CHICAGO: Recognizing the unique challenges and increasing incidence of trauma in the geriatric population, the American College of Surgeons (ACS) has announced a comprehensive set of guidelines designed to optimize trauma care for older adults.
As the United States sees a rise in the number of older adults, in 2019 making up 16% of the population, the ACS has responded to the urgent need for specialized trauma care practices for this group. By 2040, older adults are projected to represent 21.6% of the U.S. population, translating into a significant increase in geriatric trauma cases.1-2 Unintentional injuries are not only the seventh leading cause of death among this demographic but also lead to poorer outcomes compared to younger individuals, with age being an independent risk factor for mortality.3-8
The new guidelines, titled Best Practices Guidelines in Geriatric Trauma Management, aim to address critical aspects of care for injured older adults (aged 65 years and above) who present unique vulnerabilities such as diminished strength and endurance and unreliable vital sign measures.
Avery Nathens, MD, PhD, FACS, the medical director of Trauma Quality Programs, underscores the evolution of care quality, stating, “The population we care for in trauma centers has changed significantly over the past decade, with a greater proportion of older patients. That we are caring for so many seniors is a wonderful testament to healthy and active aging. These guidelines, in concert with our new standards on geriatric trauma, recognize the unique needs of older trauma patients and will improve the quality of trauma care so that patients have the best chance of getting back to their activities at home with their friends and families.”
Key points from the guidelines include:
- Falls Prevention: Falls remain the leading cause of both non-fatal and fatal injuries in older adults. The guidelines emphasize the need for fall prevention strategies as a cornerstone of geriatric trauma care.
- Tailored Criteria: The type of injury sustained and vital signs may not always accurately help trauma departments triage older adult patients. The ACS recommends specific geriatric criteria to better support and more accurately prioritize patient care in the geriatric population.
- Interdisciplinary Approach: Calling for an interdisciplinary approach from the emergency department onwards, the guidelines advocate for comprehensive care considering the geriatric spectrum of needs.
- Emphasis on Gentle Care: A recommendation for a slow, gentle approach to treatment is emphasized, considering the potential confusion caused by removing visual and auditory aids during care.
The ACS’s new Best Practices Guidelines in Geriatric Trauma Management is grounded in the latest research and expert consensus. They provide a vital resource to trauma centers and healthcare professionals, ensuring the growing population of older adults receive trauma care that addresses their unique needs, improves outcomes, and reduces mortality.
The original Best Practices Guidelines in Geriatric Trauma Management was launched in 2013. The full revised guidelines are available on the ACS website and provide a detailed framework for implementing these new best practices.
References
1. Administration for Community Living. 2020 Profile of Older Americans. US Department of Health and Human Services. May 2021. Accessed September 18, 2021. https://acl.gov/sites/default/files/Aging%20 and%20Disability%20in%20America/2020ProfileOlderAmericans. Final_.pdf.
2. Centers for Disease Control and Prevention. Leading Causes of Death Reports 1981–2018. 2020. Accessed September 2, 2020. www.cdc.gov/ injury/wisqars/pdf/leading causes of death by age group 2018-a.pdf.
3. Kozar RA, Arbabi S, Stein DM, et al. Injury in the aged: geriatric trauma care at the crossroads. J Trauma Acute Care Surg. 2015;78(6):1197–1209. doi:10.1097/TA.0000000000000656.
4. Gerrish AW, Hamill ME, Love KM, et al. Postdischarge mortality after geriatric low-level falls: a five-year analysis. Am Surg. 2018;84(8):12721276.
5. Labib N, Nouh T, Winocour S, et al. Severely injured geriatric population: morbidity, mortality, and risk factors. J Trauma. 2011;71(6):1908–1914. doi:10.1097/TA.0b013e31820989ed.
6. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76(3):894–901. doi:10.1097/TA.0b013e3182ab0763.
7. Brown CVR, Rix K, Klein AL, et al. A comprehensive investigation of comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. Am Surg. 2016;82(11):1055–1062.
8. Gowing R, Jain MK. Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario. Can J Surg. 2007;50(6):437444.
