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Background The mean and median age of major trauma continues to increase for a mean of 36 years in the 1990's to 59 and 61 years respectively in 2016 and 2017. The age planning of major trauma has important implications for healthcare planning. Methods The major trauma audit was established by the National Office of Clinical Audit (NOCA) in 2013 and focuses on the most severely injured trauma patients in our healthcare system. The methodological approach is provided by the Trauma Audit and Research Network (TARN). Since 2016 all 26 eligible hospitals have been participating in the audit and the coverage is now 86%.Data has been collected on more than 15000 trauma patients to date. Results There were 5061 recorded major trauma cases of which 2233 (44%) were over 65 years in 2017. The most common form of injury (57%) was falls less than two metres (low falls) and this began aged 45 years. 50% of injuries occurred in patient's own home. Only 11% of people were received by a trauma team and this was even lower in the older adult. Older people were very unlikely to be pre-alerted to the Emergency Department prior to arrival. 64% of the mortality from major trauma occurred in the over 65 years. 6%, 7% and 10% of patients aged 65-74, 75-84 and over 85's respectively were discharged directly to nursing home. Conclusion There is a marked change in the age profile sustaining major trauma since the late 1990's. Patients today are older with more complex medical needs, have greater lengths of stay and many do not return to independent living. The most common mechanism of injury for older people is a low fall at home. We need to prevent low galls using a multidisciplinary, multi-agency approach.

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