We hope you have added to your knowledge skills and attitudes about Trauma and Falls in the Older ED Patient. The next time you are managing an older person who has been the subject of major trauma – MVC, struck by a car, fall from a height – perhaps you will keep in mind some of the subtle ways that aging physiology, comorbidities, and medication affect the nature of the resuscitation.
On almost every ED shift we see older people who have fallen. Our job is not just to assess and manage the injuries caused by the fall. Perhaps you have added to your strategies for addressing the possible causes of the fall – medication, functional decline, comorbidities, age-related causes of syncope – which may have a huge impact on preventing another even more serious fall.
You may recognize that new or increasing falls may be a symptom of another inter-current illness.
It may be clear now that there is little firm evidence or guidelines to inform the management of the most common injury of a fall – a head injury. But your awareness of changing neuro-anatomy and the consequences of anticoagulation may cause you to be more attentive to the head injured older person who “looks fine.”
Finally you may have a new understanding of the role of other members of the health care team in providing a more complete assessment of the older person who has fallen.
Review the Learning Objectives before proceeding to the Knowledge Check.
At the end of this module you should be able to:
- Define special trauma management issues in the older patient regarding patterns of injuries and assessment of shock – the components of ATLS that are different over 65;
- Describe an approach to a patient who has fallen, identifying potential causes of falls (identified by history, physical examination and functional assessment) as well as management of injuries, coordination of a discharge plan, and prevention of future falls.
- Understand the importance of an interdisciplinary team in assessing older patients with falls.
- Communicate the key components of a safe discharge plan for older patients who have fallen (e.g., accurate medication list, plan for follow-up).