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Geriatric trauma: Initial evaluation and management

Christopher Colwell, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


In almost every developed country, the proportion of people over 60 years of age is growing faster than any other age group, as a result of longer life expectancy and declining birth rates [1]. As a result, more elderly individuals are presenting to emergency departments following trauma [2]. In addition, advances in the care of chronic diseases have increased the number of elderly people with active lifestyles, which predispose them to injury [3].

Although trauma remains a leading cause of morbidity and mortality across all ages, geriatric patients differ significantly from their younger counterparts in their greater number of comorbidities [4,5], and higher risk of severe disability and death [6,7]. Elder patients are more susceptible to injury from minor mechanisms and less able to compensate from any injury. To manage their chronic ailments, elder patients are more likely to take multiple medications, some of which may blunt their response to the physiologic stress of trauma and increase their risk for complications [8].

This topic will review important issues involved in the initial assessment and management of trauma in elder patients. Detailed discussions of trauma care in the adult and of the management of specific injuries are found separately. (See "Initial management of trauma in adults".)


Debate continues regarding the exact age at which a trauma patient should be considered elder, with suggestions starting as low as 50 [9]. One large observational study showed increased mortality, adjusted for injury severity, starting at age 70, suggesting this age is an appropriate cutoff for defining the elder population [9]. As most studies use 65 as the threshold to define the geriatric patient (albeit often without providing evidence to support the choice), we too will use this age for the purposes of the following discussion.

It is likely more important to consider the patient's age in the context of their overall health when determining their relative risk of injury following trauma than to consider age alone. Observational studies suggest that frail older trauma patients fare worse than their healthier counterparts and that pre-existing comorbidities may be more important that chronological age [10-12].


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Literature review current through: Jan 2017. | This topic last updated: Fri Feb 10 00:00:00 GMT 2017.
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