For the first time in history there are 11 million people aged 65 or over in the UK. Older people are remaining active for longer, however the risk of traumatic injury is also growing for this age group.

Causes of traumatic injury for older people

Traumatic injury has many causes, including road traffic collisions, pedestrians being hit by vehicles, assault, domestic abuse and suicide attempts.  However, the most frequent cause of injury in older people is falling, from either a low level (i.e. from standing or a chair), or a higher level (such as falling from a ladder).  Falls and fear of falling are important health issues for older people – if you or someone you knows suffers from frequent falls, this requires investigation via the GP for possible referral to a specialist falls services.

Some falls might result in relatively uncomplicated injuries, such as a small wound or a broken wrist. Whilst these may be painful and inconvenient, they will usually only cause temporary disruption to ‘normal life’ until the injury is healed.

However for some older people, both low and high level falls can result in significant traumatic injury. This may affect the head - where there is bruising or bleeding around the brain; cause broken (also known as fractured) ribs with bruising to the underlying lung; or cause fractures to large bones such as the hips or pelvis. These types of severe injury may require an operation (or set of operations), admission to the intensive care unit for close monitoring or transfer to another hospital for specialist care.

Differences for older people

Younger people also suffer these types of traumatic injuries, but ageing can mean that the effects of trauma may be more severe. In some older people the severity of injuries may be difficult to detect at first and recovery may be more complex and prolonged. This is due to a number of factors, such as:

• Physical changes that occur in the body as a result of ageing. Normal responses in the immune system or blood clotting may be altered or slower in older people. Skin and muscles become thinner with age and bone strength may be weaker. These age-related changes may delay healing and leave the older patient prone to other problems such as infection or chronic pain.
• Injury can be complicated by other diseases. Many older people have other health problems, such as high blood pressure, heart disease, diabetes or dementia which can complicate or slow recovery after injury.
• Medications may affect responses to injury. Some older patients take a number of medicines and tablets on a daily basis such as aspirin, warfarin or painkillers, and these may affect the time it takes to heal after trauma. Warfarin, a blood thinning medicine, can cause internal and external bleeding after injuries. Therefore it is recommended that older people who are prescribed warfarin should seek medical advice after trauma, even if the injury appears to be relatively simple.

As a result of injury, older people may have to spend a considerable amount of time in hospital in comparison to their younger counterparts. Relatively simple trauma may cause more severe injury, be challenging to diagnose, take much longer to heal and returning to normal ‘pre-injury’ life might take time – in some cases many months.  Some older patients are unable to return home after their injury and may require a period of care in a rehabilitation or nursing facility.

Chronic pain after injury for older people

Finally, many older people report long term pain after their injuries. Pain can persist for quite a long time after traumatic injury, in some cases for many weeks or months. Longer-term pain (known as chronic pain) can affect the quality of recovery after trauma for older patients.  After discharge from hospital it is important that older people seek advice from their doctor (GP), or nurse or physio/occupational therapist about how best to manage injury-related pain. This website offers advice for monitoring and managing chronic pain.