[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.

[3] 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.

[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.

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.

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.

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.

[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.

[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.

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.

[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: Falls and motor vehicle crashes are the most common types of injuries among geriatric adults.

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.

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.

However, elderly patients with severe trauma often do not meet the standard TTA criteria due to normal age-related changes and reduced physiologic capacities.

In the setting of shock, expected declines in blood pressure may not occur, leading to misinterpretation of the geriatric patient's condition.

[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.