Penetrating Trauma in the Elderly (65 Years and Older): An Expression of Despair

Abstract

Background: As the US population ages, geriatric patients are sustaining more traumatic injuries. The injury etiologies, patterns and outcomes in geriatric patients are vastly different from their younger cohorts. Geriatric patients are usually associated with falls, and penetrating trauma is usually associated with gang affiliation. However, there is a paucity of literature pertaining to penetrating trauma in the geriatric population, a trauma pattern which we hypothesized would be associated with self inflicted injuries in an ever increasingly socially isolated population. We describe the pattern of penetrating trauma in a geriatric population aged 65 years and older compared with a younger cohort of 18-35 year old patients. Methods: The populations studied were geriatric patients aged 65 years and older In order to best appreciate these geriatric patients, we choose a much younger contemporary cohort of 18-35 year old penetrating trauma patients. This was a retrospective chart review over 14 years of penetrating trauma presenting to a single level 1 trauma center. Charts were reviewed for gender, mechanism of injury (gunshot, stab, non-violent), Injury Severity Score (ISS), presence of psychiatric illness, suicide attempt, injuries sustained, anatomic regions, and mortality. Results: There were 1,209 young and 62 geriatric patients. Male gender predominated, most significantly among younger patients (90% vs 76%; p=0.0002). ISS was not significantly different (9.7 vs 7.8; p=0.156). However, psychiatric illnesses (36% vs 1%; p=0.0001) and suicide attempts (37% vs 6.3%; p=0.0001) were both significantly elevated in the elderly cohort. There were significantly more head injuries (20.5% vs 6.8%; p=0.0036) and less abdominal injuries (32% vs 47.8%; p=0.04) in the geriatric population. 50% of the geriatric gunshot wounds were to the head vs 11.5% in young patients. Mortality was higher in the elderly (17.7% vs 8.6%; p=0.02) and more pronounced in suicide attempts (43.5% vs 19.7%; p=0.0295). Suicide accounted for 90% of the geriatric mortality versus 14% of the younger deaths (p=0.02). Conclusion: Penetrating trauma in geriatric patients differs from that in younger patients. It is associated with underlying psychiatric conditions and suicide attempts. Gunshot wounds to the head predominated in the geriatric population compared with the younger cohort. The frequency of this problem is anticipated to increase as the population of the US ages. Penetrating Geriatric trauma should raise concerns for social isolation and feelings of despair among our aging population, particularly in those with psychiatric illnesses.