Traumatic injury in the geriatric population is increasing and is associated with higher mortality and morbidity compared to younger patients. Decreased physical reserve, various comorbid diseases, and an increased risk of elderly complications such as delirium has called for the development of geriatric specific care and protocols. The idea to employ better risk assessments, incorporate preventative strategies, improve surveillance and recognition of complications when they occur will reduce mortality and morbidity in the geriatric trauma patient population.

I. Objective: A multidisciplinary approach will be used to improve geriatric trauma patient care and decrease morbidity and mortality.

II. Multidisciplinary Team could consist of:

• Trauma Surgeon (lead)
• Nurse Supervisor
• Geriatrics
• Physical /Occupational Therapists
• Emergency Services
• Respiratory Therapists
• Neurosurgery
• Nutritionists
• Anesthesia
• Palliative Care
• Internal Medicine
• Case Coordinators
• Cardiology Orthopedics
• Registered Nurses Advanced Practice Providers
• Pharmacy
• Speech Therapy
• Hospital administrators
• Trauma Coordinators
• Social Workers
• Injury Prevention Coordinator

III. Geriatric Trauma Program Goals:
A. 30 minutes from emergency department presentation to trauma service evaluation
B. 4 hours from emergency department presentation to inpatient room
C. 36 hours from emergency department presentation to operating room
D. 5 days from emergency department to safe and appropriate discharge/disposition

IV. Criteria:
A. Age 65 years old or greater
B. Traumatic injury requiring hospitalization (primary diagnosis for initial admission must be acute, identifiable injury, which on its own, regardless of age, would require an admission to the hospital for treatment)

V. Discharge Planning
A. Within 24 hours of admission, all must have a pre-planned disposition, agreed upon by the patient, and/or family and the admitting physician

VI. Geriatric Trauma Activation
A. Seen first by an emergency department physician to establish criteria
B. Geriatric team notification
C. Goal of activation to exam of 30 minutes
a. Seen by trauma service initially
D. Appropriate sub-specialists notified
E. Expedited pre-procedure medical clearance
F. Admitted to SICU or geriatric unit (geriatric trauma service)

VII. Multidisciplinary Rounds
A. Team Members could include:

• Trauma Surgeon
• Occupational Therapist
• Nurse Practitioner
• Physical Therapist
• Registered Nurse
• Chaplin
• Respiratory Therapist
• Trauma Clinical Coordinator
• Nurse Manager
• Social Workers

References

1. ACS TQIP Geriatric Trauma Management Guidelines. Available at: https://www.facs.org/~/media/files/quality%20programs/trauma/tqip/geriatric%20guide%20tqip.ashx. Accessed March 8, 2016.

2. An innovative program designed to improve geriatric trauma patient care at Methodist Dallas. Available at: www.methodisthealthsystem.org/blank.cfm?print=yes&iirf_redirect=1&id_3811. Accessed March 4, 2016.

3. Managram, A. J. G60-Geriatric Trauma. Available at: https://intermountainphysician.org/intermountaincme/Documents/02_Sat_Mangram_G60%20Trauma.pdf. Accessed March 8, 2016.

4. Managram, A. J., Shifflette, V. K., Mitchell, C. D., Johnson, V. A., Lorenzo, M., Truitt, M. S.. . Dunn, E. L. (2011). The creation of a geriatric trauma unit "G-60". The American Surgeon, 77(9), 1144.

Resources

ACS TQUIP Geriatric Trauma Management Guidelines
ACS NSQIP Geriatric 2016 Guidelines
Geriatric Trauma Service: A One Year Experience
The Creation of a Geriatric Trauma Unit “G60”

• Summary of Delirium Clinical Practice Guideline Recommendations [PDF]
  
• Updated Beers Criteria – 2015

• Pain Management Guideline [PDF]
  

• Elder Abuse Management Guideline [PDF]
  

These guidelines are not intended as a directive or to present a definitive statement of the applicable standard of patient care. They are offered as an approach for quality assurance and risk management and are subject to (1) revision as warranted by the continuing evaluation of technology and practice; (2) the overall individual professional discretion and judgment of the treating provider in a given patient circumstance; and (3) the patient’s willingness to follow the recommended treatment.

Senior Lifestyle & Injury Prevention Program (SLIP)

SLIP Program PowerPoint

• Pedestrian
• Home
• Right Road
• Balance Your Life

Recommended Resources on Fall Prevention

Fall Prevention Program Guides

• Fall Prevention Fair

Activities

• Stepping On
  Stepping On is an evidence based fall prevention program offering community based, small group multifaceted training. CDC support established upwards of 50% reduction in falls. Training and train the trainer resources available from the Wisconsin Institute for Healthy Aging.
• Tai Chi for Arthritis
  Tai Chi for Arthritis: Dr. Paul Lam tai chi specialist established a program to provide focused tai chi training to improve balance, reduce pain and prevent falls. CDC has established effectiveness of the program in reducing falls.
• Otago
  Otago: Evidence based fall prevention program. Developed in New Zealand. 8 week program focusing on exercise, balance and strengthening practice. Training programs regionally and now supported with online modules.
• Matter of Balance
• ThinkFirst National Injury Prevention Foundation

Assessment Tools

• STEADI Materials for Health Care Providers
  As a health care provider, you are already aware that falls are a serious threat to the health and wellbeing of your older patients. You play an important role in caring for older adults and you can help reduce these devastating injuries. The STEADI Tool Kit contains resources and tools that will help make fall prevention an integral part of your clinical practice. STEADI materials can be used to assess, treat, and refer older adult patients based on their fall risk. Educational materials specifically designed for older adults and their friends and family are also included (CDC, 2016)
• STEADI Materials for Your Older Adult Patient
  Falls affect us all—whether personally or someone we love or care about. Every second of every day an older adult falls. In 2014 alone, more than one in four older adults reported falling and more than 27,000 older adults died as a result of falls—that’s 74 older adults every day. There are simple steps you can take to prevent falls and decrease falls risks. CDC has developed the STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative which includes educational materials and tools to improve fall prevention
• Elder Abuse – Administration on Aging

Program Development

• Preventing Falls: A Guide to Implementing Effective Community - Based Fall Prevention Program (CDC publication, 2015)
• CDC Compendium of Effective Fall Interventions: What Works for Community - Dwelling Older Adults, 3rd Edition (CDC Publication, 2015)

Pedestrian Safety

• Safe Route Program
• Pedestrian Safety Tip Sheets
• Vision Zero: New York City pedestrian safety. Resource guides available. Focuses on pedestrians, driver safety and street design and redesign targeting at risk areas.

Driving Safety

• Safe Mobility for Life Coalition - Driving safety self-assessment tools
• CarFit Program
  CarFit program: Educational program for older adults providing education on the proper “fit” for particpants in their car to ensure safety. In addition the program focuses on increasing participant mobility in the community and matching resources to increase their personal driving safety.
• AARP Programs
  AARP programs: Many program options offered for distracted driving awareness, driving safety for the older adult and strategies to improve defensive driving skills.
• National Highway Traffic Safety Administration (NHTAS): Promoting Older Driver Safety
  Getting older does not necessarily mean a person's driving days are over. But it is important to plan ahead and take steps to ensure the safety of your loved ones on the road. NHTSA offers free materials to help you learn more about how to recognize and discuss changes in your older loved one's driving
• The America Geriatric Society: Clinician’s Guide to Assessing and Counseling Older Drivers 3rd Edition
• American Automotive Association (AAA): Senior Driving Web Site
• Drivers 65 Plus: Check Your Performance
  A Self-Rating Tool with Facts and Suggestions for Safe Driving
• The Association for Driver Rehabilitation Specialists
  Provides national search tools to find equipment and training nationwide
• Roadwise Review online
  Screening program to assist in educating public about the changes that occur with aging that affect safety behind the wheel
• University of Florida: Fitness-to-Drive Screening Measure On-line
• The University of Michigan Transportation Research Institute and the UM Drive-Ability Program

Outreach Programs for Fall Prevention

• National Council on Aging
• National Clearinghouse on Abuse in Later Life

In 2030, when all of the baby boomers will be 65 and older, nearly one in five U.S. residents is expected to be 65 and older. This age group is projected to increase to 88.5 million in 2050, more than doubling the number in 2008 (38.7 million).

Similarly, the 85 and older population is expected to more than triple, from 5.4 million to 19 million between 2008 and 2050. (US Census Bureau, 2008 National Population Projections, Press Release, August 14, 2008)