Trauma in the elderly in Trinidad and Tobago

Abstract:Objectives Falls are common in older people, causing significant mortality and morbidity but little is known about this phenomenon in developing countries. This study aimed to investigate falls in older people in the developing world, comparing fallers with other trauma patients. Methods We conducted a prospective observational study of older trauma patients in Trinidad over a 4 month period, comparing falls victims with other trauma patients, in relation to their demographic, pre morbid and injury characteristics. Results 439 older trauma patients (aged ≥65 years) were included. Fallers were older (median age 75 years vs 70 years in non fallers). 65.2% of fallers were female, compared to 43.7% of non fallers. Fallers were more likely to suffer from multiple pre existing diseases, with 29.8% having ≥ 3 comordibities, compared to 9.7% of non fallers. Fallers were also more likely to be on multiple medications: 7.1% were on 5 medications, compared to no non fallers. Fallers also sustained more severe injuries and presented with higher acuity than non fallers. Admission and referral rates were higher among fallers compared to other trauma patients (59.9% vs 30.4%). Conclusions Older patients who fall are a distinct group from other older trauma patients, with unique demographic, clinical and injury related characteristics. This information is useful in planning preventive and management strategies for these patients. Abstract ObjectivesFalls are common in older people, causing significant mortality and morbidity but little is known about this phenomenon in developing countries. This study aimed to investigate falls in older people in the developing world, comparing fallers with other trauma patients. MethodsWe conducted a prospective observational study of older trauma patients in Trinidad over a 4 month period, comparing falls victims with other trauma patients, in relation to their demographic, pre&morbid and injury characteristics. of fallers were female, compared to 43.7% of non&fallers. Fallers were more likely to suffer from multiple pre&existing diseases, with 29.8% having ≥ 3 comordibities, compared to 9.7% of non&fallers. Fallers were also more likely to be on multiple medications: 7.1% were on 5 medications, compared to no non&fallers. Fallers also sustained more severe injuries and presented with higher acuity than non&fallers.Admission and referral rates were higher among fallers compared to other trauma patients (59.9% vs 30.4%).

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“…The higher incidence of severe limb injuries in fallers reflects the increased risk of fractures in this group (3,5).…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the health and social problems that face older people is particularly relevant in these countries (5,6). …”

Section: Introductionmentioning

confidence: 99%

Are older fallers different? Comparing older fallers and non-fallers in a developing country

Yogi

Sammy

Paul

et al. 2017

Trauma

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“…While falls are common in older people, they remain a poorly understood mechanism of injury in the developing world [ 1 , 2 ]. Many authors have investigated falls in developed countries, but little research has been done on this phenomenon in the Caribbean [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Research into trauma and ageing in the developing world suggests that, while there are similarities between patients in developed and developing countries, there are also significant differences. Using data from 2009, Naraynsingh et al showed that older trauma patients in the developing world represented a smaller proportion of all trauma victims seen in the Emergency Department (ED), compared to the developed world [ 2 ]. In that study, 10% of all patients were aged 65 and older, compared to 14.1% of UK trauma patients being 75 and older in the same year in the UK [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Naraynsingh et al documented the differences between younger and older trauma patients in Trinidad and Tobago, but did not specifically look at falls as a mechanism of injury [ 2 ]. Trinidad and Tobago is an Commonwealth Caribbean state, of 1.3 million people, whose main economic activities are centred around petroleum production and manufacturing.…”

Section: Introductionmentioning

confidence: 99%

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Falls in older people: comparing older and younger fallers in a developing country

Yogi

Sammy

Paul

et al. 2017

Eur J Trauma Emerg Surg

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PurposeWhile falls are common in older people, causing significant mortality and morbidity, this phenomenon has not been extensively studied in the Caribbean. This study aimed to compare falls in older and younger people in this setting.MethodsWe conducted a prospective observational study of older trauma patients in Trinidad, comparing older and younger patients sustaining falls.Results1432 adult trauma patients were included (1141 aged 18–64 years and 291 aged 65 years and older). Older fallers were more likely to be female (66.7 vs 47.2%; p < 0.001), suffer from multiple pre-existing diseases (24.7 vs 2.4%; p < 0.001) and take multiple medications (16.1 vs 0.8%; p < 0.001). They also sustained more severe injuries and presented with higher acuity than younger fallers. Admission rates were higher among older fallers (29.9 vs 13.1%; p < 0.001).ConclusionsIn our study, older patients who fell were a distinct group from younger falls victims, with unique demographic, clinical and injury related characteristics. Their increased risk of injury within the home, coupled with their propensity for more severe injuries made them a high risk patient group. More research is needed to better understand this patient group and plan specific preventive interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s00068-017-0818-2) contains supplementary material, which is available to authorized users.

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Geriatric Trauma in a High‐Volume Trauma Centre in Cape Town: How Do We Compare?

Breedt

Steyn

2022

World j. surg.

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Background Little is known about the injury profile of older persons from low‐and‐middle‐income countries, such as South Africa, where violence is prevalent. This study aimed to identify common mechanisms of injury (MOI), severity, complications, and outcomes in elderly patients admitted to a referral trauma centre in Cape Town. Methods A retrospective review was performed of all patients ≥60 years presenting at Tygerberg hospital trauma centre over an eight‐month period. Descriptive statistics were computed for all variables of interest, and the relationship between the MOI, injury severity score (ISS), complications, and outcomes were assessed. Results Of the total 7,635 trauma cases admitted, patients ≥60 years accounted for 4% (n = 275). The most frequent MOI was low falls (58%). Of these 11% of injuries were intentionally inflicted. Among them 35% of the patients experienced complications. The ISS was positively associated with the number of complications (p < 0.01). The mortality rate was 6.5%. An ISS of ≥10 was associated with increased mortality (p < 0.01). The number of complications was positively associated with mortality (p < 0.01). Conclusions In contrast to high‐income countries (HICs), the cohort of elderly patients admitted to the trauma centre made up a relatively small portion of the total admissions. Compared to HICs, intentionally inflicted injuries and preventable MOI were common in our sample, underscoring the importance of addressing causative factors. Notably, the ISS was strongly associated with the number of complications and an ISS ≥10 was associated with mortality, highlighting the utility of the ISS in identifying elderly trauma patients most at risk of negative outcomes.

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Trauma in the elderly in Trinidad and Tobago

Cited by 14 publications

References 4 publications

Are older fallers different? Comparing older fallers and non-fallers in a developing country

Are older fallers different? Comparing older fallers and non-fallers in a developing country

Falls in older people: comparing older and younger fallers in a developing country

Geriatric Trauma in a High‐Volume Trauma Centre in Cape Town: How Do We Compare?

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