An ageing trauma population: The Auckland experience

As the population ages, the number of elderly patients suffering injuries is increasing. Reports from North America have shown an increasing proportion of elderly admissions with a disproportionate number of deaths. However, this trend has not yet been examined in New Zealand. The aim of this study was to determine unique characteristics of geriatric patients as compared to the general trauma population.

The trauma database at Auckland City Hospital (ACH) was queried for patients age 65 years and above admitted between 2005-2012. Demographics, mechanism of injury, length of stay, and disposition were recorded.

1644 patients were included. The proportion of elderly patient admissions increased from 15% to 20% over the study period (p=<0.001). There were 93 deaths (6%); mortality increased with age-9% for patients 85+ compared to 5% for age 65-84 (p=0.004). Elderly trauma patients accounted for 38% of all trauma deaths. Average length of stay for survivors was 9 +/- 10 days, with 63% discharged home (n=1042), 19% to rehabilitation (n=316) and 7% to rest home (n=111). Falls were the most common mechanism (n=1261, 76%), however these patients had lower mortality compared to road traffic collision (4% vs. 12%, p<0.001) and pedestrians struck (4% vs. 11%, p<0.001).

ACH has seen a significant increase in elderly trauma admissions without a change in catchment or referral pattern. These patients have a higher mortality than those under 65, longer length of stay, and are less likely to return home. Specific education on fall prevention should be increased to lessen the burden on the health system as a whole. Given the linear increase in mortality, specialised geriatric care should be considered starting at age 75.