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My name is MDAS. And today we'll be talking about elderly trauma. This is the first lecture in a series where we will explore the unique challenges and considerations when managing trauma in older adults. Today's session will give you an introduction to elderly trauma, including the common causes of injury, physiological changes that affect trauma outcomes and why it's essential to approach this population. Let's dive in and start by discussing what we mean by elderly trauma and why it's such an important topic in modern health care. There is an increasing incidence of trauma in older people with a higher mortality and higher rate of complications. All the trauma patients are a unique and growing patient population that requires consideration of their reduced physiological reserve and blunted response to injury, physiological aging comorbidities and polypharmacy are more common among the patients and may mask signs of shock as well as make assessment and initial management. More challenging falls and fall related injuries are a common and serious problem for older people and people aged 65 and older have the highest risk of falling with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall falls are estimated to cost the NHS more than 2.3 billion lbs per year. Therefore, falling has an impact on quality of life. Health and health care costs. Falls are the leading cause of trauma related mortality in older adults. Even low mechanism falls such as those from standing height can result in significant morbidity and mortality. All the patients are more likely to be hospitalized, face complications and require rehabilitation. After four, risk factors include cognitive impairment, musculosus issues, and sarcopenia or muscle atrophy, polypharmacy, malnutrition and comorbid conditions like Parkinson's disease, strokes and cardiac issues. Further increase for risk sensory declines in vision and hearing along with age related changes in reflexes also contribute to syncope or temporary loss of consciousness, often triggers falls. This can result from acute conditions like infections, heart disease or medication effect. A comprehensive assessment should be conducted after any four to evaluate for underlying conditions. Additionally, environmental factors like stairs, rugs or poor footwear often play a role in these incidents in general fractures are the most common serious injury resulting from falls in older persons. Specifically fractures of the femur wrist humerus and pelvis in this age group result from the combined effects of force osteoporosis and other factors that increase susceptibility to injury. Other serious injuries resulting from falls include subneural hematoma, joint dislocation, severe laceration, sprain and other disabling soft tissue injury. Now, let's discuss the impact of comorbidities in elderly trauma, which is an important consideration when managing these patients. As we know, the elderly population often has multiple chronic medical conditions that affect not only their response to injury but also their recovery. First, let's talk about polypharmacy. Many elderly patients are on several medications. This presents a challenge you trauma care. For example, the use of anticoagulants like warfarin or direct oral anticoagulants is common in older adults to prevent strokes or manage atrial fibrillation. While these medications are life saving, they increase the risk of severe bleeding after trauma, even with relatively minor injury. So in every case of trauma, we need to carefully assess the medication history and be prepared to manage complications like internal bleeding or delayed clotting. Additionally, elderly patients are often on medications that may impaired their mental status or coordination such as sedatives, antipsychotics and antihypertensives. These drugs not only increase the risk of falls but also complicate the clinical picture by masking symptoms or contributing to delirium after injury. Next, let's address how chronic conditions further complicate trauma management. For instance, diabetes is prevalent in the elderly and is associated with delayed wound healing and a higher risk of infections. When we're managing fractures or surgical wounds. In elderly trauma patients, we must monitor closely for signs of infection and provide aggressive wound care to avoid complications like ulcer, cardiovascular disease is another major concern. Many elderly patients have underlying heart disease which limits their ability to tolerate blood loss or surgery. This makes them more susceptible to postoperative complications such as myocardial infarction or heart failure, even from relatively minor trauma. And then there's dementia in patients with cognitive impairment, it's often difficult to get a clear history or determine the mechanism of injury. They may not be able to describe their pain or cooperate with treatment which can lead to delays in diagnosis or mismanagement. Additionally, these patients are at higher risk for developing delirium during hospitalization which can further complicate the care overall. The presence of comorbidities in elderly trauma patients requires a highly individualized approach where we don't just treat the injury but manage the whole patient. This often means working closely with other specialties and being more vigilant in monitoring their response to treatment. Let's move on to elderly trauma management principles. Managing trauma in the elderly goes beyond simply treating the injury itself. It requires a comprehensive approach that accounts for the unique challenges this population faces such as frailty, decreased physiological reserves and the presence of multiple comorbidities. Let's start with the initial assessment. Elderly patients often present with challenges that can obscure the true severity of their injuries. Cognitive impairments like dementia or delirium as well as hearing or vision loss can make it difficult for them to communicate effectively. This means that our assessment need to be more thorough. We may need to rely on family members or caregivers to gather information about the incident and the patient's medical history. Simple measures like taking extra time to explain the process or using hearing aids if available can make a significant difference in how accurately we assess the condition next. It's crucial to emphasize the importance of a multidisciplinary approach in elderly trauma care. Unlike younger patients, where trauma care can often be managed by a smaller team. Elderly patients require input from multiple specialties. Trauma surgeons need to work closely with geriatricians who manage comorbidities, anesthetists to assess the risk of surgery or sedation and rehabilitation teams to plan for recovery. This collaborative effort ensures that we are not just focusing on immediate injuries but also planning for the long term recovery and quality of life. For example, an elderly patient with a hip fracture might need surgery but their cardiac risk must be assessed beforehand and plans must be made for early rehabilitation to prevent complications like pressure sores or pneumonia. This teamwork helps us tailor the care plan to each patient's specific needs. Finally, we need to discuss tailored care plans. Management of trauma in the elderly is not a one size fits all situation. These patients are more sensitive to medications such as addictives and painkillers and are at a higher risk of adverse effects such as respiratory depression or delia. We must adjust medication doses carefully balancing pain control with minimizing risks. Additionally, postoperative care must include careful monitoring for complications like deep vein thrombosis infections and delirium. Early mobilization and physiotherapy should be started as soon as possible to prevent deconditioning which can significantly delay recovery in the elderly. In summary, geriatric trauma care requires a patient centered multidisciplinary approach. We must account for the complexities of aging physiology, comorbidities and the social and psychological needs of the elderly to ensure the best possible outcome. Thank you all for your attention. Today. This concludes the first lecture on elderly trauma. As you can see, this is a complex and critical area of care that requires both a thorough understanding of the unique challenges faced by elderly patients and a disciplinary approach to management. We will be continuing this series with a few more lectures where we'll dive deeper into specific injuries, management strategies and prevention tactics tailored for elderly trauma patients. Before you go, we'd really appreciate your feedback on today's session. Please take a moment to scan the barcode on the screen which will take you to a quick feedback for your input, helps us improve the series and ensures we're covering the topics you find most valuable. Thank you again and I look forward to seeing you in the next lecture.