Critical systemic and psychosocial considerations in management of trauma in the elderly

Traumatic injuries in the elderly are increasing commensurately with the activeness and healthiness of the lifestyles seen in our expanding geriatric population. Census data suggest that the elderly population will expand by 50% in future years and will represent a larger percentage of Americans by the year 2050. The annual occurrence of traumatic injuries in the elder cohort is reported to be as high as 29%. Perioperative management of acutely injured elderly patients is different from the care rendered to younger patients and is typically more complex. The purposes of this article are to (1) review factors related to aging that may have profound effects on the care and outcomes of senior citizens with craniofacial trauma, (2) consider the perioperative medical evaluation of the older patient, (3) discuss nutritional support and anesthetic management in the elderly, (4) discuss the unique physiological factors that may influence the treatment of craniofacial trauma in older patients, and (5) provide a rationale for facial trauma repair in the elderly that is influenced by the risk-benefit outcome of treatment planning decisions.