Geriatric Trauma: Not Just Older Adults, An Interview with Christopher Colwell, MD

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Christopher Colwell, MD FACEP

Author: M. Kaitlin Parks, MSIV
Medical Student
Oklahoma State University COM
AAEM/RSA Publications and Social Media Committee

Interviewee: Dr. Christopher Colwell, MD FACEP
Chief of Emergency Medicine
San Francisco General Hospital and Trauma Center, Professor, UCSF

Just as any pediatrician would tell you, “a child is not just a small adult”. The same goes for the geriatric population. There are many physiologic differences in the geriatric population that are important to understand in order to deliver the best and most tailored care. An area where this is especially pertinent to the emergency physician is in the setting of trauma. A lot of what we know about trauma has come from military medicine, which sees a strong bias towards the young and healthy. As our population ages, we are seeing an increasing number of geriatric trauma patients in the emergency department (ED).[1,2] Older patients have higher morbidity and mortality in the setting of trauma.[3] Our geriatric patients are also more likely to have comorbidities and medications that both worsen their response (such as anti-coagulation and clotting) or blunt their capacity to compensate (such as beta-blockers and heart rate).[4] Age has been integrated into Trauma Triage criteria but many criteria are based on vitals that may not adequately measure the severity of select trauma cases in the geriatric population.[5]

Updates in Geriatric Emergency Medicine

Authors: Phillip Magidson, MD MPH; David Bostick, MD MPH; Erica Bates, MD; Robert Brown, MD
Edited by: Jay Khapde, MD FAAEM and Michael C. Bond, MD FAAEM

Between the 2000 and 2010 U.S. Census, the population over age 65 increased at a higher rate that the overall U.S. population. For the purposes of this article, we will use age greater than 65 as the definition of a geriatric patient. By 2050, there will be over 83 million geriatric Americans, double the number from 2012.1 Currently, over 15% of emergency department (ED) visits, equaling 20 million total visits, are from geriatric patients.2 These numbers are certain to increase and will represent a unique challenge to the U.S. health care system, specifically to the ED. In this month’s “Resident Journal Review,” we focus on the evaluation, diagnosis, and treatment of geriatric patients presenting to the ED.