Outcome from critical care in the "oldest old" trauma patients

Outcome in elderly injured patients: injury severity versus host factors

To evaluate the differences between the outcome of elderly patients with severe injuries and that of their contemporaries with a less severe injury, we reviewed 42 severely injured elderly patients and compared them with 76 patients with a femoral neck fracture. We analysed the influence of injury severity and host factors (age, sex and pre-injury medical status) on outcome. The in-hospital mortality rate was 31 per cent in the severely injured patients and 3 per cent in those with a femoral neck fracture. Home was the main discharge destination in the severely injured elderly (34 per cent) and a nursing home in patients with a femoral neck fracture (65 per cent). Functional outcome 1 year after injury was better in the severely injured elderly group. Long-term survival was mainly determined by host factors and not by injury severity. Physicians and policy makers should be careful in predicting the outcome of elderly injured patients merely on the basis of injury severity, because host factors are of greater importance.

Care of the traumatized older adult

Older adults are experiencing excellent health and maintaining active lifestyles. They continue to engage in the activities they have enjoyed throughout their lives, but as they grow older they are at increased risk for injury related to these activities. Older adults suffer injuries of equivalent severity as those of younger patients; however, the consequences are much more severe. The older adult presents a unique and complex scenario that requires nurses to understand the normal physiological changes of aging and the effects of chronic disease. This article provides guidelines for the emergency care of the older adult patient with trauma and emphasizes areas that require special considerations.