Geriatric trauma

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Geriatric trauma
23659-1511JEMS Geriatric1.jpg
Medical personnel attend to geriatric trauma patient.
Specialty Emergency medicine

Geriatric trauma refers to a traumatic injury that occurs to an elderly person. People around the world are living longer than ever. In developed and underdeveloped countries, the pace of population aging is increasing. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. [1] While this trend presents opportunities for productivity and additional experiences, it also comes with its own set of challenges for health systems. More so than ever, elderly populations are presenting to the Emergency Department following traumatic injury. [2] In addition, given advances in the management of chronic illnesses, more elderly adults are living active lifestyles and are at risk of traumatic injury. In the United States, this population accounts for 14% of all traumatic injuries, of which a majority are just mainly from falls. [3]

Contents

Trauma is a leading cause of morbidity and mortality across all age groups, however, geriatric populations are unique compared to younger counterparts in the amount of existing health issues and inherent risk of disability and death. [4] As a whole, older populations are more vulnerable to trauma from minor mechanisms of injury and less able to recover following injury. [5] At the same time, medications to manage existing chronic conditions and co-morbidities may negatively affect older adults’ physiological responses to traumatic injuries and increase the risk for complications later on. [6]

Risk Factors

Biomechanics of injury

A progressive decline in central nervous system function leads to a loss of proprioception, balance and overall motor coordination, as well as a reduction in eye–hand coordination, reaction time and an unsteady gait. [7] These degenerative changes are often accompanied by osteoarthritis (degenerative joint disease), which leads to a reduction in the range of motion of the head, neck and extremities. Furthermore, elderly people frequently take multiple medications for control of various diseases and conditions. The side effects of some of these medications may either predispose to injury, or may cause a minor trauma to result in a much more severe condition. For example, a person taking warfarin (Coumadin) and/or clopidogrel (Plavix) may experience a life-threatening intracranial hemorrhage after sustaining a relatively minor closed head injury, as a result of the defect in the hemostatic mechanism caused by such medications. The combined effects of these changes greatly predisposes elderly people to traumatic injury. Both the incidence of falls and the severity of associated complications increase with advancing age. [7]

Physiologic differences in the elderly

Virtually all organ systems experience a progressive decline in function as a result of the aging process. [8] [9] One example is a decline in circulatory system function caused in part by thickening of the cardiac muscle. This can lead to congestive heart failure or pulmonary edema. [10] [11] Another example is the decline in muscle mass, which although highly variable among individuals, rapidly speeds up in older age and can decreases up to 50% when compared to the weight of the individual. [12] This loss of muscle mass can compromise the elderly adult's ability to maintain a straight posture. [13]

Atrophy of the brain begins to accelerate at around seventy years of age, [11] which leads to a significant reduction in brain mass. Since the skull does not decrease in size with the brain, there is significant space between the two when this occurs which puts the elderly at a higher risk of a subdural hematoma after sustaining a closed head injury. [9] The reduction of brain size can lead to issues with eyesight, cognition and hearing. [11]

Falls

Because falls are the most common mechanism of injury in severely injured geriatric patients, [14] the risk factors for geriatric trauma overlap significantly with those that predispose older adults to falls. Falls may often be described as “mechanical” or “non-mechanical.” A “mechanical fall” implies that an object or force in the patient's external environment caused the fall to occur. However, the use of this term may result in a failure to conduct a thorough evaluation of intrinsic factors related to the fall. Even in cases of community-dwelling older adults experiencing falls related to slipping, tripping, or stumbling, the patients’ co-morbidities and health status are often involved. In addition, a proportion of patients with reported “non-mechanical falls” have been shown to have environmental factors. [15] For this reason, it is crucial to consider the interactions between environmental hazards and increased individual susceptibility from the accumulated effects of intrinsic risk factors when evaluating why a fall occurred in an older adult.

From a meta-analysis examining risk factors for falls in both community-dwelling and institutionalized populations, the most common intrinsic determinants of falls risks include: [16]

Other important intrinsic risk factors for falls indicated by other studies include peripheral nerve dysfunction with postural instability, [17] use of sedatives, hypnotics, antidepressants, benzodiazepines, [18] and vasodilators, [19] and history of problem drinking. [20]

Lastly, in one study, home modifications like adding handrails for outside and inside stairs, grab rails for bathrooms, outdoor lighting, and slip-resistant floors was shown to cause a 26% reduction in the rate of injuries caused by falls at home per year compared to a control group without these interventions. This demonstrates the value in creating a more accommodating and safe home environment for a community-dwelling elder, especially if they have several intrinsic risk factors for falls. [21] Another study found a lower risk of falls associated with wearing athletic shoes and canvas shoes compared to other types of footwear including slippers, sandals, and high heels. [22]

Motor Vehicle Crashes

Motor vehicle crashes are the second most frequent mechanism of injury to explain trauma in older adults. [23] Risk factors that affect driving performance in older adults include:

Burns

Although the survivability of burn injuries continues to improve across all age groups, this improvement may be less for older burn victims. This observation may be attributable to a greater degree of co-morbidities and slow wound healing that result in an increased length of stay and higher mortality in the elderly compared to patients less than 60 years. [31] Therefore, it is important to recognize and address risk factors that predispose older adults to burns.

Factors that increase the risk of incurring burn injury in older adults include:

Elder Abuse

Geriatric trauma may be caused by elder physical, emotional, or sexual abuse, resulting in an increased risk of death at the end of a 13-year follow-up period in one study. [35] According to a published uniform definition from the National Center for Injury Prevention and Control, Division of Violence Prevention, elder abuse is “an intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.” [36]

To prevent or identify patients who may experience elder abuse, it is crucial to identify which older adults are at an increased risk. Some findings correlated with risk of elder mistreatment are presented below:

Types of Injuries

Falls and motor vehicle crashes are the most common types of injuries among geriatric adults. As a whole, older populations are more vulnerable to mortality from all causes of trauma given that they are less able to compensate following injury. [5]

Falls account for three-quarters of all trauma in this population. [14] In one review, the estimated probability of falling at least once in any given year for individuals 65 years and older was 27%. [41] One out of five falls causes a serious injury such as broken bones or a head injury. [42] In the United States, over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture. [43]

Motor vehicle crashes are the second most common mechanism of injury among geriatric adults, and the most common cause of traumatic mortality. [44] Of the possible injuries, older adults are especially at risk of chest injuries (such as rib fractures) which may negatively interact with existing cardiopulmonary comorbidities—increasing the risk of complications like pneumonia and respiratory failure. [45] In addition, the highest mortality rate in geriatric trauma is among older pedestrians struck by a vehicle.

Burns are also especially dangerous in geriatric populations. Relating back to physiology, comorbidities and slow wound healing can result in an increase length of stay, and higher mortality in the elderly compared to patients less than 60 yr of age. [46]

Falls

Falls are the most common cause of injury in older adults. According to the Behavior Risk Factor Surveillance System in 2018, approximately 28 percent of individuals aver 65 years old reported a fall within the last year. This would account for approximately 36 million falls, of which approximately 8.4 million resulted in injuries. [47] These falls are often underreported and can significantly threaten the individual's independence.  

Every year, about 5 percent of falls result in hospitalizations in the geriatric population. These injuries lead to an increase in morbidity and a greater likelihood that they will be admitted to a nursing home. [48] Approximately 95 percent of all hip fractures reported are due to an unforeseen fall and 25-75 percent of those do not recover fully to the mobility they had prior to the fall. [49] Of those older adults who fall, only about half are able to stand back up on their own, the other half experience a “long lie” which makes them more likely to experience a steeper decline on their activities of daily living than those who are able to stand back up on their own. [50] Furthermore, the medical complications arising from these falls make it so that they become the leading cause of death from injury in populations over 65 years old and fifth overall cause of death.

As a result of a fall, older adults can also experience post-fall anxiety syndrome. This fear of falling was present in 60 percent of community dwelling geriatric populations, and was demonstrated by their reduction in levels of activity; 15 percent of which severely restricted their mobility out of fear of having another fall. [51] This further contributes to morbidity because it can contribute to cognitive impairment, depression, isolation, increase in rates of obesity, and further mobility impairment.  

Burns [52]

The geriatric population is at increased risk for burn injury. While geriatric burns account for less than 5% of burns in developing countries, nearly 20% of burns in developed countries are experienced by the geriatric population. These burn injuries tend to occur at home—particularly in the kitchen or the bathroom—and most commonly consist of flame and scald burns.

Importantly, geriatric patients are at increased risk for downstream complications. This is in part due to limited mobility, decreased ability to react rapidly to threats, and pre-existing medical problems such as vision impairment and medication side effects. Additionally, due to the natural processes of aging, the skin of geriatric patients has impaired mechanisms to protect against burns, including impaired neurosensory sensitivity, skin permeability, and regeneration capacity. These impairments lead to deeper wounds, prolonged wound healing, and lower potential for complete recovery.

Treatment Implications

Fluid resuscitation and pain control are key components of burn treatment. In the geriatric population, extra care must be paid to provide appropriate fluids, as age is significantly associated with increased volume requirement in the first 48 hours post-injury. Additionally, geriatric patients are often not provided with adequate pain control management, in part due to a misconception that pain decreases with age (there is no evidence to support this claim). Appropriate pain management is critical for recovery, and must consider patients' co-morbidities, organ functions, and current medications.

Skin-grafting is another important form of treatment for burns. However, age is a risk factor for unsuccessful grafting due to the natural thinning of the skin that occurs with age. Other risk factors for failed skin relevant to the geriatric population for unsuccessful skin grafting include being over age 55, peripheral vascular disease, diabetes mellitus, and related problems of limb ischemia.

Outcomes

Studies suggest that few geriatric patients return to their previous state of health following burn injury. Long-term consequences in this population include exacerbation of pre-existing conditions, decreased mobility, loss of independence, worsened nutrition, pain, and psychological sequelae including depression.

Trauma Team Activation

One significant problem in the acute assessment of geriatric trauma patients is under-triage. Trauma team activation (TTA) must be done liberally due to limited costs and resources. Therefore, the criteria for TTA is established by the American College of Surgeons and individual trauma centers. The criteria used to identify patients with a greater need for high level care include vital signs (systolic blood pressure below 90 mmHg or heart rate above 120 bpm), level of consciousness, and mechanism of injury. However, elderly patients with severe trauma often do not meet the standard TTA criteria due to normal age-related changes and reduced physiologic capacities. For example, older adults have a less profound tachycardic response to hemorrhage, pain, or anxiety following trauma. This explains why mortality increases in the elderly above a heart rate of 90 bpm, an association not observed until heart rate of 130 bpm in younger patients. Similarly, in older adults, systemic vascular resistance is increased, which may result in baseline hypertension. In the setting of shock, expected declines in blood pressure may not occur, leading to misinterpretation of the geriatric patient's condition. This supports why mortality significantly increases with systolic blood pressure below 110 mmHg in older adults but not until 95 mmHg in younger patients. [53] [54] This is why several centers and studies support using older age as a TTA criterion as a means to reduce mortality in this population, regardless of the mechanism of injury. [55]

See also

Related Research Articles

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<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum number of drugs. Polypharmacy is often the consequence of having multiple long-term conditions, also known as multimorbidity. An excessive number of medications is worrisome, especially for older patients with many chronic health conditions, because this increases the risk of an adverse event in those patients.

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<span class="mw-page-title-main">Aspiration pneumonia</span> Medical condition

Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may include lung abscess, acute respiratory distress syndrome, empyema, and parapneumonic effusion. Some include chemical induced inflammation of the lungs as a subtype, which occurs from acidic but non-infectious stomach contents entering the lungs.

<span class="mw-page-title-main">Hip fracture</span> Broken bone in hip joint region

A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.

<span class="mw-page-title-main">Sarcopenia</span> Muscle loss due to ageing or immobility

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<span class="mw-page-title-main">Fall prevention</span> Interventions to prevent injury in domestic settings

Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological or orthopedic indications.

<span class="mw-page-title-main">Gerontological nursing</span> Specialty of nursing pertaining to older adults

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<span class="mw-page-title-main">Frailty syndrome</span> Weakness in elderly person

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<span class="mw-page-title-main">Falls in older adults</span> Age-related health problem

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<span class="mw-page-title-main">Falling (accident)</span> Cause of injury or death

Falling is the action of a person or animal losing stability and ending up in a lower position, often on the ground. It is the second-leading cause of accidental death worldwide and a major cause of personal injury, especially for the elderly. Falls in older adults are a major class of preventable injuries. Construction workers, electricians, miners, and painters are occupations with high rates of fall injuries.

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References

  1. ↑ "Ageing and health". www.who.int. Retrieved 2021-09-11.
  2. ↑ McLean, Allan J.; Le Couteur, David G. (June 2004). "Aging biology and geriatric clinical pharmacology". Pharmacological Reviews. 56 (2): 163–184. doi:10.1124/pr.56.2.4. ISSN   0031-6997. PMID   15169926. S2CID   9948208.
  3. ↑ Rosen's emergency medicine : concepts and clinical practice. John A. Marx, Robert S. Hockberger, Ron M. Walls, Michelle H. Biros, Daniel F. Danzl, Marianne Gausche-Hill (Eighth ed.). Philadelphia, PA. 2014. ISBN   978-1-4557-4987-4. OCLC   853286850.{{cite book}}: CS1 maint: others (link)
  4. ↑ McGwin, Gerald; MacLennan, Paul A.; Fife, Jessaka Bailey; Davis, Gregory G.; Rue, Loring W. (June 2004). "Preexisting conditions and mortality in older trauma patients". The Journal of Trauma. 56 (6): 1291–1296. doi:10.1097/01.ta.0000089354.02065.d0. ISSN   0022-5282. PMID   15211139.
  5. 1 2 Perdue, P. W.; Watts, D. D.; Kaufmann, C. R.; Trask, A. L. (October 1998). "Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death". The Journal of Trauma. 45 (4): 805–810. doi:10.1097/00005373-199810000-00034. ISSN   0022-5282. PMID   9783625.
  6. ↑ Clare, Drew; Zink, Korie L. (May 2021). "Geriatric Trauma". Emergency Medicine Clinics of North America. 39 (2): 257–271. doi:10.1016/j.emc.2021.01.002. ISSN   1558-0539. PMID   33863458. S2CID   233278820.
  7. 1 2 Committee on Trauma, American College of Surgeons (2008). "Chapter 10: Extremes of Age". ATLS: Advanced Trauma Life Support Program for Doctors (8th ed.). Chicago: American College of Surgeons. pp. 243–74. ISBN   978-1-880696-31-6.
  8. ↑ Grande, Christopher M.; Søreide, Eldar (2001). Prehospital trauma care. New York, N.Y: Marcel Dekker. pp. 441–50. ISBN   0-8247-0537-8.
  9. 1 2 Campbell, John Creighton (2008). ITLS. Upper Saddle River, N.J: Pearson/Prentice Hall. pp.  279–87. ISBN   978-0-13-237982-3.
  10. ↑ Campbell, John Creighton (2000). Basic trauma life support for paramedics and other advanced providers. Upper Saddle River, New Jersey: Brady/Prentice Hall Health. pp. 231–8. ISBN   0-13-084584-1.
  11. 1 2 3 Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC, eds. (2008). "Chapter 48: Geriatric Trauma". The Trauma Manual (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 524–32. ISBN   978-0-7817-6275-5.
  12. ↑ "UpToDate". www.uptodate.com. Retrieved 2021-09-13.
  13. ↑ "UpToDate". www.uptodate.com. Retrieved 2021-09-13.
  14. 1 2 Labib, Noura; Nouh, Thamer; Winocour, Sebastian; Deckelbaum, Dan; Banici, Laura; Fata, Paola; Razek, Tarek; Khwaja, Kosar (December 2011). "Severely injured geriatric population: morbidity, mortality, and risk factors". The Journal of Trauma. 71 (6): 1908–1914. doi:10.1097/TA.0b013e31820989ed. ISSN   1529-8809. PMID   21537212.
  15. ↑ Sri-on, Jiraporn; Tirrell, Gregory Philip; Lipsitz, Lewis A.; Liu, Shan Woo (March 2016). "Is there such a thing as a mechanical fall?". The American Journal of Emergency Medicine. 34 (3): 582–585. doi:10.1016/j.ajem.2015.12.009. ISSN   0735-6757. PMC   6785031 . PMID   26795891.
  16. ↑ Rubenstein, Laurence Z.; Josephson, Karen R. (2006-09-01). "Falls and Their Prevention in Elderly People: What Does the Evidence Show?". Medical Clinics of North America. 90 (5): 807–824. doi:10.1016/j.mcna.2006.05.013. ISSN   0025-7125. PMID   16962843.
  17. ↑ Richardson, J. K.; Hurvitz, E. A. (July 1995). "Peripheral neuropathy: a true risk factor for falls". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 50 (4): M211–215. doi:10.1093/gerona/50a.4.m211. ISSN   1079-5006. PMID   7614243.
  18. ↑ Woolcott, John C.; Richardson, Kathryn J.; Wiens, Matthew O.; Patel, Bhavini; Marin, Judith; Khan, Karim M.; Marra, Carlo A. (2009-11-23). "Meta-analysis of the impact of 9 medication classes on falls in elderly persons". Archives of Internal Medicine. 169 (21): 1952–1960. doi:10.1001/archinternmed.2009.357. ISSN   1538-3679. PMID   19933955.
  19. ↑ Myers, A. H.; Baker, S. P.; Van Natta, M. L.; Abbey, H.; Robinson, E. G. (1991-06-01). "Risk factors associated with falls and injuries among elderly institutionalized persons". American Journal of Epidemiology. 133 (11): 1179–1190. doi:10.1093/oxfordjournals.aje.a115830. ISSN   0002-9262. PMID   1903589.
  20. ↑ Cawthon, Peggy M.; Harrison, Stephanie L.; Barrett-Connor, Elizabeth; Fink, Howard A.; Cauley, Jane A.; Lewis, Cora E.; Orwoll, Eric S.; Cummings, Steven R. (November 2006). "Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men". Journal of the American Geriatrics Society. 54 (11): 1649–1657. doi:10.1111/j.1532-5415.2006.00912.x. ISSN   0002-8614. PMID   17087690. S2CID   23330849.
  21. ↑ Keall, Michael D.; Pierse, Nevil; Howden-Chapman, Philippa; Cunningham, Chris; Cunningham, Malcolm; Guria, Jagadish; Baker, Michael G. (2015-01-17). "Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: a cluster-randomised controlled trial". Lancet. 385 (9964): 231–238. doi:10.1016/S0140-6736(14)61006-0. ISSN   1474-547X. PMID   25255696. S2CID   33528302.
  22. ↑ Koepsell, Thomas D.; Wolf, Marsha E.; Buchner, David M.; Kukull, Walter A.; LaCroix, Andrea Z.; Tencer, Allan F.; Frankenfeld, Cara L.; Tautvydas, Milda; Larson, Eric B. (September 2004). "Footwear style and risk of falls in older adults". Journal of the American Geriatrics Society. 52 (9): 1495–1501. doi:10.1111/j.1532-5415.2004.52412.x. ISSN   0002-8614. PMID   15341551. S2CID   18185642.
  23. ↑ Labib, Noura; Nouh, Thamer; Winocour, Sebastian; Deckelbaum, Dan; Banici, Laura; Fata, Paola; Razek, Tarek; Khwaja, Kosar (December 2011). "Severely Injured Geriatric Population: Morbidity, Mortality, and Risk Factors". Journal of Trauma and Acute Care Surgery. 71 (6): 1908–1914. doi:10.1097/TA.0b013e31820989ed. ISSN   2163-0755. PMID   21537212.
  24. ↑ Sims, Richard V.; Owsley, Cynthia; Allman, Richard M.; Ball, Karlene; Smoot, Tonya M. (1998). "A Preliminary Assessment of the Medical and Functional Factors Associated with Vehicle Crashes by Older Adults". Journal of the American Geriatrics Society. 46 (5): 556–561. doi:10.1111/j.1532-5415.1998.tb01070.x. ISSN   1532-5415. PMID   9588367. S2CID   45721546.
  25. ↑ Ball, K.; Owsley, C.; Sloane, M. E.; Roenker, D. L.; Bruni, J. R. (October 1993). "Visual attention problems as a predictor of vehicle crashes in older drivers". Investigative Ophthalmology & Visual Science. 34 (11): 3110–3123. ISSN   0146-0404. PMID   8407219.
  26. ↑ Fitten, L. Jaime; Perryman, Kent M.; Wilkinson, Candace J.; Little, Roderick J.; Burns, Marcelline M.; Pachana, Nancy; Mervis, J. Randolph; Malmgren, Roberta; Siembieda, Douglas W.; Ganzell, Steven (1995-05-03). "Alzheimer and Vascular Dementias and Driving: A Prospective Road and Laboratory Study". JAMA. 273 (17): 1360–1365. doi:10.1001/jama.1995.03520410054026. ISSN   0098-7484. PMID   7715061.
  27. 1 2 Sims, R. V.; McGwin Jr, G.; Allman, R. M.; Ball, K.; Owsley, C. (2000-01-01). "Exploratory study of incident vehicle crashes among olderdrivers". The Journals of Gerontology: Series A. 55 (1): M22–M27. doi: 10.1093/gerona/55.1.M22 . ISSN   1079-5006. PMID   10719769.
  28. ↑ Hetland, Amanda; Carr, David B (April 2014). "Medications and Impaired Driving: A Review of the Literature". The Annals of Pharmacotherapy. 48 (4): 494–506. doi:10.1177/1060028014520882. ISSN   1060-0280. PMC   3965581 . PMID   24473486.
  29. ↑ Kwon, MiYoung; Huisingh, Carrie; Rhodes, Lindsay A.; McGwin, Gerald; Wood, Joanne M.; Owsley, Cynthia (January 2016). "Association between Glaucoma and At-fault Motor Vehicle Collision Involvement among Older Drivers: A Population-based Study". Ophthalmology. 123 (1): 109–116. doi:10.1016/j.ophtha.2015.08.043. ISSN   1549-4713. PMC   4695303 . PMID   26459997.
  30. ↑ Crizzle, Alexander M.; Classen, Sherrilene; Uc, Ergun Y. (2012-11-13). "Parkinson disease and driving: an evidence-based review". Neurology. 79 (20): 2067–2074. doi:10.1212/WNL.0b013e3182749e95. ISSN   1526-632X. PMC   3511919 . PMID   23150533.
  31. ↑ Wibbenmeyer, Lucy A.; Amelon, Marge J.; Morgan, Lori J.; Robinson, Bonnie K.; Chang, Phyllis X.; Lewis Ii, Robert; Patrick Kealey, G. (2001-09-01). "Predicting survival in an elderly burn patient population". Burns. 27 (6): 583–590. doi:10.1016/S0305-4179(01)00009-2. ISSN   0305-4179. PMID   11525852.
  32. ↑ Ehrlich, Amy R.; Bak, Rebecca Y.; Wald-Cagan, Paulette; Greenberg, Debra F. (2008-11-01). "Risk Factors for Fires and Burns in Homebound, Urban Elderly". Journal of Burn Care & Research. 29 (6): 985–987. doi:10.1097/BCR.0b013e31818ba1ab. ISSN   1559-047X. PMID   18849831. S2CID   3695845.
  33. 1 2 3 4 Warda, L.; Tenenbein, M.; Moffatt, M. (June 1999). "House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury". Injury Prevention. 5 (2): 145–150. doi:10.1136/ip.5.2.145. ISSN   1353-8047. PMC   1730498 . PMID   10385837.
  34. ↑ Harper, R. D.; Dickson, W. A. (May 1995). "Reducing the burn risk to elderly persons living in residential care". Burns: Journal of the International Society for Burn Injuries. 21 (3): 205–208. doi:10.1016/0305-4179(95)80010-l. ISSN   0305-4179. PMID   7794502.
  35. ↑ Lachs, M. S.; Williams, C. S.; O'Brien, S.; Pillemer, K. A.; Charlson, M. E. (1998-08-05). "The mortality of elder mistreatment". JAMA. 280 (5): 428–432. doi: 10.1001/jama.280.5.428 . ISSN   0098-7484. PMID   9701077.
  36. ↑ Hall J, Karch DL, Crosby A. Elder abuse surveillance: Uniform definitions and recommended core data elements. National Center for Injury Prevention and Control, Division of Violence Prevention. 2016. Available at: https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf (Accessed on January 25, 2021).
  37. ↑ Dong, XinQi; Simon, Melissa A.; Gorbien, Martin; Percak, Jeffrey; Golden, Robyn (2007). "Loneliness in Older Chinese Adults: A Risk Factor for Elder Mistreatment". Journal of the American Geriatrics Society. 55 (11): 1831–1835. doi:10.1111/j.1532-5415.2007.01429.x. ISSN   1532-5415. PMID   17944895. S2CID   6587602.
  38. 1 2 3 Burnes, David; Pillemer, Karl; Caccamise, Paul L.; Mason, Art; Henderson, Charles R.; Berman, Jacquelin; Cook, Ann Marie; Shukoff, Denise; Brownell, Patricia; Powell, Mebane; Salamone, Aurora (2015). "Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study". Journal of the American Geriatrics Society. 63 (9): 1906–1912. doi:10.1111/jgs.13601. ISSN   1532-5415. PMID   26312573. S2CID   13579189.
  39. ↑ Lachs, Mark S.; Pillemer, Karl (2009-08-19). "Abuse and Neglect of Elderly Persons". New England Journal of Medicine. 332 (7): 437–443. doi:10.1056/nejm199502163320706. PMID   7632211 . Retrieved 2021-09-20.
  40. ↑ Dyer, Carmel Bitondo; Connolly, Marie-Therese; McFeeley, Patricia (2003). The Clinical and Medical Forensics of Elder Abuse and Neglect. National Academies Press (US).
  41. ↑ Ganz, David A.; Bao, Yeran; Shekelle, Paul G.; Rubenstein, Laurence Z. (2007-01-03). "Will my patient fall?". JAMA. 297 (1): 77–86. doi:10.1001/jama.297.1.77. ISSN   1538-3598. PMID   17200478.
  42. ↑ Alexander, B H; Rivara, F P; Wolf, M E (July 1992). "The cost and frequency of hospitalization for fall-related injuries in older adults". American Journal of Public Health. 82 (7): 1020–1023. doi:10.2105/ajph.82.7.1020. ISSN   0090-0036. PMC   1694056 . PMID   1609903.
  43. ↑ "Important Facts about Falls | Home and Recreational Safety | CDC Injury Center". www.cdc.gov. 2019-02-01. Retrieved 2021-09-13.
  44. ↑ Keller, Julie M.; Sciadini, Marcus F.; Sinclair, Elizabeth; O'Toole, Robert V. (September 2012). "Geriatric trauma: demographics, injuries, and mortality". Journal of Orthopaedic Trauma. 26 (9): e161–165. doi:10.1097/BOT.0b013e3182324460. ISSN   1531-2291. PMID   22377505. S2CID   205492388.
  45. ↑ Lee, W. Y.; Yee, W. Y.; Cameron, P. A.; Bailey, M. J. (January 2006). "Road traffic injuries in the elderly". Emergency Medicine Journal. 23 (1): 42–46. doi:10.1136/emj.2005.023754. ISSN   1472-0213. PMC   2564127 . PMID   16381081.
  46. ↑ Wibbenmeyer, L. A.; Amelon, M. J.; Morgan, L. J.; Robinson, B. K.; Chang, P. X.; Lewis, R.; Kealey, G. P. (September 2001). "Predicting survival in an elderly burn patient population". Burns: Journal of the International Society for Burn Injuries. 27 (6): 583–590. doi:10.1016/s0305-4179(01)00009-2. ISSN   0305-4179. PMID   11525852.
  47. ↑ Moreland, Briana; Kakara, Ramakrishna; Henry, Ankita (2020-07-10). "Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018". MMWR. Morbidity and Mortality Weekly Report. 69 (27): 875–881. doi:10.15585/mmwr.mm6927a5. ISSN   1545-861X. PMC   7732363 . PMID   32644982.
  48. ↑ Gill, Thomas M.; Murphy, Terrence E.; Gahbauer, Evelyne A.; Allore, Heather G. (2013-08-01). "Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons". American Journal of Epidemiology. 178 (3): 418–425. doi:10.1093/aje/kws554. ISSN   1476-6256. PMC   3816345 . PMID   23548756.
  49. ↑ Rubenstein, Laurence Z.; Josephson, Karen R. (September 2006). "Falls and their prevention in elderly people: what does the evidence show?". The Medical Clinics of North America. 90 (5): 807–824. doi:10.1016/j.mcna.2006.05.013. ISSN   0025-7125. PMID   16962843.
  50. ↑ Tinetti, M. E.; Liu, W. L.; Claus, E. B. (1993-01-06). "Predictors and prognosis of inability to get up after falls among elderly persons". JAMA. 269 (1): 65–70. doi:10.1001/jama.1993.03500010075035. ISSN   0098-7484. PMID   8416408.
  51. ↑ Deshpande, Nandini; Metter, E. Jeffrey; Lauretani, Fulvio; Bandinelli, Stefania; Guralnik, Jack; Ferrucci, Luigi (April 2008). "Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study". Journal of the American Geriatrics Society. 56 (4): 615–620. doi:10.1111/j.1532-5415.2007.01639.x. ISSN   1532-5415. PMC   2645621 . PMID   18312314.
  52. ↑ Abu-Sittah, G.S.; Chahine, F.M.; Janom, H. (2016-12-31). "Management of burns in the elderly". Annals of Burns and Fire Disasters. 29 (4): 249–245. ISSN   1592-9558. PMC   5347309 . PMID   28289356.
  53. ↑ Heffernan, Daithi S.; Thakkar, Rajan K.; Monaghan, Sean F.; Ravindran, Radhika; Adams, Charles A.; Kozloff, Matthew S.; Gregg, Shea C.; Connolly, Michael D.; Machan, Jason T.; Cioffi, William G. (October 2010). "Normal presenting vital signs are unreliable in geriatric blunt trauma victims". The Journal of Trauma. 69 (4): 813–820. doi:10.1097/TA.0b013e3181f41af8. ISSN   1529-8809. PMID   20938267.
  54. ↑ "UpToDate". www.uptodate.com. Retrieved 2021-09-20.
  55. ↑ Bardes, James M.; Benjamin, Elizabeth; Schellenberg, Morgan; Inaba, Kenji; Demetriades, Demetrios (2019-08-01). "Old Age With a Traumatic Mechanism of Injury Should Be a Trauma Team Activation Criterion". The Journal of Emergency Medicine. 57 (2): 151–155. doi:10.1016/j.jemermed.2019.04.003. ISSN   0736-4679. PMID   31078345. S2CID   153306286.
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