Skip to main content

Advertisement

SpringerLink
Log in

Anesthetic Challenges in Treating the Older Adult Trauma Patient: an Update

  • Anesthesia for Trauma (TE Grissom, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To highlight challenges specific to anesthesia and perioperative care of injured older adults and present novel modalities to improve outcomes in this vulnerable population.

Recent Findings

We will describe some of the current directions available for anesthesiologists to improve outcomes in the elderly surgical population: interventions to ameliorate perioperative neurocognitive disorders, reversal of treatment with anti-coagulant medications, controversies in pain management, and increasing utilization of regional anesthesia techniques. Finally, frailty assessment and comprehensive geriatric care as efficient method of assessing risk and improving outcomes will be discussed.

Summary

Perioperative care for older injured adults presents numerous challenges for the anesthesiologist. While novel modalities show promise, ample opportunities to improve still exist.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. bureau Usc. Population by age and sex:2018 2018 [Available from: https://www2.census.gov/programs-surveys/demo/tables/age-and-sex/2018/older-population/table1.xls.

  2. CDC. Deaths, percent of total deaths, and death rates for the 15 leading causes of death in 5-year age groups, by race and hispanic origin, and sex: United States, 2015–2017. 2017.

  3. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged >/=65 years - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(37):993–8.

    Article  PubMed  Google Scholar 

  4. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lowe JA, Pearson J, Leslie M, Griffin R. Ten-year incidence of high-energy geriatric trauma at a level 1 trauma center. J Orthop Trauma. 2018;32(3):129–33.

    Article  PubMed  Google Scholar 

  6. Joseph B, Orouji Jokar T, Hassan A, Azim A, Mohler MJ, Kulvatunyou N, et al. Redefining the association between old age and poor outcomes after trauma: the impact of frailty syndrome. J Trauma Acute Care Surg. 2017;82(3):575–81.

  7. Joseph B, Pandit V, Rhee P, Aziz H, Sadoun M, Wynne J, et al. Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer? J Trauma Acute Care Surg. 2014;76(1):196–200.

    Article  PubMed  Google Scholar 

  8. Kojima M, Endo A, Shiraishi A, Otomo Y. Age-related characteristics and outcomes for patients with severe trauma: analysis of Japan’s nationwide trauma registry. Ann Emerg Med. 2019;73(3):281–90.

    Article  PubMed  Google Scholar 

  9. Vanzant EL, Hilton RE, Lopez CM, Zhang J, Ungaro RF, Gentile LF, et al. Advanced age is associated with worsened outcomes and a unique genomic response in severely injured patients with hemorrhagic shock. Crit Care. 2015;19(1):77.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bickel H, Gradinger R, Kochs E, Forstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26(1):26–31.

    Article  PubMed  Google Scholar 

  11. Smith TO, Cooper A, Peryer G, Griffiths R, Fox C, Cross J. Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2017;32(4):386–96.

    Article  PubMed  Google Scholar 

  12. Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2017;29(2):115–26.

    Article  PubMed  Google Scholar 

  13. Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosenthal AC. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit. J Trauma Acute Care Surg. 2014;77(6):944–51.

    Article  PubMed  Google Scholar 

  14. Ruggiero C, Bonamassa L, Pelini L, Prioletta I, Cianferotti L, Metozzi A, et al. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons. Osteoporos Int. 2017;28(2):667–75.

  15. Bellelli G, Mazzola P, Morandi A, Bruni A, Carnevali L, Corsi M, et al. Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc. 2014;62(7):1335–40.

    Article  PubMed  Google Scholar 

  16. Shi Z, Mei X, Li C, Chen Y, Zheng H, Wu Y, et al. Postoperative delirium is associated with long-term decline in activities of daily living. Anesthesiology. 2019;131(3):492–500.

  17. Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893–902.

  18. Kronzer VL, Avidan MS. Preventing postoperative delirium: all that glisters is not gold. Lancet. 2016;388(10054):1854–6.

    Article  PubMed  Google Scholar 

  19. •• Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. JAMA Surg. 2017;152(8):e171505 A large scale randomized study that was not able to demonstrate improvement in rate of postoperative delirium when using intraoperative dexmedetomidine infusion.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wang BJ, Li CJ, Hu J, Li HJ, Guo C, Wang ZH, et al. Impact of dexmedetomidine infusion during general anaesthesia on incidence of postoperative delirium in elderly patients after major non-cardiac surgery: study protocol of a randomised, double-blinded and placebo-controlled trial. BMJ Open. 2018;8(4):e019549.

  21. Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Byrne AJ, Hudetz AG, et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23(5):651–7.

  22. • Avidan MS, Maybrier HR, Abdallah AB, Jacobsohn E, Vlisides PE, Pryor KO, et al. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Lancet. 2017;390(10091):267–75 A large sized multinational randomized trial that showed that a single subanaesthetic dose of ketamine given post-induction did not decrease delirium in older adults after major surgery, and might increase hallucinations and nightmare rates.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Chan MT, Cheng BC, Lee TM, Gin T. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25(1):33–42.

    Article  PubMed  Google Scholar 

  24. MacKenzie KK, Britt-Spells AM, Sands LP, Leung JM. Processed electroencephalogram monitoring and postoperative delirium: a systematic review and meta-analysis. Anesthesiology. 2018;129(3):417–27.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Deiner S, Luo X, Silverstein JH, Sano M. Can intraoperative processed EEG predict postoperative cognitive dysfunction in the elderly? Clin Ther. 2015;37(12):2700–5.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Punjasawadwong Y, Chau-In W, Laopaiboon M, Punjasawadwong S, Pin-On P. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database Syst Rev. 2018;5:Cd011283.

    PubMed  Google Scholar 

  27. •• Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial. Jama. 2019;321(5):473–83 A large-sized pragmatic randomized trial that showed that, among older adults undergoing major surgery, EEG-guided anesthetic administration did not decrease the incidence of postoperative delirium compared to usual care.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mador B, Nascimento B, Hollands S, Rizoli S. Blood transfusion and coagulopathy in geriatric trauma patients. Scand J Trauma Resusc Emerg Med. 2017;25(1):33.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bradburn EH, Gross BW, Jammula S, Adams WH, Miller JA, Rogers F. Improved outcomes in elderly trauma patients with the implementation of two innovative geriatric-specific protocols-final report. J Trauma Acute Care Surg. 2018;84(2):301–7.

    Article  PubMed  Google Scholar 

  30. Maung AA, Bhattacharya B, Schuster KM, Davis KA. Trauma patients on new oral anticoagulation agents have lower mortality than those on warfarin. J Trauma Acute Care Surg. 2016;81(4):652–7.

    Article  CAS  PubMed  Google Scholar 

  31. Prexl O, Bruckbauer M, Voelckel W, Grottke O, Ponschab M, Maegele M, et al. The impact of direct oral anticoagulants in traumatic brain injury patients greater than 60-years-old. Scand J Trauma Resusc Emerg Med. 2018;26(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Feeney JM, Santone E, DiFiori M, Kis L, Jayaraman V, Montgomery SC. Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: a TQIP study. J Trauma Acute Care Surg. 2016;81(5):843–8.

    Article  CAS  PubMed  Google Scholar 

  33. Wood B, Nascimento B, Rizoli S, Sholzberg M, McFarlan A, Phillips A, et al. The anticoagulated trauma patient in the age of the direct oral anticoagulants: a Canadian perspective. Scand J Trauma Resusc Emerg Med. 2017;25(1):76.

    Article  PubMed  PubMed Central  Google Scholar 

  34. von Heymann C, Rosenthal C, Kaufner L, Sander M. Management of direct oral anticoagulants-associated bleeding in the trauma patient. Curr Opin Anaesthesiol. 2016;29(2):220–8.

    Article  CAS  Google Scholar 

  35. • Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23(1):98 These are the most recent guidelines for treatment of traumatic bleeding, addresing specifically patients taking DOACs.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB, et al. Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop Relat Res. 2018;476(6):1178–88.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017;17(1):87.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Neuman MD, Ellenberg SS, Sieber FE, Magaziner JS, Feng R, Carson JL. Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN): protocol for a pragmatic, international multicentre trial. BMJ Open. 2016;6(11):e013473.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kowark A, Adam C, Ahrens J, Bajbouj M, Bollheimer C, Borowski M, et al. Improve hip fracture outcome in the elderly patient (iHOPE): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia. BMJ Open. 2018;8(10):e023609.

  40. Platts-Mills TF, Flannigan SA, Bortsov AV, Smith S, Domeier RM, Swor RA, et al. Persistent pain among older adults discharged home from the emergency department after motor vehicle crash: a prospective cohort study. Ann Emerg Med. 2016;67(2):166–76.e1.

    Article  PubMed  Google Scholar 

  41. Quattromani E, Normansell D, Storkan M, Gerdelman G, Krits S, Pennix C, et al. Oligoanalgesia in blunt geriatric trauma. J Emerg Med. 2015;48(6):653–9.

  42. Ko A, Harada MY, Smith EJ, Scheipe M, Alban RF, Melo N, et al. Pain assessment and control in the injured elderly. Am Surg. 2016;82(10):867–71.

  43. Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433–9.

  44. Unneby A, Svensson O, Gustafson Y, Olofsson B. Femoral nerve block in a representative sample of elderly people with hip fracture: a randomised controlled trial. Injury. 2017;48(7):1542–9.

    Article  PubMed  Google Scholar 

  45. Arsoy D, Huddleston JI 3rd, Amanatullah DF, Giori NJ, Maloney WJ, Goodman SB. Femoral nerve catheters improve home disposition and pain in hip fracture patients treated with total hip arthroplasty. J Arthroplast. 2017;32(11):3434–7.

    Article  Google Scholar 

  46. Arsoy D, Gardner MJ, Amanatullah DF, Huddleston JI 3rd, Goodman SB, Maloney WJ, et al. Continuous femoral nerve catheters decrease opioid-related side effects and increase home disposition rates among geriatric hip fracture patients. J Orthop Trauma. 2017;31(6):e186–e9.

    Article  PubMed  Google Scholar 

  47. Mangram AJ, Oguntodu OF, Hollingworth AK, Prokuski L, Steinstra A, Collins M, et al. Geriatric trauma G-60 falls with hip fractures: a pilot study of acute pain management using femoral nerve fascia iliac blocks. J Trauma Acute Care Surg. 2015;79(6):1067–72 discussion 72.

    Article  PubMed  Google Scholar 

  48. Guay J, Parker MJ, Griffiths R, Kopp S. Peripheral nerve blocks for hip fractures. Cochrane Database Syst Rev. 2017;5:Cd001159.

    PubMed  Google Scholar 

  49. Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23 discussion 23-5.

    Article  PubMed  Google Scholar 

  50. Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF 3rd. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004;52(5):805–8.

    Article  PubMed  Google Scholar 

  51. Barry R, Thompson E. Outcomes after rib fractures in geriatric blunt trauma patients. Am J Surg. 2018;215(6):1020–3.

    Article  PubMed  Google Scholar 

  52. Adhikary SD, Liu WM, Fuller E, Cruz-Eng H, Chin KJ. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 2019;74(5):585–93.

    Article  CAS  PubMed  Google Scholar 

  53. Womack J, Pearson JD, Walker IA, Stephens NM, Goodman BA. Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study. Anaesthesia. 2019;74(5):594–601.

    Article  CAS  PubMed  Google Scholar 

  54. O’Connell KM, Quistberg DA, Tessler R, Robinson BRH, Cuschieri J, Maier RV, et al. Decreased risk of delirium with use of regional analgesia in geriatric trauma patients with multiple rib fractures. Ann Surg. 2018;268(3):534–40.

  55. El-Boghdadly K, Wiles MD. Regional anaesthesia for rib fractures: too many choices, too little evidence. Anaesthesia. 2019;74(5):564–8.

    Article  CAS  PubMed  Google Scholar 

  56. Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, et al. Ortho-geriatric service--a literature review comparing different models. Osteoporos Int. 2010;21(Suppl 4):S637–46.

  57. • Gleich J, Pfeufer D, Zeckey C, Bocker W, Gosch M, Kammerlander C, et al. Orthogeriatric treatment reduces potential inappropriate medication in older trauma patients: a retrospective, dual-center study comparing conventional trauma care and co-managed treatment. Eur J Med Res. 2019;24(1):4 Dual center cohort study that shows benefit to integrated trauma-geriatric care over standard trauma care for elderly patients using well-established clinical protocols to reduce polyphrmacy—one of the leading causes to complications in this population.

    Article  PubMed  PubMed Central  Google Scholar 

  58. •• Olufajo OA, Tulebaev S, Javedan H, Gates J, Wang J, Duarte M, et al. Integrating geriatric consults into routine care of older trauma patients: one-year experience of a level I trauma center. J Am Coll Surg. 2016;222(6):1029–35 Large prospective study in a major trauma center showing the benefit of a mandatory geriatric consultation to trauma patients in terms of outcome and goals of care discussions.

    Article  PubMed  Google Scholar 

  59. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169(18):1712–7.

    Article  PubMed  Google Scholar 

  60. Fisher AA, Davis MW, Rubenach SE, Sivakumaran S, Smith PN, Budge MM. Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare. J Orthop Trauma. 2006;20(3):172–8 discussion 9-80.

    Article  CAS  PubMed  Google Scholar 

  61. Fallon WF Jr, Rader E, Zyzanski S, Mancuso C, Martin B, Breedlove L, et al. Geriatric outcomes are improved by a geriatric trauma consultation service. J Trauma. 2006;61(5):1040–6.

    Article  PubMed  Google Scholar 

  62. Tillou A, Kelley-Quon L, Burruss S, Morley E, Cryer H, Cohen M, et al. Long-term postinjury functional recovery: outcomes of geriatric consultation. JAMA Surg. 2014;149(1):83–9.

  63. Schmid S, Blobner M, Haas B, Lucke M, Neumaier M, Anetsberger A, et al. Perioperative multi-system optimization protocol in elderly hip fracture patients: a randomized-controlled trial. Can J Anaesth. 2019;66(12):1472–82

  64. Southerland LT, Gure TR, Ruter DI, Li MM, Evans DC. Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines. J Surg Res. 2017;216:56–64.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res. 2004;425:72–81.

    Article  Google Scholar 

  66. Cogan L, Martin AJ, Kelly LA, Duggan J, Hynes D, Power D. An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006. Ir J Med Sci. 2010;179(1):51–5.

    Article  CAS  PubMed  Google Scholar 

  67. Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y. Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med. 2007;39(3):232–8.

    Article  PubMed  Google Scholar 

  68. Forch S, Kretschmer R, Haufe T, Plath J, Mayr E. Orthogeriatric combined management of elderly patients with proximal femoral fracture: results of a 1-year follow-up. Geriatr Orthop Surg Rehabil. 2017;8(2):109–14.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Pioli G, Giusti A, Barone A. Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res. 2008;20(2):113–22.

    Article  PubMed  Google Scholar 

  70. McKevitt EC, Calvert E, Ng A, Simons RK, Kirkpatrick AW, Appleton L, et al. Geriatric trauma: resource use and patient outcomes. Can J Surg. 2003;46(3):211–5.

  71. Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C. Outcomes of elderly survivors of intensive care: a review of the literature. Chest. 2005;127(5):1764–74.

    Article  PubMed  Google Scholar 

  72. de Rooij SE, Abu-Hanna A, Levi M, de Jonge E. Factors that predict outcome of intensive care treatment in very elderly patients: a review. Crit Care. 2005;9(4):R307–14.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Sacanella E, Perez-Castejon JM, Nicolas JM, Masanes F, Navarro M, Castro P, et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med. 2009;35(3):550–5.

    Article  PubMed  Google Scholar 

  74. Nathanson BH, Higgins TL, Brennan MJ, Kramer AA, Stark M, Teres D. Do elderly patients fare well in the ICU? Chest. 2011;139(4):825–31.

    Article  PubMed  Google Scholar 

  75. Christensen K, Hansen TG, Rasmussen LS. Intensive care units and the oldest-old: are we doing good, too little, or too much? Acta Anaesthesiol Scand. 2013;57(6):681–3.

    Article  CAS  PubMed  Google Scholar 

  76. Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469–72.

  77. • Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc. 2017;18(12):1082–6 Retrospective cohort study in a major trauma center demonstrating the importance of frailty assessment in trauma patients and showing a practical way to conduct frailty screening in this population.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Haas B, Gomez D, Xiong W, Ahmed N, Nathens AB. External benchmarking of trauma center performance: have we forgotten our elders? Ann Surg. 2011;253(1):144–50.

    Article  PubMed  Google Scholar 

  79. Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149(8):766–72.

  80. Mitnitski AB, Song X, Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004;59(6):M627–32.

    Article  PubMed  Google Scholar 

  81. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.

  82. Robinson TN, Wallace JI, Wu DS, Wiktor A, Pointer LF, Pfister SM, et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213(1):37–42 discussion −4.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Robinson TN, Wu DS, Stiegmann GV, Moss M. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg. 2011;202(5):511–4.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, et al. Frailty in surgery. J Trauma Acute Care Surg. 2014;76(4):1151–6.

  85. Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183(1):104–10.

    Article  PubMed  Google Scholar 

  86. Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM, et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449–55.

  87. Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH Jr, et al. Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg. 2012;72(6):1526–30 discussion 30-1.

    Article  PubMed  Google Scholar 

  88. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Guidet B, de Lange DW, Boumendil A, Leaver S, Watson X, Boulanger C, et al. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study. Intensive Care Med. 2020;46(1):57–69

  91. Bentov I, Kaplan SJ, Pham TN, Reed MJ. Frailty assessment: from clinical to radiological tools. Br J Anaesth. 2019;123(1):37–50.

    Article  PubMed  Google Scholar 

  92. Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg. 2017;152(3):233–40.

  93. Inouye SK. Delirium in Older Persons. N Engl J Med. 2006;354(11):1157–65.

  94. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

  95. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Rabin Medical Center, Petah Tikva, Israel

    Nadav Sheffy

  2. Tel-Aviv University, Tel Aviv-Yafo, Israel

    Nadav Sheffy & Rotem Tellem

  3. Geriatric Division, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel

    Rotem Tellem

  4. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA

    Itay Bentov

Authors
  1. Nadav Sheffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rotem Tellem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Itay Bentov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadav Sheffy.

Ethics declarations

Conflict of Interest

Nadav Sheffy declares that he has no conflict of interest. Rotem Tellem declares that she has no conflict of interest. Itay Bentov receives research funding from the University of Washington Royalty Research Fund (UW-RRF).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Anesthesia for Trauma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sheffy, N., Tellem, R. & Bentov, I. Anesthetic Challenges in Treating the Older Adult Trauma Patient: an Update. Curr Anesthesiol Rep 10, 209–217 (2020). https://doi.org/10.1007/s40140-020-00378-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-020-00378-6

Keywords

Search

Navigation