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Trauma in elderly

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In terms of major trauma elderly defined as 55 years or older

Mechanisms

Most common mechanisms:

  • Falls
  • Road traffic accidents

Decreased reserve

  • age related decrease in organ function independent of disease
    • Cardiovascular
      • alpha adrenergic activity maintained (results in high systolic BP)
      • decreased beta-adrenergic activity: decreased heart rate and decreased maximal heart rate
      • ventricular hypertrophy
      • conducting system fibrosis
      • increased susceptibility to arrhythmias
      • increased stroke volume
      • increase in end-diastolic volume
      • increased importance of atrial contraction
    • Respiratory
      • increase in dead space
      • reduced FRC - decreased oxygen reserve
      • increased work of breathing
      • increased ventilation-perfusion mismatch - lower normal PaO2
      • decreased airway reflexes and secretion clearance
      • decreased response to hypoxia and hypercarbia
    • Renal
      • decreased GFR
      • increased risk of renal failure
      • increased mortality from established renal failure
    • CNS
      • brain shrinkage because of loss of supporting structures
      • decreased cerebral blood flow
      • "brittle" vessels
      • increased risk of confusion
      • impaired baroreflexes
  • higher incidence of systemic disease. Common diseases included:
    • hypertension
    • diabetes
    • ischaemic heart disease
  • degree of decrease in reserve is major determinant of outcome

Prognosis

  • Higher mortality
  • Most deaths occur in first 24 hours, usually due to head injury
  • Late mortality related to severity of organ failure and premorbid condition
  • Approximately 1/3 of long term survivors require nursing home care
 

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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