Common Causes of Geriatric Trauma

Thanks to the advancements in geriatric care, our elderly now have the opportunity to lead independent and happy lives – an advantage which unfortunately the previous generation did not enjoy. As happy as we are to see the changing trend in the lifestyle of elderly people, there are also some challenges they face which have to be acknowledged so that we can be proactive in safeguarding their mobility and health.

Geriatric trauma refers to any harmful event that happens to an elderly person. The most common cause of trauma is a fall. This is followed by road traffic accidents, burn injuries and physical abuse.

The elderly form a significant portion of the patients coming to the emergency department as a result of some kind of trauma. There are a number of reasons for this:

• As a person ages, his/her ability to respond quickly reduces. Therefore, they might not be able to stop a fall by holding onto something.
• There is also a reduction in muscle strength. So, the injury sustained even from a low-impact fall is more compared to a younger adult.
• Bone density too decreases with age and a person is more prone to fractures from falls.
• The comorbidities an elderly person usually has also contribute to complications from a traumatic injury.
• Medications the elderly might be on for other conditions could also affect their ability to respond fast.

Falls: This is the leading cause of trauma in elderly. Falls often lead to brain injuries and other disabilities as well. Sometimes, a fall could even be fatal.

• Falls are often the result of balance issues as well as vision impairment.
• Certain health conditions could also lead to giddiness and consequently a fall.

Environmental factors could also contribute to a fall:

• Poor lighting, especially near staircases.
• Wires and rugs on the floor.
• An urgency to reach the toilet.
• Wet flooring or flooring that has been polished or newly laid.
• Doing simple odd jobs at home that require the use of heavy tools or a ladder could result in a fall.

There are a number of things we can do to reduce the possibility of a fall.

• Perform balance and strength training exercises.
• Get vision checked regularly.
• Perform routine house checks to identify conditions that could cause a fall.
• Install grab bars in bathrooms.
• Ensure adequate lighting around the house.
• Secure rugs and have mats that do not move when stepped on.
• Wear proper footwear.
• Get professionals to do household repairs.
• If any medication is leading to drowsiness/reduction in alertness, talk to the doctor regarding alternatives.

Road Traffic Accidents:

• There is an increase in the number of elderly people who arrive at the emergency department due to involvement in a road traffic accident.
• Most of them are pedestrians and they often sustain multiple fractures.
• The mortality rate of elderly involved in road accidents is significantly higher than that of younger adults.

Road accidents can be prevented by following these safety tips:

• As agility decreases with age, an older person has to give himself extra time to cross a road.
• Avoid distractions like talking on the phone; the focus should be entirely on the road.
• Cross in well-lit areas, preferably at marked junctions.
• Try to have eye contact with the driver of the approaching vehicle to judge when it would be prudent to cross.
• While walking at night, it is better to wear bright colored clothes.
• If driving, wearing the seat belt is mandatory.
• Choose routes that are less congested.
• Avoid night driving whenever possible.

Family members might have to intervene and take a stand if they feel driving is unsafe for the elderly person. Often older people fear they will lose their independence if they stop driving. These issues need to be considered, discussed and a solution arrived at.

Burn Injuries:

Though less common than the other two types of trauma mentioned above, its effects are no less traumatic. Commonly sustained in the kitchen, the elderly who suffer from burn injuries have increased chances of developing pneumonia, sepsis, pulmonary edema, urinary tract infections, etc. Treatment and recovery both take longer, and restoring the same quality of life they enjoyed before the injury, might prove difficult.

A few simple precautions will help prevent burn injuries:

• Wearing cotton clothes while cooking is essential. The clothes should be well fitting and not too long.
• Cooking while drowsy, on medications or while not fully alert should be avoided.
• Do not leave the kitchen with a dish on simmer. If it has to be done, set a reminder on the phone.
• Hot oil can splutter; if it happens, keep a lid close-by to cover it and turn off the stove.
• Hot water/liquids and steam can be just as dangerous as hot vessels. Handle with extreme care.
• Avoid overloading power outlets with adapters.
• Unplug all gadgets when not in use.
• Make sure the kitchen floor is always dry.
• Kitchen alarms are easily available and can be installed.

While all the above measures are with reference to the kitchen, it is essential for the house to have an alternative way out in case of a fire.

Physical Abuse:

It is reported that physical abuse of the elderly is often caused by the people whom they trust. There was an increase in physical abuse reported during the pandemic. Physical abuse can lead to grave physical conditions and can affect mental health as well.

Often the elderly will not want to admit to abuse. In such cases, there are some signs which we can watch out for.

• The person seems suddenly quiet and depressed.
• Weight loss and disinterest in personal hygiene.
• Visible signs of injury.
• House is unkempt.

While there may be other reasons for the above scenarios, elder abuse will have to be ruled out.

India does have a toll-free Elder Line, that persons experiencing abuse can reach out to for help.