Growing trend in older patients with severe injuries: mortality and mechanisms of injury between 1991 and 2010 at an inner city major trauma centre

摘要

The ageing population has been identified as a major challenge facing the heath-care system in Australia and abroad.1 The proportion of Australians aged 65 years and older has increased from around 11 % to 14% between 1990 and 2010, and is projected to increase further in the next decade.2 These trends pose particular challenges for the care of injured patients. Age is a well-described predictor of morbidity and mortality after trauma.3 A large study in the USA demonstrated a three- to fivefold increase in mortality and morbidity after adjusting for injury severity.4 Similarly a Victorian study showed a twofold higher mortality rate in older patients involved in road trauma.5 Elderly patients who are injured require more hospital resources compared with younger patients with the same mechanism of injury.6-7 This includes longer intensive care admissions and hospital length of stay, presumably due to pre-existing co-morbidities, declining physiological reserve and increasing rates of complications.8-10