Number of ED visits for injured elderly increasing

Are you treating more injured elderly patients in your ED? A report from the Bethesda, MD-based U.S. Consumer Product Safety Commission shows a 73% increase in the number of patients 75 and older treated for product-related injuries in EDs from 1991 to 2002, with falls the leading cause of injury.

"As this population continues to grow, we will see an ever increasing number of elderly trauma patients," says Kathleen Loeffler, RN, research nurse at Harborview Medical Center in Seattle. "Being prepared and proactive will be the best defense."

ED nurses can make a huge difference in the lives of their elderly patients by careful assessment, says Loeffler. "Understanding the unique physiological and anatomical differences in this age group and providing early, appropriate interventions is crucial for the best possible outcomes," she says.

To improve care of elderly patients with falls, consider the following:

  • Even a relatively minor fall can lead to serious complications.

Falls in seniors are related to the decreased functions of their special senses, which in turn lead to decreased vision and impaired gait, balance, and proprioception, says Loeffler. "Further complicating this are issues like syncope, medication interactions, drug or alcohol use, and delayed response times," she says.

  • Falls may have multiple causes.

An overmedicated patient may trip over a scatter rug while wearing unsafe shoes, says Loeffler. "Those osteoporotic bones can snap like a dry twig," she says. "A sudden, awkward turn causes the femoral neck to fracture, leading to a fall from standing.’"

  • Hip and femur fractures are common results of falls.

Blood loss from these injuries can range from 500 cc to 1,500 cc, says Loeffler. "Remember that the elderly cannot easily compensate for this change in blood volume," she says. "Keeping a blood pressure of 120 or greater and a hematocrit of 30 or higher is critical."

  • Traumatic brain injury also is frequently seen with falls in elders.

The increased fragility of the cerebral blood vessels along with cerebral atrophy leaves more intracranial room to bleed and swell, says Loeffler. "Patients who come in complaining of a persistent headache that is often worse at night often have impressive subdural hematomas," she says. "Many times, the patient will give no history of trauma or perhaps a minor fall a few days prior to arrival in the ED."