Polytrauma in the elderly: a review

Overview

This review looks at the growing number of older adults who suffer multiple injuries. Their assessment and management differ in important ways from those of younger trauma patients. It is relevant to trauma surgeons, emergency physicians, orthopaedic surgeons, intensivists and geriatricians.

Why older patients differ

Reduced physiological reserve, comorbidities and multiple medications, including anticoagulant and antiplatelet therapy, change how older patients respond to injury. Low-energy mechanisms such as falls from standing height can cause serious injury. Normal vital signs may hide significant hypoperfusion. These factors contribute to systematic under-triage. The review stresses a low threshold for trauma team activation and for advanced imaging in older patients.

Key injury patterns

Traumatic brain injury is a particular concern, especially in patients taking anticoagulants. Chest wall injuries and rib fractures carry a high risk of respiratory complications. Pelvic and spinal fractures are common and often under-recognised.

Management principles

The review recommends prompt reversal of anticoagulation when indicated, careful fluid and haemodynamic management, and effective analgesia that includes regional techniques. Early definitive fixation and mobilisation are advised where possible. Systematic frailty assessment, prevention of delirium and early geriatric co-management are highlighted as ways to improve outcomes.

Implications for practice

Care should be adapted to physiological age and frailty rather than chronological age alone. Early discussion of goals of care with patients and families should be part of management, because outcomes and recovery priorities can differ considerably in this group.