Older adults who suffer traumatic injuries have worse outcomes than younger patients. In this episode Dr. Zara Cooper (acute care and trauma surgeon at Brigham and Women’s hospital) and I discuss some of the reasons for this, and also ways to avoid missing injuries in older adults. Falls are the most common cause of trauma in older patients, and understanding how falls are a geriatric syndrome can help you understand how to help prevent future falls.

There are lots of references for this talk!

1. Flanagan SR, Hibbard MR, Riordan B, Gordon WA. Traumatic brain injury in the elderly: Diagnostic and treatment challenges. Clin Geriatr Med. 2006;22(2):449-68; x. doi: S0749-0690(05)00101-1
2. Filer W, Harris M. Falls and traumatic brain injury among older adults. N C Med J. 2015;76(2):111-114. doi: 76212
3. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: Epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54(10):1590-1595. doi: JGS894
4. LeBlanc J, de Guise E, Gosselin N, Feyz M. Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury. Brain Inj. 2006;20(8):779-790. doi: J01222288L4N2014
5. Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61(2):218-223. doi: BCP2543
6. Harvey LA, Close JC. Traumatic brain injury in older adults: Characteristics, causes and consequences. Injury. 2012;43(11):1821-1826. doi: 10.1016/j.injury.2012.07.188 [doi].
7. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-6; PMID 10866248 
8. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: The breakpoint for mortality. Surgery. 2005;138(4):717-23; PMID 16269301
9. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis. Injury. 2012;43(1):8-17. PMID 21256488 
10. Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905-911. PMID 18404055
11. Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004;136(2):426-430. PMID 15300210
12. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: A systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009;56(3):230-242. PMID 19247744 
13. Duch P, Moller MH. Epidural analgesia in patients with traumatic rib fractures: A systematic review of randomised controlled trials. Acta Anaesthesiol Scand. 2015. PMID 25683770
14. Todd SR, McNally MM, Holcomb JB, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg. 2006;192(6):806-811. PMID 17161098
15. Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: Excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380-390.
16. Peck et al. Death after discharge: predictors of mortality in older brain injured patients. J Trauma Acute Care Surg 77;6, 2014
17. Tinetti ME, Inouye SK, Gill TM, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995;273(3):1348–1353.
18. ACEP guidelines on TBI Neuroimaging and Decisionmaking 2008 http://www.acep.org/MobileArticle.aspx?id=48423&coll_id=618&parentid=
19. Zia et al. Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk. Postgrad Med 2015127 (3)
20. De Jong et al. Drug-related falls in older patients: implicated drugs, consequences and possible prevention strategies. 2013 Ther Adv Drug Saf 4(4)
21. Woolcott et al. Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons. 2009 JAMA Int Med 169(21)
22. The MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008 http://www.crash.lshtm.ac.uk/Risk%20calculator/index.html
23. Heffernan D, Thakkar R, Monaghan S, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010;69(4):813-820. [PubMed]
24. Salottolo K, Mains C, Offner P, Bourg P, Bar-Or D. A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs. Scand J Trauma Resusc Emerg Med. 2013;21:7. [PubMed]
25. Neville A, Nemtsev D, Manasrah R, Bricker S, Putnam B. Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg. 2011;77(10):1337-1341. [PubMed]
26. Martin J, Alkhoury F, O’Connor J, Kyriakides T, Bonadies J. “Normal” vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010;76(1):65-69. [PubMed]
27. Callaway D, Shapiro N, Donnino M, Baker C, Rosen C. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66(4):1040-1044. [PubMed]
28. Eastridge B, Salinas J, McManus J, et al. Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291-7; discussion 297-9. [PubMed]

This podcast uses sounds from freesound.org by Jobro and HerbertBoland.
Image is from: [1]