Major trauma in the elderly: unique challenges and considerations

Challenges of managing trauma in the elderly
The elderly patient presenting with major trauma poses several challenges to the trauma team involved in their care. Age-related changes in physiology and pharmacology, an increased prevalence of comorbidities, reduced physiological reserve and frailty make elderly patients especially vulnerable to the physiological stress of major trauma. Preexisting conditions and their pharmacological treatments may result in atypical presentations and mask adverse clinical signs, presenting an additional
Prognostication
Assessing and planning care following major trauma requires multidisciplinary input including specialists in care of the elderly and rehabilitation following trauma. This assessment should take place as soon as possible following the traumatic injury and adopt a holistic approach, addressing areas such as pain management, treatment of infections, resolution of delirium, psychological wellbeing and medication optimisation.23 Accurately predicting outcomes following trauma in the elderly is
Conclusions
The demographic of the ‘typical’ major trauma patient is rapidly evolving from young and predominantly male to the older adult of either sex with increasing frailty, comorbidity and medical complexity. Providing a high standard of trauma care to this growing and important cohort of patients requires a fundamental understanding of ageing physiology and how this impacts management, from arrival at the door of the emergency department through to surgical intervention and beyond.