Trauma in the aged
Outline
Trauma in the Elderly
CM Ursic
I don't want to achieve immortality through my work...
I want to achieve it through not dying. Woody Allen
WHO Classification
“Aging is the combination of a set of gradual
physiologic, organic, and emotional alterations,
or the gradual and irreversible organic deterioration
to adapt to environmental alterations.”
Middle Age 45-59 yrs
Elderly 60-74 yrs
Aged 75-90 yrs
Very Old >90 yrs
NZ MEDIAN AGE:
2002: 35 yrs
2021: 40 yrs
2051: 45 yrs
POPULATION GROWTH BY AGE AUSTRALIA
POPULATION, Age and Sex NEW ZEALAND
ST GEORGE HOSPITAL TRAUMA ADMISSIONS: ISS>15 2003
TRAUMA MORTALITY BY AGE
Geriatric Trauma Victims Have:
Higher Mortality Rate
Higher Complication Rate
Longer Hospital Stay
- For Equivalent Injury Severity
Champion, et al, AJPH 1989
Pre-existing Diseases and Mortality
Milzman DP, et al J. Trauma 1992
Increased Relative Risk of Death by Chronic Medical Condition and Injury Severity Score (ISS)
McGwin, et al J Trauma 2004
PHYSIOLOGY OF AGING
Myocardium
Degeneration
Fatty infiltration
Stiffening, loss of elasticity
Conduction
Beta receptors
Pacing myocytes
AV node atrophy
Bundle branch atrophy
Impaired ability to raise heart rate in response to stress
Atherosclerotic occlusive disease
Valvular thickening & calcification
Drugs
Beta blockers
Calcium channel blockers
Afterload reducers
Pacemakers
Decline in Baseline Cardiac Index
Respiratory System
Alveolar elasticity
Alveolar size
Atelectasis
Air trapping
Cough & laryngeal reflexes
Cough strength
LES tone
Mucociliary transport
aspiration risk
Loss of Lung Surface
PROBLEM AGE OF ONSET
Chest wall Stiffening 20
Loss of rib density/strength 30
Nervous System
Structural Changes
Cerebral atrophy:10% loss of weight
greater movement of brain within skull
Shearing / rotation
hematomas
Functional changes
Dendrite deterioration, accumulation of senile plaque, and atherosclerosis
Memory
Cognition
Sensation
Vision
Hearing
Vestibular
Renal System
Loss of Glomeruli
Progressive fall in creatinine clearance by 80-90% over lifespan
Impaired thirst & ADH insensitivity: chronic dehydration
Sensitivity to
Contrast
Aminoglycosides
Hypovolemia
Acute ICU Renal Failure in elderly: 50% mortality
Other Systems
Bone density and strength susceptibility to fractures
Muscle mass strength and coordination
Vitamin / mineral deficiencies poor wound healing
T & B cell dysfunction infections
Causes of Death: Age > 65
Zeitlow et al. J. Trauma 1994
Mechanisms of Injury
Champion HR, et al 1989
The Man-Killing Trees of Kogarah
Falls
PREDISPOSING FACTORS
Visual acuity
Hearing
Vestibular / proprioceptive functions
Memory
Cerebrovascular disease
Cardiac dysrrhythmias
Dehydration
Medications
75% of deaths occur in geriatric population
50% 1-year mortality if hospitalized for fall
Rubeinstein, et al. West J Med, 1983
Injury Patterns for all Falls
Sterling, et al - 2001
Crashes
Leading mechanism of injury bringing elderly to trauma centers
Leading cause of trauma death in ages 65-74
Incidence is second only to < 25 year-olds
50% due to driver error
Elderly more likely to be involved:
Good weather
Close to home
In daylight hours
At intersections
Without alcohol use
Predisposing Factors
Dementia, memory loss
Visual acuity
Auditory acuity
Arthritis, loss of strength
Medications
Auto vs Pedestrian:age 65+
64% occur within a crosswalk
20% of all fatalities occur in > 65 yrs age group
(highest age group)
Average U.S. cross-walk requires pedestrian speed 4 feet / second
Burns
50% in-hospital mortality
Predispositions:
Impaired sensorium
Living alone
Thinner dermis
Epidermal proliferation
Poor prognosis:
Lower extremity burns
High fluid requirements
Pneumonia
Anous, et al. 1986
Neurotrauma
Fall: most common mechanism
Mortality 4 X greater overall
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Ministry of Health
