Elderly People And Frailty Flashcards

1
Q

What percentage of trauma patients are over 65

A

52%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common mechanism of trauma in older people

A

Fail from <2m eg from standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does TBI present differently in older people

A

Often have higher GCS than younger people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why may older pts recieve less specialist trauma care

A

Poor prehospital and ED identification of injuries as major trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Challenges for airway in older people

A

Damaged or missing teeth
Thin fragile lips
Inability to open mouth widely
TMJ disease
Arthritis
Oropharyngeal cancers
Shirt stiff neck
Thyroid masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why should there be high suspicion for cervical spine injuries in elderly pts

A

Pre existing degenerative spinal disease
May be alert and have normal neurology
X ray interpretation may be challenging due to degen disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

First line imaging modality for neck in elderly

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of prolonged immobilisation in elderly

A

Pressure ulcers
Pneumonia
Respiratory failure
Dysphagia
Delirium
Raised ICP
Lying flat can worsen resp conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Imaging considerations for elderly trauma

A

Assessment imaging and image reporting within 2 hours
Movement restrictions clearly documented
Specialist esce,action for challenging interpretation of imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Breathing challenges in older people

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What factors should trigger a trauma call and immediate consultant/reg review in a pt over 65 with an obvious injury or MOI

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Circulation challenges in older pt

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Maximum heart rate at 20 and 60

A

20 194
60 162

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blunted tachycardia

A

Older trauma pt may lack compensatory tachycardia with hypervolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of blunted tachycardia in elderly

A

Catecholamine insensitivity
Athersclerosis
Myocyte fibrosis
Conduction abnormalities
Beta blockers
Calcium channel bLockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why are elderly more susceptible to subdural subarachnoid and intra ventricular haemorrhage

A

Fragile vessels
Shearing stresses
Anticoagulants
Expanded subarachnoid spaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does raised ICP presentation differ in elderly pts

A

Signs less likely to manifest due to brain atrophy
More blood can pool in haematoma or haemorrhage before signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is it more difficult to identify intercranial injury in elderly

A

May not have hard neuro signs
Medication and comorbidities complicate
Less likely to manifest signs of raised ICP due to brain atrophy

19
Q

Environment/exposure considerations in elderly

A

Temp management
Pressure area care
Early imaging
Holistic approach
Lying flat can exacerbate resp condition
Environment without visual cues can bring on delirium

20
Q

What can prevent injuries being identified in elderly

A

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

21
Q

Considerations for analgesia and anaesthetics in elderly

A

May need smaller doses
Less cardiac output may mean drugs take longer to be circulated and have effect
Pain can trigger delirium

22
Q

Why do elderly people have ‘lower’ physiological boundaries for triage

A

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

23
Q

What can make assessment of pupils difficult in elderly

A

Blindness
Glass eyes

24
Q

Why are whole body scans usually better for elderly than selective scans

A

Less likely to miss injuries
Radiation exposure less likely to be important in elderly

25
Considerations for contrast/non contrast scans
May have kidney issues Contrast still indicated if bleed suspected
26
What investigation should also be done if an elderly pt meets head CT criteria
Neck CT
27
What condition can increase the change of trauma from minor mechanism
Osteoporosis
28
Renal differences in elderly pt
Decr GFR Decr drug clearance time Diminished acid base balance control Inefficient concentrating and diluting Poor RAAS response
29
Neurological changes in elderly
Decr brain size Decr functioning neurones
30
GI changes in elderly
Decr gut motility Decr bowel absorbtion Poor nutritional status Decr body mass
31
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
32
Signs of occult haemorrhaged
HR >90 SBO <110 Lactate >2.5
33
What medications may hide a normal shock response
Beta blockers Anticoagulants Steroids
34
What comorbidities increase mortality
Renal impairment Hepatic impairment Chronic steroid use Previous malignancy
35
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
36
Increased intracranial bleeding risk factors in elderly
Fragility of vessels Hypertension Amyloid angioplasty Haematological conditions Alcohol Anticoagulant use
37
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
38
Most common sites of spinal injury in elderly
C1 on c2 Thoracolumbar junction T12-L2
39
What condition is a major risk factor for vertebral compression fractures
Osteoporosis Common in post menopausal women
40
Why is there increased mortality for blunt thoracic trauma in elderly
Finished physiological reserve Resp compromise Incr susceptibility to infections
41
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
42
Fracture types more common in elderly
Pathological fractures Peri prosthetic fractures
43
What features specific to elderly care should be assessed in all elderly trauma
Cognition Anticoagulation status Frailty Treatment escalation plan