Abstract
Background
With an ageing population, the elderly will increasingly represent a growing subgroup of trauma. A high-risk group with multiple comorbidities, decreased physiological reserves and frailty, this contributes to the complexity of management in facial trauma. Falls represent the most common presentation for facial-related injuries, but there are variations amongst gender that is important to aid diagnosis, management, and treatment plans. Our aim is to identify epidemiological trends of facial fractures in the elderly, understand differences amongst gender and elderly age groups, and the impact this has on clinical outcomes and management.
Methods
A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All facial fractures of the elderly, 65 years and above, that attended or were referred to the unit were included in this study.
Results
Three hundred fifty-five elderly patients presented with a facial fracture with falls (82.5%) as the most common mechanism of injury. The orbitozygomatic fracture was the most common type of facial fracture with 48.7% of the cohort sustaining an associated injury. There were differences between men and women for age, age groups, socioeconomic status, season, alcohol, mechanism of injury, and facial fractures (p<0.05). The 75–85 and 85+ age groups were 2.4 and 15.1 times more likely to have a fall-related facial fracture than the 65–75 age group, and less likely to have surgery (p<0.05). Associated injuries were independently associated with increased length of stay (p<0.001).
Conclusions
Geriatric men and women have differences in facial fractures and aetiologies, but an overall non operative approach was favoured on a balanced approach of comorbidities, function, and quality of life. Elderly patients are complex with associated injuries and comorbidities, and they often require interdisciplinary care across fields of medicine and surgery to minimize their length of stay and yield good outcomes.
Level of evidence: Level III, therapeutic; diagnostic; risk/prognostic study.
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References
Australian Institute of Health and Welfare (2018) Older Australia at a glance. Cat. no. AGE 87. Canberra: AIHW. https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance. Accessed 10th Jul 2020.
Moller J (2003) Projected costs of fall related injury to older persons due to demographic change in Australia. Commonwealth Department of Health and Ageing, Canberra
Australian Bureau of Statistics (2008) Information paper. an introduction to Socio- Economic Indexes for Areas (SEIFA) 2006(2039.0). ABS: Canberra, Australia
David DJ, Simpson DA (1995) Craniomaxillofacial trauma: a system of multidisciplinary management by members of the Australian craniofacial unit. Churchill Livingstone, Edinburgh
Independent hospital pricing authority, National Hospital Cost Data Collection Report: Public Sector, Round 22 Financial Year 2017-18
Australian Institute of Health and Welfare. Australian refined diagnosis-related group (AR-DRG) data cubes 2017-18. AIHW: Canberra, Australia. https://www.aihw.gov.au/reports/hospitals/ar-drg-data-cubes/contents/data-cubes. Accessed 15th July 2020
Ferrera PC, Bartfield JM, D’Andrea CC (2000) Outcomes of admitted geriatric trauma victims. Am J Emerg Med 18(5):575–580
Gillies D (1999) Elderly trauma: they are different. Aust Crit Care 12(1):24–30
Valley VT, Hepp H, DeBehnke DJ, Lawrence SW, Aprahamian C (1994) A profile of geriatric trauma in southeastern Wisconsin. Wis Med J 93(4):165–168
Lord SR, Sherrington C, Menz HB (2007) Falls in older people: risk factors and strategies for prevention, 2nd edn. Cambridge University Press, Cambridge
Duckham RL, Procter-Gray E, Hannan MT, Leveille SG, Lipsitz LA, Li W (2013) Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study. BMC Geriatr 13:133
Peel NM, Kassulke DJ, McClure RJ (2002) Population based study of hospitalised fall related injuries in older people. Inj Prev 8:280–283
Rehman K, Edmondson H (2002) The causes and consequences of maxillofacial injuries in elderly people. Gerodontology 19:60–64
Sidal T, Curtis DA (2006) Fractures of the mandible in the aging population. Spec Care Dentist 26(4):145–149
Abdul Rahman N, Ramli R, Abdul Rahman R et al (2010) Facial trauma in geriatric patients in a selected Malaysian hospital. Geriatr Gerontol Int 10:64–69
Balard F, Beluche I, Romieu I et al (2011) Are men aging as oaks and women as reeds? A behavioral hypothesis to explain the gender paradox of French centenarians. J Aging Res 2011:371039
O’Connell H, Chin AV, Cunningham C, Lawlor B (2003) Alcohol use disorders in elderly people--redefining an age old problem in old age. BMJ. 327(7416):664–667
Zautcke JL, Coker SB Jr, Morris RW, Stein-Spencer L (2002) Geriatric trauma in the State of Illinois: substance use and injury patterns. Am J Emerg Med 20(1):14–17
Stenbacka M, Jansson B, Leifman A, Romelsjö A (2002) Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study. Alcohol. 28(1):9–16
Lawlor DA, Patel R, Ebrahim S (2003) Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 327(7417):712–717
Cillo J, Holmes T (2016) Interpersonal violence is associated with increased severity of geriatric facial trauma. J Oral Maxillofac Surg 74(5):1023.e1–1023.e7
Chang VC, Do MT (2015) Risk factors for falls among seniors: implications of gender. Am J Epidemiol 181(7):521–531
Gale CR, Cooper C, Sayer AA (2016) Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age Ageing 45(6):789–794
Yeung PY, Chau PH, Woo J, Yim VWT, Rainer TH (2011) Higher incidence of falls in winter among older people in Hong Kong. J Clin Gerontol Geriatr 2:13–16
Velayutham L, Sivanandarajasingam A, O’Meara C, Hyam D (2013) Elderly patients with maxillofacial trauma: the effect of an ageing population on a maxillofacial unit’s workload. Br J Oral Maxillofac Surg 51(2):128–132
Atisha DM, Tv B, Allori AC et al (2016) Facial fractures in the aging population. Plast Reconstr Surg 137:587–593
Vlavonou S, Nguyen TM, Touré G et al (2018) Epidemiology of facial fractures in the elderly. JPRAS Open 16:84–92
Sveikata K, Balciuniene I, Tutkuviene J et al (2011) Factors influencing face aging. Literature review. Stomatologija 13(4):113–116
Shaw R, Katzel E, Koltz P et al (2010) Aging of the mandible and its aesthetic implications. Plast Reconstr Surg 125(1):332–342
Toivari M, Suominen A, Lindqvist C et al (2016) Among patients with facial fractures, geriatric patients have an increased risk for associated injuries. J Oral Maxillofac Surg 74(7):1403–1409
Lai SH, Liao KF, Liao CC et al (2010) Polypharmacy correlates with increased risk for hip fractures in the elderly: a populationbased study. Medicine 89:295–299
Harvey LA, Close JCT (2012) Traumatic spine injuries in older adults: characteristics, causes and consequences. Injury 43:1821–1826
Majdan M, Brazinova A, Mauritz W (2016) Epidemiology of traumatic spinal cord injuries in Austria 2002-2012. Eur Spine J 25:62–73
Bulger EM, Arneson MA, Mock CN, Jurkovich GJ (2000) Rib fractures in the elderly. J Trauma 48(6):1040–1046 discussion 1046-7
Brucoli M, Boffano P, Romeo I et al (2019) Management of maxillofacial trauma in the elderly: a European multicenter study. Dent Traumatol 36(3):241–246
Back CP, McLean NR, Anderson PJ et al (2007) The conservative management of facial fractures: indications and outcomes. J Plast Reconstr Aesthet Surg 60(2):146–151
Burkhard J, Pitteloud C, Klukowska-Rötzler J et al (2019) Changing trends in epidemiology and management of facial trauma in a Swiss geriatric population. Gerodontology 36(4):358–364
Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T (2005) Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol 89(1):53–59
Patel A, Haas J, Skibba K, Morrison CS (2020) Outcomes following orbital floor fractures in the elderly. J Craniofac Surg 31(5):1376–1378
Aldekhayel S, Aljaaly H, Fouda-Neel O, Shararah AW, Zaid WS, Gilardino M (2014) Evolving trends in the management of orbital floor fractures. J Craniofac Surg 25:258–261
Keller JM, Sciadini MF, Sinclari E et al (2012) Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma 26:161
Clavijo-Alvarez A, Deleyiannis W, Peitzman B et al (2012) Risk factors for death in elderly patients with facial fractures secondary to falls. J Craniofac Surg 23(2):494–498
Australian Institute of Health and Welfare; Bradley C (2013) Trends in hospitalisations due to falls by older people, Australia 1999–00 to 2010–11. Injury research and statistics no. 84. Cat. no. INJCAT 160. Canberra: AIHW
Watson WL, Clapperton A, Mitchell RJ (2011) The burden of fall-related injury among older persons in New South Wales. Aust N Z J Public Health 35:170–175
Clemson L, Finch C, Hill K et al (2010) Fall prevention in Australia: policies and activities. Clin Geriatr Med 26(4):733–749
Irwin M, Hayen A, Finch C (2008) Methodological issues in using routinely collected electronic population mortality data: guidelines for using the national coroners information system for fatal injury surveillance in NSW. University of New South Wales. http://www.irmrc.unsw.edu.au/documents/NCISreport08.pdf. Accessed 10th November 2020
Acknowledgements
We would like to acknowledge the members of the craniofacial, plastics, and oral maxillofacial unit whom provided ongoing support in the project and collection of the data.
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The authors contributed to the conception and design of the manuscript, revised it critically for important intellectual content, approved the final version to be published, and agreed to be accountable for all aspects of the work.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration. This project has been approved by the Human Research Ethics Committee at South Australia [HREC/17/RAH/402].
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Informed consent was obtained from all individual participants included in the study.
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Jason Diab and Mark Moore declare to have no conflicts of interest.
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Diab, J., Moore, M.H. Facial fractures in the elderly: epidemiology, clinical characteristics, and management. Eur J Plast Surg 44, 577–586 (2021). https://doi.org/10.1007/s00238-021-01800-w
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DOI: https://doi.org/10.1007/s00238-021-01800-w