State of the Art Interventions in Geriatric Trauma
Wade Hopper DOa; [email protected]; ORCID: 0000-0001-9394-2483
Mentor Ahmeti MDa,b; [email protected]; ORCID: 0000-0003-3266-3565
a University of North Dakota, School of Medicine & Health Sciences
Department of Surgery 1919 North Elm Fargo, ND 58102
b Sanford Medical Center Fargo, Department of Trauma and Acute Care Surgery
5225 23rd Ave. S. Fargo, North Dakota 58104
Corresponding Author:
Wade Hopper, DO
[email protected]
University of North Dakota School of Medicine & Health Sciences
Department of Surgery
1301 N Columbia Rd
Grand Forks, ND, 58203
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Abstract
The geriatric population is a unique subgroup of injured patients. Geriatric age is commonly defined as 65 years or above. The most common geriatric injury mechanisms are falls and motor vehicle accidents. Geriatric adults are overrepresented among all trauma patients and experience undertriage more frequently. Misjudgment of injury severity in the elderly is related to low energy mechanisms, misleading vital signs, and limited patient participation. These factors have led to exploring whether the geriatric population should have unique and specific triage criteria. Frailty is also a major age-related contributor to adverse outcomes of trauma.
Over the past decade, novel clinical management strategies have emerged to improve geriatric trauma outcomes. Frailty screening and interdisciplinary interventions can lower rates of readmission and delirium. Environmentally focused treatment bundles can reduce the duration and severity of delirium when it occurs. Formal medication reconciliation has been shown to reduce polypharmacy and is linked to modest reductions in hospital readmissions. Adherence to early palliative care pathways improves outcomes and should be a target for institutional quality improvement. Evidence-based guidance is still wanted for key topics of overtriage and fracture risk reduction.
The future of geriatric trauma care is encouraging, and the field has greatly evolved over the past decade. Triage practices represent the area of greatest potential improvement. Accurate estimation of frailty will be a key driver of future research. Due to an aging global population, there remains great need for novel clinical strategies that improve geriatric trauma care.
Keywords: Trauma; geriatrics; elderly; trauma centers; state-of-the-art review
