Trauma in the geriatric patient
From TraumaWiki.com
Contents |
Background
Geriatric patients constitute an increasingly larger proportion of the overall population in developed countries. In addition, the proportion of elderly who enjoy the benefits of active lifestyle is growing. The resulting increase in trauma contacts and admissions is changing many of the paradigms of the modern trauma.
Geriatric trauma victims constitute a distinct group of patients, characterized not only by their age, but also by age-related comorbidities and the increasing number of effective medical treatments for various chronic health conditions [1]. The presence of pre-existing disease has been shown to be associated with increased mortality in the elderly population [2]. Of special importance is the fact that chronic health conditions may disproportionately contribute to mortality among geriatric trauma patients in the setting of mild injuries [2].
Anticoagulants and Anti-platelet Agents
Geriatric trauma patients often use anticoagulants and/or anti-platelet agents. Although these medications contribute to increased survival, improved quality of life, and prevent many of the dreaded age-related cardio-vascular events, the effect of 'blood thinners' in the setting of traumatic injury adds an additional level of complexity [3].
The use of anticoagulants and anti-platelet agents is especially important in the setting of solid organ and neurologic injury. In fact, blunt head trauma is reported to have a clinically significant intracranial hemorrhage rate of 7% in the geriatric patient receiving anticoagulation therapy [4]. In addition, significantly elevated INR (3.0) in elderly patients with head injuries can carry a mortality rate as high as 50% [5].
The Public Health Triangle and the concept of Susceptible Host
The public health triangle describes the relationship between the disease entity (in this case - traumatic injury), the environment (i.e., the circumstance under which the injury occurred), and the host (i.e., the victim of traumatic injury).
The concept of SUSCEPTIBLE HOST is based on the underlying increase in susceptibility of the host (i.e., the patient) to develop morbidity and mortality related to the disease process (i.e., increased likelihood of complications and/or death following traumatic injury). In addition, the SUSCEPTIBLE HOST will be more likely to exhibit clinical signs and symptoms that are out of proportion to or inconsistent with the initial injurious stimulus (i.e., a septic patient on long-term glucocorticoid administration who exhibits little or no signs of sepsis until clinical decompensation and death occur).
Polypharmacy
Polypharmacy is especially prevalent in the geriatric population, with marked increases in multiple medical therapy use mirroring the trend toward long-term maintenance of chronic co-morbid health conditions [6]. Polypharmacy predisposes patients to drug-drug interactions, physiologic alterations associated with specific medications (i.e., hypotension associated with alpha-adrenergic blocking agents, and potential drug-related toxicity (i.e., hepatic toxicity from statin agents) [6].
Notes & References
[1] McMahon DJ, Schwab CW, Kauder D. Comorbidity and the elderly trauma patient. World J Surg 1996;20:1113-1119.
[2] Camilloni L, Farchi S, Giorgi Rossi P, Chini F, Borgia P. Mortality in elderly injured patients: the role of comorbidities. Int J Inj Contr Saf Promot 2008;15:25-31.
[3] Victorino GP, Chong TJ, Pal JD. Trauma in the elderly patient. Arch Surg. 2003;138:1093-1098.
[4] Li J, Brown J, Levine M. Mild head injury, anticoagulants, and risk of intracranial injury. Lancet. 2001;357:771-772.
[5] Karni A, Holtzman R, Bass T, et al. Traumatic head injury in the anticoagulated elderly patient: a lethal combination. Am Surg. 2001;67:1098-1100.
[6] Stawicki SP, Gerlach AT. Polypharmacy and medication errors: Stop, listen, look, and analyze... OPUS 12 Scientist 2009;3(1):6-10.
Credits & Notices
Authors-contributors to this page (listed alphabetically, last name, first & middle initial only, no institutional affiliations, no scientific titles):
Stawicki SP
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