Traumatic injury in the older adult from head to toe

Abstract

This review demonstrates essential issues to consider when caring for older trauma patients, including baseline physical status, mental health, comorbidities, and risk factors for sequelae and future injuries. The impact of a traumatic injury on older adults is complex. Issues of normal aging, functional status, chronic health conditions, and response to treatment affect health care and related decisions. Studies that have examined outcomes for older trauma patients to date have been mainly descriptive or confined to a single institution, limiting our ability to generalize. Other studies, using large data sets, have provided some information regarding possible primary prevention strategies, yet have limitations in the individual level detail collected. Nevertheless, this review also demonstrates the dearth of available evidence-based recommendations that provides support to treatment protocols in this complex and diverse patient population. The lack of an evidence base to use in the management of older trauma patients demonstrates the critical need for research in this rapidly growing population. An example of one such area includes the use of pulmonary artery catheters in older trauma patients. Although evidence to date suggests that pulmonary artery catheters are of benefit in the management of patients with physiologic compromise, it is unclear whether using these published cardiac output management recommendations leads to improved outcomes. In light of newly published data suggesting equivocal benefit from use of pulmonary artery catheters, with increased side effects, this controversy is an important area for future research. Critical care nurses, with their emphasis on multidisciplinary, holistic practice, can expand their influence as essential members of the interdisciplinary team caring for older trauma patients by cultivating geriatric specialty knowledge. Older trauma patients would benefit greatly from this type of specialty nursing care during all phases of the recovery trajectory, particularly in terms of adequate symptom management and prevention of sequelae, as well as with timely and appropriate initiation of consultative services. Using the intersection of primary and secondary prevention as the overall guide for practice, critical care nurses and other health care providers who possess an understanding of aging processes and comorbid conditions can significantly improve outcomes for older adults with traumatic injuries.