Geriatric Patients Fare Worse After Trauma

Be alert for rhabdomyolysis, especially in patients who have been immobile for a prolonged period, he said. In this setting, creatine kinase is more sensitive than urine myoglobin.

If "somebody comes in and they have multiple long bone fractures, multiple upper extremity fractures, a lot of bruising," consider the possibility of elder abuse or neglect, Dr. Levy further advised.

"And always, always, always look for medical causes in trauma," he stressed, as a patient’s accident may have been precipitated by a stroke or myocardial infarction that can be overlooked in the rush to treat their injuries.

Geriatric trauma patients are potential candidates for being discharged home if they had minor closed head trauma and are not on anticoagulation, they had a simple fall and do not have ambulatory difficulties, or they have isolated extremity fractures, provided they have adequate mobility and home support. "I would say pretty much consider admissions for most if not all others," he said.

A final consideration to be aware of is end-of-life issues in patients with little potential for recovery, Dr. Levy noted. Risk stratification tools can help physicians and families make treatment decisions in this context, he said. For example, the combination of age, base deficit, and head injury severity assessed on arrival in the emergency department can help predict if care is likely to ultimately be futile in geriatric trauma patients (J. Trauma 2004;57:37-41).

"We can consider that within the context of everything else: Are they demented, living in a nursing home, on a feeding tube? Or are they a fully functional individual in the community?" Dr. Levy said. "Certainly, these are all factors in the equation to consider when you are making that decision."