**2.3. Common mechanisms of injury**

The common causes of geriatric trauma include falls, motor vehicle collisions, pedestrian injuries and thermal injuries and elder abuse (**Figure 1**).

**Falls** remain the leading cause of geriatric trauma and affect approximately 30% of persons aged ≥65 years each year [17]. Approximately 50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls [18]. Women experience significantly more fall-related injuries than men (35.7 vs.24.6%, respectively) [19]. Falls account for 40% of all injury-associated deaths [20]. Predisposing risk factors include age-related changes in muscle strength, gait and balance, poor vision and home hazards. İn addition, drugs and alcohol may contribute to falls. Anticoagulants usage are frequent in elderly and it may cause potentially lethal injuries even with minor traumas. Osteoporosis and the tendency to fall increase the risk of hip fractures. Also, falls are the most common cause of traumatic brain injury in the elderly. Even when those injuries are minor, they seriously affect older

**Organ system** Respiratory system

**Age-related alterations**

Elastin component of the lung matrix

type III collagen [5].

Pulmonary compliance

Osteoporosis

Stiffness of the thoracic cage

Outward recoil

Kyphosis [6].

Chest wall compliance

Thickening of the alveolar basement membrane [7].

Diffusion capacity

Gas change

Muscle atrophy

Respiratory muscle weakness [8].

Vascular stiffness

Elevated baseline blood pressure

Atherosclerosis of coronary vessel

Risk for cardiac ischemia

Increased risk of dysrhythmias

Impaired cardiac reserve

Cardiac index

Lack of classic response to hypovolemia

Left ventricle (LV) wall thickness

[10].

Retarded early diastolic cardiac filling and

LV diastolic function

Afterload

Left atrial size

myocyte mass with

deposition of amyloid and collagen

Deterioration of the cardiac conduction

Decreased sensitivity to catecholamines

Maximal heart rate

Maximum tachycardia response [11].

Geriatric Trauma

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Circulatory system

**Clinical consequences**

Risk for pneumonia [5]

Poor tolerance to rib fractures

Work of breathing

Risk for respiratory failure [8].

Forced expiratory volume in one second (FEV1)

Forced vital capacity (FVC)

FEV1/FVC [9].

Functional residual capacity (FRC)

Residual volume (RV)

Vital capacity (VC)


Geriatric trauma patients are less likely to be injured than younger people; however, they are more likely to have fatal outcomes. Death rates for Americans have decreased in the last century. Although there is a dramatic decline in deaths from cardiovascular diseseas, heart diseases remain the leading cause of deaths in the elderly. Also, trauma became the more common cause of death. According to the National Center for Health Statistics 2015 report,

Aging is characterized by a progressive loss of physiological integrity, leading to impaired function and increased vulnerability to death [3]. This multifactorial and extremely complex process results in significant anatomic and functional changes in all major organ systems.

**Airway**: The anatomy and physiology of the airway are affected with the aging process. Tooth decay which is common in elderly may cause loose, dislodged and subsequently aspiration of the teeth during emergency procedures such as endotracheal intubation (ET). Esthetic operations and loss of teeth interfere with achieving a good face-mask seal. Pharynx becomes more dry and fragile and care must be taken to prevent profuse bleeding while using laryngoscope. Oral cavity tumors and macroglossia may limit visualization of the vocal cords. Usage of Miller blade can be considered [4]. Also, cervical osteoarthritis increases the risk for spinal

The common causes of geriatric trauma include falls, motor vehicle collisions, pedestrian inju-

**Falls** remain the leading cause of geriatric trauma and affect approximately 30% of persons aged ≥65 years each year [17]. Approximately 50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls [18]. Women experience significantly more fall-related injuries than men (35.7 vs.24.6%, respectively) [19]. Falls account for 40% of all injury-associated deaths [20]. Predisposing risk factors include age-related changes in muscle strength, gait and balance, poor vision and home hazards. İn addition, drugs and alcohol may contribute to falls. Anticoagulants usage are frequent in elderly and it may cause potentially lethal injuries even with minor traumas. Osteoporosis and the tendency to fall increase the risk of hip fractures. Also, falls are the most common cause of traumatic brain injury in the elderly. Even when those injuries are minor, they seriously affect older

unintentional injuries became the seventh common cause of death in the elderly [2].

Most important systems which are affected are seen in **Table 1**.

cord injury. Excessive movement of the neck should be avoided.

**Age-related alterations:** See **Table 1.**

**2.3. Common mechanisms of injury**

ries and thermal injuries and elder abuse (**Figure 1**).

**2.2. Age-related alterations and clinical consequences**

**2. Pathophysiology**

**2.1. What is aging?**

116 Trauma Surgery


**Table 1.** Age-related alterations and their clinical consequences.

adults' quality of life by inducing a fear of falling, which can lead to self-imposed activity

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[64].

**Motor vehicle collision** involving elderly continue to increase. Age-related changes that include vision and hearing impairment, decreased night vision and glare resistance are the prominent factors on the incidence of injury and death. Additionally, medical conditions and medications may distort the reaction time, attention and judgment which increase the risk for

**Pedestrian injuries:** according to the 2015 pedestrian data, 19% of all pedestrian fatalities and an estimated 13% of all pedestrians injured were people aged 65 and older in the United States, and pedestrian-motor vehicle collisions are one of the most lethal mechanisms of

**Thermal injuries:** There is a direct relationship between age and burn mortality, as evidenced by the traditionally taught BauxScore. The empiric formula is clearly the simplest, whereby the sum of the patient's age and burn size predict mortality. Based on the data from the American Burn Association (ABA) National Burn Repository (NBR) from 2000 to 2009, overall

restrictions, anxiety, social withdraw and depression [21].

**Figure 1.** Common causes of falls in the elderly

injury in this age group with a 53% case fatality rate [22].

the collision.


**Figure 1.** Common causes of falls in the elderly [64].

**Organ system** Musculoskeletal system

Spontaneous rupture

Joint stability

ineffective repair of cartilage tissue

Osteoarthritis (cervical, temporomandibular)

Bone volume-mass

Muscle size-number [12].

Osteoporosis

Sarcopenia

Nutrition and metabolism

Taste acuity, smell and appetite decrease

Food intake [13].

Less contusions

Clinical signs may manifest late

More subdural hematoma

Vision and auditory functions [16].

Reaction time

Attention span

Less epidural hematoma

Risk for spine and spinal cord injury

Poor dentition

Inability to eat independently

Brain volume decreases

Replaced by cerebrospinal fluid [14].

Protection against contusions

Blood can be collected

Parasagittal bridging veins stretch

More prone to tear injury

Demyelination

Peripheral conduction velocity slows

Dura adheres to the skull more tightly

Cerebral blood flow

Cerebral oxygen consumption [15].

Degeneration of vertebras, intervertebral disks and facet joints.

**Table 1.**

Age-related alterations and their clinical consequences.

Central nervous system

**Age-related alterations**

Stiffening of structural instruments (tendons, ligaments, cartilage)

**Clinical consequences**

118 Trauma Surgery

Risk of injury

Risk of fracture

Difficulty for oral intubation

Risk of falls

Mobility

adults' quality of life by inducing a fear of falling, which can lead to self-imposed activity restrictions, anxiety, social withdraw and depression [21].

**Motor vehicle collision** involving elderly continue to increase. Age-related changes that include vision and hearing impairment, decreased night vision and glare resistance are the prominent factors on the incidence of injury and death. Additionally, medical conditions and medications may distort the reaction time, attention and judgment which increase the risk for the collision.

**Pedestrian injuries:** according to the 2015 pedestrian data, 19% of all pedestrian fatalities and an estimated 13% of all pedestrians injured were people aged 65 and older in the United States, and pedestrian-motor vehicle collisions are one of the most lethal mechanisms of injury in this age group with a 53% case fatality rate [22].

**Thermal injuries:** There is a direct relationship between age and burn mortality, as evidenced by the traditionally taught BauxScore. The empiric formula is clearly the simplest, whereby the sum of the patient's age and burn size predict mortality. Based on the data from the American Burn Association (ABA) National Burn Repository (NBR) from 2000 to 2009, overall mortality was 4% in all age groups and 17% in seniors [23]. Moreover, for seniors there is a greater increase in mortality risk for every 1% increase in burn size and 1-year increase in age than among adults [23].
