Silver Trauma

• Elderly patients should receive the same trauma care following admission to that given to younger patients.
• Advanced age is not an absolute predictor of poor outcomes following trauma and should not be used as the sole criterion for denying or limiting care.
• An initial aggressive approach should be pursued for management of the elderly patient unless in the judgement of an experienced consultant the injury burden is severe, and the patient appears moribund.

• Elderly patients can experience significant injury despite a trivial mechanism of injury.
• Physiological response in elderly patients may be different to that of younger patients, for several reasons.
• Under triage by ambulance staff and ED staff can double the risk of death.
• Consider a trauma team activation for all trauma patients aged over 65. At ARI we have developed the following tool to aid decision making in the elderly trauma patient.

• Determine medications early - anti-coagulants, anti-platelets and anti-hypertensives.
• Consider medical conditions which may have contributed to the trauma:
  • ACS
  • Hypovolemia / dehydration
  • UTI (Urinary Tract Infection)
  • Pneumonia
  • Acute Kidney Injury
  • Cerebrovascular event
  • Syncope
• Hypo-perfusion is under-appreciated in the elderly. Utilise lactate and BE to guide your assessment.

CT should be used liberally in elderly trauma as occult injuries are common and radiation exposure has minimal risk.