COMORBIDITY AND THE ELDERLY TRAUMA PATIENT

The elderly are forming an increasingly larger proportion of the popul ation in developed countries with increasingly active life styles. The injured elderly patient has a combination of decreased physiologic re serve and a high incidence of preexisting medical conditions that caus e comparably worse outcome, complications, longer hospital stay, and h igh costs. Although the management of specific injuries is similar in the elderly, many benefit from an overall more aggressive approach to early resuscitation and optimization of cardiopulmonary dynamics. An a wareness of the importance of preexisting medical conditions and a coo rdinated, directed approach to the management of the injuries and the concomitant diseases leads to the most effective care. Upon recovery f rom injury there is often a change of functional level that precipitat es a change in social circumstance. Ethical dilemmas, both at individu al and community levels, may arise more frequently in the older trauma patient population. Increased triage to a trauma center, particularly when concomitant disease is present, is justified on the basis of imp roving outcomes.