GERIATRIC TRAUMA - 09/09/11

Doi : 10.1016/S0733-8627(05)70358-8

Diku Mandavia, MD, FRCPC ^{^{*
From the Department of Emergency Medicine, Los Angeles County/University of Southern California Medical Center, Los Angeles, California}}, Kim Newton, MD, FACEP ^{^{*
From the Department of Emergency Medicine, Los Angeles County/University of Southern California Medical Center, Los Angeles, California}}

Resumen

The aging of America is progressing, and it is estimated that by the year 2030, 25% of Americans will be over the age of 65 years. Compare this with statistics from 1900, when the elderly represented only 4% of the population, and with 1990, when this population had grown to 14%. ^{7 Chadwick B.A., Heaton T.B. Statistical Handbook on the American Family Phoenix, AZ: Oryx Press (1992).

Haga clic aquí para ir a la sección de Referencias} Medical advances have contributed to geriatric patients being the fastest-growing segment of the general population, thus requiring emergency physicians to be more knowledgeable in their specialized treatment. Just as pediatric and obstetric patients are known to have differing physiology and unique requirements for evaluation and treatment, the elderly patient's altered physiology dictates specialized knowledge and skills to provide for their needs. Trauma in the geriatric patient provides a special challenge for the emergency provider because of the complex way in which these patients respond. Increasing age narrows the “physiologic reserve” of a patient, and this limited reserve can easily be exceeded in the injured geriatric patient.

Although it is easy to categorize geriatric patients by defining them as over the age of 65 years, further subdivision into the “young-old” and the “old-old” is useful. The young-old population includes those patients between the ages of 65 and 80 years, and the old-old refers to patients over the age of 80 years. This distinction has clinical importance because patients older than age 80 have a significantly poorer outcome when injured. ^{10 Demaria E.J. Evaluation and treatment of the elderly trauma victim Clin Geriatr Med 1993 ; 9 : 461

Haga clic aquí para ir a la sección de Referencias, 47 Shabot M.M., Johnson C.L. Outcome from critical care in the “oldest old” trauma patients J Trauma 1995 ; 39 : 254 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Although chronologic age is useful for predicting outcome in this age group, physiologic age plays a significant role and should be considered individually.

Medical advances have allowed people to live longer, healthier, and more active lives. The combination of increased longevity and our highly mechanized society puts the older population at greater risk for trauma exposure. Furthermore, the elderly often continue many activities they engaged in while younger, albeit at a diminished level. They are predisposed to injury partly because of age-related deterioration in hearing and sight. Additionally, poor coordination, imbalance, and weakness further reduce the older person's ability to cope with injury hazard.

The injured older patient consumes a disproportionate amount of healthcare dollars. Although they constitute only 14% of the US population, they consume one third of all trauma healthcare resources. ^{39 Oreskovich M.R., Howard J.D., Copass M.K. , y al. Geriatric trauma: Injury patterns and outcome J Trauma 1984 ; 24 : 565 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Elderly patients are more likely to be hospitalized than are younger patients, and their hospital stays are often longer and more complicated. Despite the greater use of resources, elderly patients maintain a higher mortality rate when compared with younger cohorts matched for Injury Severity Score (ISS). ^{40 Osler T., Hales K., Baack B. , y al. Trauma in the elderly Am J Surg 1988 ; 156 : 537 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Trauma is the seventh leading cause of death in patients over 65 years of age. ^{38 National Safety Council Accident Facts Itasca, IL: National Safety Council (1996).

Haga clic aquí para ir a la sección de Referencias} This increased mortality is largely a reflection of diminished physiologic reserve associated with the aging process. ^{52 Zietlow S.P., Capizzi P.J., Bannon M.P. , y al. Multisystem geriatric trauma J Trauma 1994 ; 37 : 985 [cross-ref]

Haga clic aquí para ir a la sección de Referencias}

El texto completo de este artículo está disponible en PDF.

Esquema

Address reprint requests to Diku Mandavia, MD Department of Emergency Medicine Room 1011, General Hospital LAC/USC Medical Center 1200 North State Street Los Angeles, CA 90033