When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma

As the U.S. population ages, the number of elderly patients presenting to trauma centers will continue to increase. The mean age of the subset of the population over age 65 has increased and will continue to do so. This subgroup is more active and mobile than in previous years, increasing the likelihood of traumatic injury. That individuals live longer and are more active is a testament to the increased overall health in this age group. Nonetheless, recent reports suggest that geriatric trauma patients are the fastest growing segment of patients admitted to trauma centers. 1 In addition, geriatric trauma patients have higher rates of morbidity and mortality compared with younger patients with comparable degrees of injury. 2‐4 These observations hold for multisystem “major trauma” 2,3,5,6 and unisystem “minor trauma.” 7‐10 If the elderly population is more active because they are healthier, why are outcomes in geriatric trauma uniformly worse? Stated another way, when is the elder old? We used a state trauma registry to carry out a descriptive study of geriatric trauma and examine the impact of comorbidity or preexisting conditions (PECs) on outcome. We attempted to define the impact of specific clinical variables and PECs on mortality in an effort to identify patient subsets in which prolonged, technologically intensive care might be futile. We hypothesized that certain PECs would have a profound effect on mortality in geriatric trauma independent of injury severity.