Chapter 252

The elderly have greater adverse outcomes following trauma because of physiologic changes that occur with aging. The elderly are more susceptible to serious injury from low-energy mechanisms, less able to compensate from the stress of injury, and more likely to suffer complications during treatment and recovery.

Persons 65 years of age and older represent a large and growing segment of the population. The U.S. Census Bureau projects that those >65 years old will increase to 52 million by 2020 and to 80 million by 2050 (representing 20% of the total population).1 The number of people >85 years of age also is growing at an accelerated pace, with estimates that this group will number 14 million by the year 2040.1

Although persons >65 years of age represent 12% of the population, they account for 36% of all ambulance transports, 25% of hospitalizations, and 25% of total trauma costs.2 Geriatric trauma patients represent between 8% and 12% of the general trauma population. Although the elderly are less likely to be involved in trauma as compared with other age groups, they are more likely to have fatal outcomes when they are injured. Approximately 28% of deaths due to accidental causes involve persons 65 years and older.

There is no uniform age at which a patient is defined as being elderly. Studies have defined the geriatric patient to be as old as 85 years of age and as young as 55 years of age. Some studies have even shown increased adverse outcomes beginning as young as 45 years of age.3 Other studies have divided the elderly population into two groups: the “young old” (65 to 80 years of age) and the “old old” (80 years of age and older).2 Part of the difficulty in describing the elderly population derives from the potential discrepancy between chronologic age and physiologic age. Chronologic age is the actual number of years the individual has lived, whereas physiologic age describes the functional capacity of the patients’ organ systems in a physiologic sense. Comorbid disease states such as diabetes mellitus, coronary artery disease, arthritis, renal disease, and pulmonary disease can decrease the physiologic reserve of certain patients, making it more difficult for them to recover from injury.4 Chronologic and physiologic age can be difficult to separate because the number or severity of preexisting conditions often increases with aging.

The elderly will experience similar types of injuries that younger individuals do. There are differences, however, in the patterns of injury for elderly patients compared with younger persons.

### Falls

Falls are the most common cause of injury in patients >65 years of age.5,6 Most individuals who fall will do so on a level surface and most will suffer an isolated orthopedic injury.7,8 Falls are reported as the underlying cause of 9500 deaths each year in patients >65 years old. Many falls in ...

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