trauma in specialist populations - elderly

what are some physiological changes that happen to elderly MSK systems?

• height loss due to vertebrae disc dehydration

• more porous bones as a result of reduced calcium production - brittle and fragile bones

• changes to vertebral column may result in less injury required to damage spinal cord + decreased ROM

• weakening muscles + muscle wastage

• changes to spine shape

how does ventilatory function change in the elderly?

• increased chest wall stiffness

• alveolar surface decreases

• body loses ability to saturate haemoglobin with oxygen - elderly may tolerate lower o2 sats

how does cardiovascular function change in the elderly?

• reduced cardiovascular output (increased arterial and muscle stiffness) may contribute to hypoxia + bleeding elderly pts may deteriorate faster

• may tolerate fluids worse/increased risk of fluid overload = cardiovascular strain and pulmonary oedema

how does the nervous system change in the elderly?

• cerebral atrophy = increased cerebrospinal fluid

• also means there’s more room for blood (elderly head injury pts need scan)

• sensory changes - hearing, vision, temp, pain sensation (get hands on to ID pain)

• slowed nerve impulse conduction

• mental + psychomotor decline

what are some airway management considerations in elderly pts?

• diminished alveolar surface area impedes gas exchange

• facial structure changes (leave dentures in to give structure for mask)

• impaired cough/gag reflex (more prone to choking)

• diminished oesophageal sphincter tone (ventilation air more likely to go to stomach and cause vomiting - squeeze 1/3rd of bag only)

• increased reliance on diaphragm

• very sensitive to intra-abdominal pressure (eg bleed)

what are some circulation management considerations in elderly patients?

• cap refill poor indication of perfusion status

• pre-existing cardiovascular disease may impact presentation

• medications may impact patient physiology (eg just bc pt has normal HR doesn’t mean they’re not bleeding, they may be on beta blockers)

• blood pressure may be unreliable as elderly are commonly hypertensive - a ‘low bp’ for an elderly pt may seem normal

what are some neurological management considerations in elderly pts

• varied mentation, memory and orientation

• decreased pain and temp sensation - may be unaware to injury

• malnourishment can affect treatment

• changes in body structure may require adaptations in packaging