17. Communicating with the
Geriatric Population
 Make eye contact before speaking
 Always identify yourself
 Position yourself at the patient’s eye level
 Locate hearing aid, eyeglasses, dentures
 Be patient and gentle - give time for the patient to
respond to your questions

18. Do’s & dont’s
 DO ask about any pre-existing conditions. Finding out about
conditions, such as arthritis and osteoporosis, before you begin
packaging may save you from having to re-package or change
your strategy mid-procedure.
 DO be creative. When accommodating for physical deformities, use
whatever materials are on hand (e.g., pillows, blankets, splints) to
help make your patient more comfortable.

19.  DO NOT force the patient_s head, neck, spine or extremities into a
"neutral" position. Pre-existing conditions, like osteoporosis and
kyphosis,can make this positioning impossible, and attempting it
can lead to further injury.
 DO NOT keep dyspneic patients supine.

20.  ■ Elder patients are more susceptible to injuries than younger
patients and have a higher mortality rate for any given injury.
 ■ Physiologic changes that occur with aging alter the way in which
these patients may manifest significant injuries as well as how they
tolerate these injuries.

21.  ■ Emergency physicians must remember that elder trauma patients
may have suffered a medical event that precipitated their trauma,
or vice versa, and evaluate patients accordingly.
 ■ Resuscitation of elder trauma patients requires oxygen
supplementation, a lower threshold for advanced airway control
(endotracheal intubation), and aggressive but judicious fluid and
blood resuscitation with frequent re evaluation

22. conclusion
 Pre-existing diseases lead to more severe injuries
 Co-morbid diseases complicate recovery
 Medications alter “normal” function and vital signs

23. THANKS