Abstract
The elderly population continues to grow worldwide. Furthermore, studies suggest that seniors nowadays tend to be more active in everyday life. Therefore, the burden of geriatric (poly-) trauma patients who are in need of intensive care and the consequential costs are expected to rise over the years to come. In contrast to younger (poly-) traumatized patients, the geriatric patient often sustains severe injuries from low energy trauma as a fall from standing height. The outcome in elderly patients may worsen due to preexisting conditions and frailty. These comorbidities lead to an increased need for intensive care after suffering a trauma. The impact of ethical aspects of intensive care treatment itself and the therapeutic options in the elderly are not to be underestimated and complicate the decision-making as well.
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References
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.
Pijpers E, Ferreira I, Stehouwer CD, et al. The frailty dilemma. Review of the predictive accuracy of major frailty scores. Eur J Intern Med. 2012;23:118–23.
de Vries NM, et al. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.
Juma S, et al. Clinical frailty scale in an acute medicine unit: a simple tool that predicts length of stay. Can Geriatr J. 2016;19(2):34–9.
Flaatten H, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥80 years). Intensive Care Med. 2017;43(12):1820–8.
Kim S, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014;149(7):633–40.
Chen CL, et al. Frailty is associated with an increased risk of major adverse outcomes in elderly patients following surgical treatment of hip fracture. Sci Rep. 2019;9(1):19135.
Luchette FA, Yelon JA. Geriatric trauma and critical care. 2nd ed. Cham: Spinger; 2017.
Peck KA, et al. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg. 2014;76(2):431–6.
Peterer L, Ossendorf C, Jensen KO, Osterhoff G, Mica L, Seifert B, Werner CML, Simmen HP, Pape HC, Sprengel K. Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. BMC Geriatr. 2019;19(1):359.
Brooks SE, Peetz AB. Evidence - based care of geriatric trauma patients. Surg Clin North Am. 2017;97(5):1157–74.
Friedemann Nauck GM, Jürgen in der Schmitten. Behandlung im Voraus planen – Bedeutung für die Intensiv- und Notfallmedizin Einleitung Befähigung als konstitutives Element von Patientenselbstbestimmung Ein neues Konzept: Behandlung im Voraus planen (Advance Care Planning) Ungelöste Herausforderunge.
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England). 2017;390(10100):1211–59.
NCD Countdown 2030 Collaborators. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet (London, England). 2018;392(10152):1072–88.
Jaul E, Barron J. Age-related diseases and clinical and public health implications for the 85 years old and over population. Front Public Health. 2017;5:335.
Spering C, Lefering R, Bouillon B, et al. It is time for a change in the management of elderly severely injured patients! An analysis of 126,015 patients from the TraumaRegister DGU®. Eur J Trauma Emerg Surg. 2019; https://doi.org/10.1007/s00068-019-01229-8.
Wutzler S, Lefering R, Laurer HL, et al. Veränderungen in der Alterstraumatologie. Eine Analyse an 14.869 Patienten aus dem deutschen Traumaregister. [Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry]. Unfallchirurg. 2008;111(8):592–8. https://doi.org/10.1007/s00113-008-1448-2.
Ziegenhain F, Scherer J, Kalbas Y, Neuhaus V, Lefering R, Teuben M, Sprengel K, Pape HC, Jensen KO. The Trauma Register Dgu. Age-Dependent patient and trauma characteristics and hospital resource requirements-can improvement be made? an analysis from the german trauma registry. Medicina (Kaunas). 2021;57(4):330. https://doi.org/10.3390/medicina57040330. PMID: 33915888; PMCID: PMC8066778.
Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Acute Care Surg. 2001;50(1):116–9.
Brown CV, Rix K, Klein AL, Ford B, Teixeira PG, Aydelotte J, Coopwood B, Ali S. A comprehensive investigation of comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. Am Surg. 2016;82(11):1055–62.
Kocuvan S, Brilej D, Stropnik D, Lefering R, Komadina R. Evaluation of major trauma in elderly patients – a single trauma center analysis. Wien Klin Wochenschr. 2016;128(Suppl 7):535–42.
Frohlich M, et al. Do elderly trauma patients receive the required treatment? Epidemiology and outcome of geriatric trauma patients treated at different levels of trauma care. Eur J Trauma Emerg Surg. 2019;46(6):1463–9.
Jensen KO, Lempert M, Sprengel K, Simmen HP, Pothmann C, Schlögl M, Bischoff-Ferrari HA, Hierholzer C, Pape HC, Neuhaus V. Is there any difference in the outcome of geriatric and non-geriatric severely injured patients?-a seven-year, retrospective, observational cohort study with matched-pair analysis. J Clin Med. 2020;9(11):E3544.
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Obstet Gynecol Surv. 1993;342(8883):1317–22.
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Hatz, B.A., Ziegenhain, F., Jensen, K.O. (2022). ICU Management: General Management in the Elderly in ICU. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_36
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