May 26, 2022, 10:40 AM
Trauma is the 3rd leading cause of mortality among all-aged patients (Ahmadinejad et al., 2021). Based on the authors, trauma or injury is described as a disruption of the cellular and tissue function resulting in increased stress, associated with ischemic cell death or recirculation. Multiple system injuries are involved in bout 40% of all trauma patients, and 23% of hospitalized trauma patients are over 65. The most typical type of trauma in the elderly is a blunt injury (particularly fractures) resulting from falls and automobile accidents. Acute and chronic underlying diseases are common in the elderly, including postural hypotension, cardiac dysrhythmias, autonomic dysfunction, inappropriate antihypertensive drugs, hypotensive hypoglycemia, and hypoglycemia due to aging. Frailty, gait dysfunction, impaired vision, hearing, dementia, and comorbidities also increase the risk of trauma in these patients. The severity of the injury, poor pre-hospital health, age, gender, social status, and repeated trauma can also increase the risk of morbidities and mortality.
Based on Vaishya & Vaish (2020), the risk of falls is increased by the environmental factors independently or by interacting with the intrinsic factors. For example, the incidence of falls increases substantially when greater postural control and mobility are required (e.g., walking on an uneven or slippery surface) and if it is unfamiliar to an elderly (e.g., relocating to a new home). Age-related changes can also impair the nervous system, maintaining balance and stability, increasing the risk of falls. Age-related decline in vision and muscle power and speed changes may impair the ability to maintain or recover balance in response to any concern (e.g., stepping onto an uneven or slippery surface). Any muscle weakness is a significant predictor of falls. Some chronic and acute disorders and drugs are responsible risk factors for falls. Certain situational activities may also increase the risk of falls and fall-related injuries. Using Morse Fall Scale (MFS) is often employed to identify and score fall risk factors.
Vaishya & Vaish (2020) further wrote that several strategies could be used to prevent these falls. In older adults, prevention of a fall is preferred over the treatment of the injuries sustained by these falls. The risk of falls can be reduced by appropriately correcting the environmental hazards at home and using an assistive device (e.g., cane, walker, grab handles). Those with restricted mobility may benefit from the combined use of environmental, rehabilitative, and medical measures. The incidence of hip fractures can be reduced with hip protectors, especially in high-risk individuals. An appropriate flooring is crucial in preventing falls, as a compliant flooring (e.g., firm rubber) can help dissipate the impact force. Other preventive measures include strengthening exercises to improve gait, balance, coordination, and functional tasks. Vitamin D supplementation in the presence of its deficiency and treatment of osteoporosis is likewise recommended. Drugs known to increase the risk of falls should be stopped or their dosage modified. The optimization of vision and hearing, control of dizziness, and the shoes’ low heels or rubber soles are crucial factors in preventing falls. Falls may be further reduced with adequate pain control, physical therapy, and sometimes joint replacement surgery in severe knee or hip arthritis patients. The American Academy of Orthopedic Surgeons (AAOS) strongly recommends regional anesthesia in their guidelines for managing hip fractures in elderly patients. It has been reported that compared to IV and oral pain medications in elderly patients with hip fractures, femoral nerve blocks resulted in significant reductions in pain scores and opioid requirements. The older adults should also be educated on the ways to reduce the risks arising from the situational factors and should be taught about what to do if they fall and cannot get up (such as using a medic alert button).
In older hospitalized patients, reducing risk factors for hospital-acquired delirium significantly reduces the incidence of falls (as best evidence). Therefore, acute care and delirium prevention models reduce risk factors for common geriatric conditions or syndromes like hospital falls (Wright & Palmer, 2017).
Ahmadinejad, M., Mohammadzadeh, S., Shirzadi, A., Ahmadinejad, I. &
Pouryaghobi, S.M. (January 2021). Trauma factors among adults and geriatric blunt trauma patients. International Journal of Surgery; Volume 28, Pages 17-21. https://www.sciencedirect.com/science/article/pii/S2405857220301273
Vaishya, R. & Vaish, A. (January 24, 2020). Falls in older adults are serious. Indian Journal of Orthopaedics. 54(1): 69–74.
Wright, R. & Palmer, R.M. (2017). Falls. In McKean, S.C., Ross, J.J. Dressler, D.D. & Scheurer, D.B. (Eds.). Principles and Practice of Hospital Medicine (2nd ed., Chap. 87, pp. 617). McGraw-Hill Education.