Elderly People And Frailty Flashcards
What percentage of trauma patients are over 65
52%
Most common mechanism of trauma in older people
Fail from <2m eg from standing
How does TBI present differently in older people
Often have higher GCS than younger people
Why may older pts recieve less specialist trauma care
Poor prehospital and ED identification of injuries as major trauma
Challenges for airway in older people
Damaged or missing teeth
Thin fragile lips
Inability to open mouth widely
TMJ disease
Arthritis
Oropharyngeal cancers
Shirt stiff neck
Thyroid masses
Why should there be high suspicion for cervical spine injuries in elderly pts
Pre existing degenerative spinal disease
May be alert and have normal neurology
X ray interpretation may be challenging due to degen disease
First line imaging modality for neck in elderly
CT
Complications of prolonged immobilisation in elderly
Pressure ulcers
Pneumonia
Respiratory failure
Dysphagia
Delirium
Raised ICP
Lying flat can worsen resp conditions
Imaging considerations for elderly trauma
Assessment imaging and image reporting within 2 hours
Movement restrictions clearly documented
Specialist esce,action for challenging interpretation of imaging
Breathing challenges in older people
Decr lung elastic recoil
Decr small airway calibre
Decr expiratory flow
Incr dynamic airway collapse
Decr chest wall compliance
Decr respiratory muscle strength
Decr gas exchange
Decr mucociliary clearance
Enlarged alveolar ducts and alveoli
Decr elastic fibres, incr cross linked collagen
Decr surfactant
Less effective cough
Incr WOB
Atrophy of resp muscles
Decr alveoli number
Diminished chemoreceptor response
What factors should trigger a trauma call and immediate consultant/reg review in a pt over 65 with an obvious injury or MOI
Sig injury to 2+ body regions
Suspected pelvic injury
Suspected head or spinal injury
Suspected chest injury
SBP <110
HR >90
GCS <15 even if baseline
Lactate >2 or BE <-2
On anticoagulants or has bleeding disorder
Severe pain
Acute SOB
Haemorrhage
Circulation challenges in older pt
Stiffened aorta and peripheral arteries
Incr peripheral vascular resistance
Incr LV thickness
Decr cardiac output
Conduction abnormalities
Less able to incr HR
Arrhythmias may cause a fall
Maximum heart rate at 20 and 60
20 194
60 162
Blunted tachycardia
Older trauma pt may lack compensatory tachycardia with hypervolaemia
Causes of blunted tachycardia in elderly
Catecholamine insensitivity
Athersclerosis
Myocyte fibrosis
Conduction abnormalities
Beta blockers
Calcium channel bLockers
Why are elderly more susceptible to subdural subarachnoid and intra ventricular haemorrhage
Fragile vessels
Shearing stresses
Anticoagulants
Expanded subarachnoid spaces
How does raised ICP presentation differ in elderly pts
Signs less likely to manifest due to brain atrophy
More blood can pool in haematoma or haemorrhage before signs
Why is it more difficult to identify intercranial injury in elderly
May not have hard neuro signs
Medication and comorbidities complicate
Less likely to manifest signs of raised ICP due to brain atrophy
Environment/exposure considerations in elderly
Temp management
Pressure area care
Early imaging
Holistic approach
Lying flat can exacerbate resp condition
Environment without visual cues can bring on delirium
What can prevent injuries being identified in elderly
Distracting injuries
Cognitive impairment, delirium, and communication issues can prevent reporting injury
Less likely to be seen by senior doctors
Less likely to get major trauma team, trauma CT or trigger major trauma pathways
Longer injury time to spdiscovery
Considerations for analgesia and anaesthetics in elderly
May need smaller doses
Less cardiac output may mean drugs take longer to be circulated and have effect
Pain can trigger delirium
Why do elderly people have ‘lower’ physiological boundaries for triage
Less ability to compensate means vital sign derangement may be blunted or absent
○ SBP <110 and
○ HR <90
○ GCS <15 even if baseline
○ Lactate >2 or BE <-2
What can make assessment of pupils difficult in elderly
Blindness
Glass eyes
Why are whole body scans usually better for elderly than selective scans
Less likely to miss injuries
Radiation exposure less likely to be important in elderly
Considerations for contrast/non contrast scans
May have kidney issues
Contrast still indicated if bleed suspected
What investigation should also be done if an elderly pt meets head CT criteria
Neck CT
What condition can increase the change of trauma from minor mechanism
Osteoporosis
Renal differences in elderly pt
Decr GFR
Decr drug clearance time
Diminished acid base balance control
Inefficient concentrating and diluting
Poor RAAS response
Neurological changes in elderly
Decr brain size
Decr functioning neurones
GI changes in elderly
Decr gut motility
Decr bowel absorbtion
Poor nutritional status
Decr body mass
MSK differences in elderly
Decr bone mass and density
Stiffened ligaments and joints
Joint degeneration and cartilage thinning
Loss of muscle bulk and apsarcopenia
Disc degeneration
Signs of occult haemorrhaged
HR >90
SBO <110
Lactate >2.5
What medications may hide a normal shock response
Beta blockers
Anticoagulants
Steroids
What comorbidities increase mortality
Renal impairment
Hepatic impairment
Chronic steroid use
Previous malignancy
Why is there a higher risk of SDH in elderly
Brain atrophy widens subdural compartment, stretching bridging cortical veins making them more susceptible to shearing injury
Increased intracranial bleeding risk factors in elderly
Fragility of vessels
Hypertension
Amyloid angioplasty
Haematological conditions
Alcohol
Anticoagulant use
Spinal changes in elderly
Osteoporosis
Incr spinal rigidity
Spinal injury often multi level
Spinal canal stenosis
Spinal conditions may incr rigidity of mid/lower c spine, and incr mobility of superior c spine
Most common sites of spinal injury in elderly
C1 on c2
Thoracolumbar junction T12-L2
What condition is a major risk factor for vertebral compression fractures
Osteoporosis
Common in post menopausal women
Why is there increased mortality for blunt thoracic trauma in elderly
Finished physiological reserve
Resp compromise
Incr susceptibility to infections
Which pelvic fractures are more common in the elderly
Lateral compression more common than anterior posterior compression fractures
Opposite to normal pattern in younger people
Fracture types more common in elderly
Pathological fractures
Peri prosthetic fractures
What features specific to elderly care should be assessed in all elderly trauma
Cognition
Anticoagulation status
Frailty
Treatment escalation plan
