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25 - Trauma in the Elderly

Published online by Cambridge University Press:  18 January 2010

By
Jeffrey H. Silverstein
Edited by
Charles E. Smith
Jeffrey H. Silverstein
Affiliation:
Department of Anesthesiology, Mount Sinai School of Medicine, New York
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Understand the basic physiology of aging.

  2. Utilize current concepts of elderly trauma outcomes to support triage decisions.

  3. Apply knowledge of those aspects of aging required to design and execute an anesthetic plan for an elderly trauma victim.

When an elderly patient enters the trauma room, what is your first thought? Do you rush to be more aggressive because elderly patients are more fragile and need more immediate and intensive trauma care? Do you question whether the resources and effort necessary to treat such a patient are likely to provide benefit to the patient or society because the functional outcome for such patients is so poor? This chapter seeks to summarize the current knowledge regarding the best approach to elderly trauma victims.

Life expectancy in the United States continues to rise. Persons reaching the age of 65 years have an average life expectancy of an additional 18.1 years (19.4 years for females and 16 years for males) [1]. The retiring baby boomer population is more active than previous generations of elderly, many driving into their 90s and pursuing a variety of activities that increase their exposure to traumatic injury. Unintentional injury is the sixth leading cause of death among patients 65–74 years of age. This and other information can be accessed from the Web-based Injury Statistics Query and Reporting System supported by the Centers for Disease Control and Prevention (http://www.cdc.gov/ncipc/wisqars/)

Type
Chapter
Information
Trauma Anesthesia , pp. 391 - 401
Publisher: Cambridge University Press
Print publication year: 2008

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References

Greenberg S. A Profile of Older Americans: 2005. Administration on Aging, Department of Health and Human Services, Ref Type: Report, 2006.
Rowe, JW, Kahn, RL. Human aging: Usual and successful. Science 1987;237:143–9.CrossRefGoogle ScholarPubMed
Seals, DR, Esler, MD. Human ageing and the sympathoadrenal system. J Physiol 2000;528:407–17.CrossRefGoogle ScholarPubMed
Tsai, H, Buchholz, J, Duckles, SP. Postjunctional alpha 2-adrenoceptors in blood vessels: Effect of age. Eur J Pharmacol 1993;237:311–6.CrossRefGoogle ScholarPubMed
Tsai, H, Pottorf, WJ, Buchholz, JN, Duckles, SP. Adrenergic nerve smooth endoplasmic reticulum calcium buffering declines with age. Neurobiol Aging 1998;19:89–96CrossRefGoogle ScholarPubMed
Lakatta, EG. Cardiovascular reserve capacity in healthy older humans. Aging (Milano) 1994;6:213–23.Google ScholarPubMed
Lakatta, EG. Diminished beta-adrenergic modulation of cardiovascular function in advanced age (Review). Cardiol Clin 1986;4:185–200.Google Scholar
Fleg, JL, Morrell, CH, Bos, AG, Brant, LJ, Talbot, , Wright, JG, Lakatta, EG. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 2005;112:674–82CrossRefGoogle ScholarPubMed
Lakatta, EG, Levy, D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: Aging arteries: A “set up” for vascular disease. Circulation 2003;107:139–46.CrossRefGoogle ScholarPubMed
Lakatta, EG, Levy, D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Part II: The aging heart in health: Links to heart disease. Circulation 2003;107:346–54.CrossRefGoogle ScholarPubMed
Lakatta, EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Part III: Cellular and molecular clues to heart and arterial aging. Circulation 2003;107:490–7.CrossRefGoogle ScholarPubMed
Kitzman, DW, Daniel, KR. Diastolic heart failure in the elderly. Clin Geriatr Med 2007;23:83–106.CrossRefGoogle ScholarPubMed
Djokovic, JL, Hedley-Whyte, J.Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979;242:2301–6.CrossRefGoogle ScholarPubMed
Zaugg, M, Lucchinetti, E. Respiratory function in the elderly. Anesthesiol Clin N Am 2000;18:47–58, vi.CrossRefGoogle ScholarPubMed
Raine, JM, Bishop, JM. A-a difference in O2 tension and physiologic dead space in normal man. J Appl Phyiol 1963;18:284.CrossRefGoogle Scholar
Malmrose, LC, Gray, SL, Pieper, CF, Blazer, DG, Rowe, JW, Seeman, TE, Albert, MS. Measured versus estimated creatinine clearance in a high-functioning elderly sample: MacArthur Foundation Study of Successful Aging. J Am Geriatr Soc 1993;41:715–21.CrossRefGoogle Scholar
Silverstein, JH, Timberger, M, Reich, DL, Uysal, S. Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology 2007;106:622–8.CrossRefGoogle ScholarPubMed
Inouye, SK, Dyck, CH, Alessi, CA, Balkin, S, Siegal, AP, Horwitz, RI. Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941–8.CrossRefGoogle Scholar
Ely, EW, Margolin, R, Francis, J, May, L, Truman, B, Dittus, R, Speroff, T, Gautam, S, Bernard, GR, Inouye, SK. Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370–9.CrossRefGoogle Scholar
Shafer SL. Pharmacokinetics and pharmacodynamics of the elderly. In McLeskey, CH, ed. Geriatric Anesthesiology. Baltimore: Williams & Wilkins, 1997, pp 123–42.Google Scholar
Crooks, J, O'Malley, K, Stevenson, IH. Pharmacokinetics in the elderly. Clin Pharmacokinet 1976;1:280–96.CrossRefGoogle ScholarPubMed
Barrett-Connor, E. The economic and human costs of osteoporotic fracture. Am J Med 1995;98:3S–8.CrossRefGoogle ScholarPubMed
Currie, LM. Fall and injury prevention. Annu Rev Nurs Res 2006;24:39–74.Google ScholarPubMed
Moran, CG, Wenn, RT, Sikand, M, Taylor, AM. Early mortality after hip fracture: Is delay before surgery important?J Bone Joint Surg Am 2005;87:483–9.Google ScholarPubMed
Orosz, GM, Magaziner, J, Hannan, EL, Morrison, RS, Koval, K, Gilbert, M, McLaughlin, M, Halm, EA, Wang, JJ, Litke, A, Silberzweig, SB, Siu, AL. Association of timing of surgery for hip fracture and patient outcomes. JAMA 2004;291:1738–43.CrossRefGoogle ScholarPubMed
Parker, MJ, Handoll, HH. Pre-operative traction for fractures of the proximal femur in adults. Cochrane Database Syst Rev 2006;3:CD000168.CrossRefGoogle Scholar
Matot, I, Oppenheim-Eden, A, Ratrot, R, Baranova, J, Davidson, E, Eylon, S, Peyser, A, Liebergall, M. Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology 2003;98:156–63.CrossRefGoogle ScholarPubMed
Arblaster, GM. Reducing pressure sores after hip fractures. Prof Nurse 1998;13:749–52.Google ScholarPubMed
Gulur, P, Nishimori, M, Ballantyne, JC. Regional anaesthesia versus general anaesthesia, morbidity and mortality. Best Pract Res Clin Anaesthesiol 2006;20:249–63.CrossRefGoogle ScholarPubMed
Parker, MJ, Handoll, HH, Griffiths, R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 2004;CD000521.CrossRefGoogle ScholarPubMed
Brandstrup, B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol 2006;20:265–83.CrossRefGoogle ScholarPubMed
Bunn, F, Alderson, P, Hawkins, V. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev 2003;CD001319.CrossRefGoogle ScholarPubMed
Roberts, I, Alderson, P, Bunn, F, Chinnock, P, Ker, K, Schierhout, G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2004;CD000567.CrossRefGoogle ScholarPubMed
Carson, JL, Duff, A, Berlin, JA, Lawrence, VA, Poses, RM, Huber, EC, O'Hara, DA, Noveck, H, Strom, BL. Perioperative blood transfusion and postoperative mortality [see comments]. JAMA 1998;279:199–205.CrossRefGoogle Scholar
Hebert, PC, Wells, G, Blajchman, MA, Marshall, J, Martin, C, Pagliarello, G, Tweeddale, M, Schweitzer, I, Yetisir, E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409–17.CrossRefGoogle ScholarPubMed
Lawrence, VA, Silverstein, JH, Cornell, JE, Pederson, T, Noveck, H, Carson, JL. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003;43:1717–22.CrossRefGoogle ScholarPubMed
Carson, JL, Terrin, ML, Magaziner, J, Chaitman, BR, Apple, FS, Heck, DA, Sanders, D. Transfusion trigger trial for functional outcomes in cardiovascular patients undergoing surgical hip fracture repair (FOCUS). Transfusion 2006;46:2192–206.CrossRefGoogle Scholar
Price, JD, Sear, JW, Venn, RM. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev 2004;CD003004.CrossRefGoogle ScholarPubMed
Foss, NB, Kristensen, MT, Kristensen, BB, Jensen, PS, Kehlet, H. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery: A randomized, double-blind, placebo-controlled trial. Anesthesiology 2005;102: 1197–204.CrossRefGoogle ScholarPubMed
Foss, NB, Christensen, DS, Krasheninnikoff, M, Kristensen, BB, Kehlet, H. Post-operative rounds by anaesthesiologists after hip fracture surgery: A pilot study. Acta Anaesthesiol Scand 2006;50:437–42.CrossRefGoogle ScholarPubMed
Marcantonio, ER, Flacker, JM, Wright, RJ, Resnick, NM. Reducing delirium after hip fracture: A randomized trial. J Am Geriatr Soc 2001;49:516–22.CrossRefGoogle ScholarPubMed
Beaupre, , Cinats, JG, Senthilselvan, A, Lier, D, Jones, CA, Scharfenberger, A, Johnston, DW, Saunders, LD. Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway. Qual Saf Health Care 2006;15:375–9.CrossRefGoogle ScholarPubMed
Beaupre, , Jones, CA, Saunders, LD, Johnston, DW, Buckingham, J, Majumdar, SR. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 2005;20:1019–25.CrossRefGoogle Scholar
Jacobs, DG, Plaisier, BR, Barie, PS, Hammond, JS, Holevar, MR, Sinclair, KE, Scalea, TM, Wahl, W. Practice management guidelines for geriatric trauma: The EAST Practice Management Guidelines Work Group. J Trauma 2003;54:391–416.CrossRefGoogle ScholarPubMed
Champion, HR, Copes, WS, Sacco, WJ, Lawnick, MM, Keast, SL, Bain, LW Jr, Flanagan, ME, Frey, CF. The Major Trauma Outcome Study: Establishing national norms for trauma care. J Trauma 1990;30:1356–65.CrossRefGoogle ScholarPubMed
Gubler, KD, Davis, R, Koepsell, T, Soderberg, R, Maier, RV, Rivara, FP. Long-term survival of elderly trauma patients. Arch Surg 1997;132:1010–4.CrossRefGoogle ScholarPubMed
Osler, T, Hales, K, Baack, B, Bear, K, Hsi, K, Pathak, D, Demarest, G. Trauma in the elderly. Am J Surg 1988;156:537–43.CrossRefGoogle ScholarPubMed
Richter, M, Pape, HC, Otte, D, Krettek, C. The current status of road user injuries among the elderly in Germany: A medical and technical accident analysis. J Trauma 2005;58:591–5.CrossRefGoogle ScholarPubMed
Carrillo, EH, Richardson, JD, Malias, MA, Cryer, HM, Miller, FB. Long term outcome of blunt trauma care in the elderly. Surg Gynecol Obstet 1993;176:559–64.Google ScholarPubMed
Zietlow, SP, Capizzi, PJ, Bannon, MP, Farnell, MB. Multisystem geriatric trauma. J Trauma 1994;37:985–8.CrossRefGoogle ScholarPubMed
DeMaria, EJ, Kenney, PR, Merriam, MA, Casanova, , Gann, DS. Survival after trauma in geriatric patients. Ann Surg 1987;206:738–43.CrossRefGoogle ScholarPubMed
Day, RJ, Vinen, J, Hewitt-Falls, E. Major trauma outcomes in the elderly. Med J Aust 1994;160:675–8.Google ScholarPubMed
Tiret, L, Desmonts, JM, Hatton, F, Vourch, G. Complications associated with anaesthesia – A prospective survey in France. Can Anaesth Soc J 1986;33:336–44.CrossRefGoogle ScholarPubMed
Milzman, DP, Boulanger, BR, Rodriguez, A, Soderstrom, CA, Mitchell, KA, Magnant, CM. Pre-existing disease in trauma patients: A predictor of fate independent of age and injury severity score. J Trauma 1992;32:236–43.CrossRefGoogle ScholarPubMed
Pellicane, JV, Byrne, K, DeMaria, EJ. Preventable complications and death from multiple organ failure among geriatric trauma victims. J Trauma 1992;33:440–4.CrossRefGoogle ScholarPubMed
Finelli, FC, Jonsson, J, Champion, HR, Morelli, S, Fouty, WJ. A case control study for major trauma in geriatric patients. J Trauma 1989;29:541–8.CrossRefGoogle ScholarPubMed
Ma, MH, MacKenzie, EJ, Alcorta, R, Kelen, GD. Compliance with prehospital triage protocols for major trauma patients. J Trauma 1999;46:168–75.Google ScholarPubMed
Clancy, TV, Ramshaw, DG, Maxwell, JG, Covington, DL, Churchill, MP, Rutledge, R, Oller, DW, Cunningham, PR, Meredith, JW, Thomason, MH, Baker, CC. Management outcomes in splenic injury: A statewide trauma center review. Ann Surg 1997;226:17–24.CrossRefGoogle ScholarPubMed
Scalea, TM, Simon, HM, Duncan, AO, Atweh, NA, Sclafani, SJ, Phillips, TF, Shaftan, GW. Geriatric blunt multiple trauma: Improved survival with early invasive monitoring. J Trauma 1990;30:129–34; discussion 134–6.CrossRefGoogle ScholarPubMed
Harvey, S, Stevens, K, Harrison, D, Young, D, Brampton, W, McCabe, C, Singer, M, Rowan, K. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: A systematic review and a randomised controlled trial. Health Technol Assess 2006;10:1–150.CrossRefGoogle Scholar
Hadian, M, Pinsky, MR. Evidence-based review of the use of the pulmonary artery catheter: Impact data and complications. Crit Care 2006;10(Suppl 3):S8.CrossRefGoogle ScholarPubMed
Heresi, GA, Arroliga, AC, Weidemann, HP, Matthay, MA: Pulmonary artery catheter and fluid management in acute lung injury and the acute respiratory distress syndrome. Clin Chest Med 2006;27:627–35.CrossRefGoogle ScholarPubMed
Shoemaker, WC, Wo, CC, Chien, LC, Lu, K, Ahmadpour, N, Belzberg, H, Demetriades, D. Evaluation of invasive and noninvasive hemodynamic monitoring in trauma patients. J Trauma 2006;61:844–53.CrossRefGoogle ScholarPubMed
Silverstein, JH and Zaugg, M. Chapter 69. Geriatrics Foundations of Anesthesia, 2nd edition. St. Louis, MO: Mosby, 2005.Google Scholar

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  • Trauma in the Elderly
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.028
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  • Trauma in the Elderly
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.028
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Trauma in the Elderly
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.028
Available formats
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