What is Geriatric Trauma?
Looking after elderly patients who have experienced trauma can be quite unique and requires special care. As the number of older people increases, so do the instances of elderly trauma patients. Caring for elderly patients is challenging due to changes that occur with age, which increase their risk of health issues and death. Many elderly patients have mild to severe cognitive impairments and problems with their heart and lungs among other health issues, leading to a general state of frailty. These age-related changes can mean that elderly patients don’t respond as well to trauma as younger people, putting them at a higher risk of complications and death.
What Causes Geriatric Trauma?
Falls, car accidents, and burns are the most regular types of injuries. In 2014, data from the Centers for Disease Control and Prevention (CDC) shows that older Americans had 29 million falls, which led to seven million injuries and cost about $31 billion in Medicare costs for the year. When planning care for each patient, it’s crucial to figure out why the fall happened. The reason could be a single physical event, or it could be due to a health condition that could put the patient in danger of more falls. Things to think about include what the patient’s everyday capabilities were before the fall and where and how the fall occurred.
Even if it’s clear that a physical issue caused the fall, a thorough medical check-up should be done to see if an underlying health condition contributed to the fall. Conditions like hidden anemia, abnormal levels of body salts, or problems with sugar metabolism should be considered.
Care should also be given to the chance that a heart-related issue caused the fall. This could be a sudden drop in blood pressure when standing up, irregular heartbeat, or heart attacks. Other health conditions that could lead to falls include infections in the urinary tract, lungs, or tissue. Neurological conditions like seizures should also be considered. Lastly, the effect of multiple medications and possible disruptions to normal body functions can play a part and should not be underestimated.
Risk Factors and Frequency for Geriatric Trauma
Trauma is the fifth leading cause of death in older people, and it’s responsible for nearly a quarter of all trauma-based hospital admissions. Certain factors make it more complicated in this age group, including multiple coexisting health problems, use of many medications, lower physical capacity, and a higher risk of serious health issues and death compared to younger adults.
As more people live longer, the number of older adults experiencing trauma will also increase. After 70 years of age, the chances of dying from trauma tends to go up, even when taking into account the severity of the injuries. Criteria used in emergency responses to injuries in older adults help with identifying those in need of care at a trauma center.
Signs and Symptoms of Geriatric Trauma
It’s important to gather as much information as possible when assessing a patient. Knowing their normal mental state can be key in spotting serious injuries. Vital signs, like blood pressure and heart rate, may look normal until the patient’s condition quickly worsens. These signs could be misleading because medication could affect them. The presence of other health conditions should also be considered. After checking the patient’s airway, breathing, and circulation, the doctor should do a full body check from head to toe.
Testing for Geriatric Trauma
When managing older adults who have experienced trauma, it’s vital to follow established emergency care protocols. The evaluation of older patients should be well-rounded and must consist of a medical assessment, a cognitive (or mental) health evaluation, a functional appraisal (how well they can perform everyday tasks), and a social review. It’s crucial to go through a detailed examination even when a mechanical fall (or accidental trip or slip) is known to have occurred. This thorough checkup will ensure no hidden injuries or underlying health conditions are missed.
Identifying frailty or weakness upon admission into the hospital is another crucial element of managing older adults with trauma. Frailty refers to a progressive decline in physiological health and resilience that comes with age, leading to an increased risk of complications, the need for a care facility, disability, and even death when faced with acute illness or stress.
It’s essential to understand that frailty is not based solely on age. Many under-65 patients suffering from chronic poor health can also be considered frail. While frailty was traditionally seen as a physical deterioration (resulting in weight loss, loss of muscle mass, weakness, and slow walking speed), modern understanding incorporates deficits in social interactions and cognitive function.
Currently, no perfect test exists for detecting frailty in older adults. However, various tools can help identify those at most risk for poor outcomes. One such instrument is the FRAIL scale, which monitors fatigue, resistance, ambulation (walking), illnesses, and weight loss. Each area is assigned a score between 0 and 1. Lower scores indicate better health, with 0 suggesting good health and higher scores increasing levels of frailty. Specialized tools like the geriatric trauma-specific frailty index employing 15 variables can assist clinicians in planning post-hospital care.
Additional tools have been developed to predict the likelihood of in-hospital death for elderly trauma patients. An example is the Geriatric Trauma Outcome Score. The prognostic indicator combines the patient’s age, severity of injury, and whether the patient required a blood transfusion within the first 24 hours of admission. New predictors like the quick and full elderly mortality after trauma scores can help estimate in-hospital mortality accurately.
Treatment Options for Geriatric Trauma
Based on a patient’s medical history, physical examination, and risk factors, several tests may be necessary. A complete blood count, comprehensive metabolic panel, EKG, urinalysis, and radiographic studies like X-rays and ultrasounds might be used. If a patient is taking anti-platelet or anticoagulant medications, which thin the blood and prevent clotting, imaging of the brain might also be necessary.
If a patient on these medications has a serious internal bleed in the brain, immediate treatment is needed. These drugs’ effects must be quickly reversed to limit the bleeding and prevent further damage.
Different oral anticoagulants – drugs like dabigatran (Pradaxa), apixaban (Eliquis), and rivaroxaban (Xarelto) – work in different ways to prevent clotting. These drugs are used to treat various conditions often seen in older adults, such as blood clots in the veins, stroke prevention related to abnormal heart rhythms, and heart attack. They work differently from warfarin (Coumadin), another blood thinner. Also, the process to undo their effects varies from warfarin. Only dabigatran has a specific drug (idarucizumab or Praxbind) that can quickly reverse its effects. However, new antidote drugs are currently being developed.
In the past, the anticoagulation effects of warfarin were reversed with vitamin K and fresh frozen plasma (FFP), a blood product. However, this approach has several drawbacks, such as taking up to an hour to thaw the FFP and requiring large volumes for it to work effectively. Now, treatment with vitamin K and prothrombin complex concentrates is becoming more common. Prothrombin complex concentrates are quicker to administer, require smaller volumes, and don’t need to be matched to the patient’s blood type.
The process of reversing the effects of warfarin or the new oral anticoagulants should always follow the latest guidelines set out by a healthcare institution, which are constantly revised based on new evidence.
It is crucial to thoroughly evaluate and actively treat elderly patients with injuries to improve their outcomes.
What else can Geriatric Trauma be?
- Changes in mental state
- Specific problems with body movement or sensation
- Headache
- Stroke caused by blocked blood flow to the brain
- Bleeding within the brain tissues
- Bleeding inside the skull not caused by an injury
- Collection of blood on the surface of the brain, beneath the protective outer layer
- Injuries to the space between the brain and its protective outer layer
- Damage to the brain caused by a traumatic event
