Trauma in an Older Adult: Small Accidents, Big Injuries

Care of trauma patients is a cornerstone of emergency medicine. Trauma assessment and management in older person is more complex than in younger people due to age-related anatomical and physiological changes and polypharmacy, including anticoagulation, affecting all aspects of trauma assessment and management [1]. Based on this concept, it is not surprising that injured older adults have higher mortality, longer intensive care stays, and more prolonged hospital admissions than younger people [2]. Furthermore, this also unfortunately highlights that even a minor trauma for an older adult can be associated with significant injuries that lead to functional decline and loss of independence [1]. Hence it is essential to practice as a team on how best to approach geriatric trauma. In addition, there are crucial practice points to consider, including understanding typical injuries in this age group and common geriatric trauma resuscitation pearls and pitfalls [3].

Although the most common geriatric trauma is a fall from a standing height [4], we have chosen another low-speed injury, such as a golf cart (buggy) injury, for our geriatric trauma case scenario, as falls are covered in other chapters in this book. Falls from a golf cart remain an essential source of injury for people of all ages, including older adults. The rate of golf cart injuries to older adults significantly increased from 2007 to 2017 by 67.6%, as noted by a US study [5]. Traumatic brain injury (TBI) in injured older adults is a common cause of hospital admission [6]. Recognizing a significant TBI in older adults might be tricky to detect initially, especially when older adults present with a normal level of consciousness, i.e. normal Glasgow Coma Scale (GCS) [1].

The high use of antiplatelet/anticoagulation medications in this age group can add another layer of complexity to managing the injured older adult, which this scenario also highlights.