• Geriatric Trauma/ACS Committee

     
     
     
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    According to the US Census Bureau, the estimated population of individuals older than 65 years was 35 million in 2006, and it is expected that this population will double to 70 million by 2030 (1). This group is also anticipated to grow to more than 86 million, or 1 in five persons, by 2050 (2–4). Currently, older adults have fewer disabilities and more active lifestyles than those of previous generations, which increases their risk of injury. At least one study from 1990 estimated that by 2050, 40 percent of all trauma patients will be 65 years or older (5). The true number is likely to be higher as some major trauma centers are already exceeding that figure (6).

    Trauma in the elderly accounts for $12 billion in annual medical expenditures and $25 billion in total annual healthcare expenditures (7). In addition, the burden of geriatric patients among our emergency general surgery practices is increasing: the elderly population is making a significant contribution to the overall increase in admissions and operative procedures done (8). As the need for emergency surgery increases with age, so does the rate of complications and risk of death (9). The increase in the elderly population along with the increasing incidence of their presenting with emergency surgical conditions, and the added risks of emergency surgery in the geriatric patient, present a huge challenge to acute care surgeons.

    In 2013, Dr. Robert Mackersie gave his presidential address to the AAST entitled, "For the Care of the Underserved." In that address, he identified the growing population of injured elderly patients as an underserved patient population and subsequently convened the Ad-Hoc Geriatric Trauma Committee to advise the AAST regarding the problems, issues, and needs of the geriatric patient.

    Under the leadership of Dr. Steven Shackford, the committee transitioned from an Ad-Hoc to a standing committee by Presidents William Cioffi and Thomas Scalea at the Annual Meeting in September 2014. In 2015, the committee published a white paper, first authored by Dr. Rosemary Kozar, entitled "Injury in the Aged: Geriatric Trauma Care at the Crossroads." Since that time, continuing the work of Dr. Shackford, but now under the leadership of Dr. Robert Barraco, the committee has become engaged in a number of activities that directly address the committee’s mission statement: “The mission of the Geriatric Trauma Committee is to advance the care of elderly patients with acute surgical illness and injury through research, education, and advocacy.” These activities, and subsequent work products, have been designed to directly address the priorities of not only of the committee’s mission, but also the priorities laid out in the AAST Strategic Plan, which was presented by President Raul Coimbra at the 2017 Annual Meeting.

    The committee’s current activities are stratified into overarching specific aims as originally outlined by the committee in 2014:

    • Work collaboratively with all professional societies and organizations interested in the well-being and care of the elderly.
      • In collaboration with the American College of Surgeons, and with support from the American Geriatrics Society, the Geriatric Trauma Coalition (GeriTrac) was started by the AAST Geriatric Trauma Committee in 2015 to bring together stakeholder organizations around improving care for older injured patients. Under the leadership of Drs. Robert Barraco, Zara Cooper, and Bellal Joseph, the Coalition has a number of initiatives outlined below.
      • Hold initial conversations with members of the American Geriatrics Society’s (AGS) Geriatrics-for-Specialists Initiative (AGS-GSI) to consider membership by the AAST.
    • Develop a research agenda that supports the mission of the Geriatric Trauma Committee.
      • One AAST MITC (Geri-TBI)—actively recruiting
      • Two other AAST MITCs planned—one evaluating frailty and one addressing nutritional status
      • Geriatric TBI review article authored by the members of the committee—in process
      • R21/R33 grant submission to the National Institute of Aging for a Geriatric Trauma Research Center—currently being written under the leadership of Dr. Bellal Joseph through GeriTrac
      • In collaboration with members of Dr. Karen Brasel’s Critical Care Committee, Drs. Orlando Kirton, Jay Yelon, and Ty Putnam are conducting a review of major critical care papers to evaluate the relevance to, and participation of, geriatric acute care surgery patients.
      • Plan a collaborative MITC with the Acute Care Surgery Committee to specifically address issues in the geriatric ACS patient—in process
    • Educate providers about the physiologic and anatomic changes that affect the well-being of the elderly, specifically as they relate to injury incidence and recovery, and develop evidence-based guidelines for common injuries and acute surgical illnesses that affect the well-being of the elderly, and develop guidelines that promote the maximal functional recovery of the elderly.
      • Under the leadership of Dr. Zara Cooper, 12 evidence-based reviews are in their final phases. They address a variety of topics of interest to Acute Care Surgeons through the GeriTrac collaborative
      • Drs. Andrew Bernard and Matt Carrick have put together an exceptional slide deck. It is available to members of AAST through the Geriatric Committee website. Please check it out!
      • In collaboration with the Acute Care Surgery Committee, the members of the Geriatric Trauma Committee—including Drs. Toan Huynh, Ahijit Pathak, and David Lindsey—will be reviewing the current online modules for geriatric-specific content, and they will be assisting with writing additional geriatric-specific modules
      • Sasha Adams has been diligently working on maintaining and updating the Geriatric Committee website.
    • Educate the public about the most common causes of injury and acute surgical illness in the elderly.
      • We are in the planning stages of creating outreach activities to non-trauma societies and community surgeons under the leadership of Drs. Jody DiGiacomo, Matt Carrick, and Jennifer Hubbard
    • Promote injury prevention measures specific to the elderly.
      • In collaboration with the Injury Prevention Committee, Drs. Carrie Simms, Kenji Inaba, and Toan Huyhn are leading a group that is writing a white paper on geriatric fall prevention.

     

    I am honored to serve as Chairperson of this committee for the AAST. On behalf of Vice-Chair, Dr. Jody DiGiacomo, and myself, we would like to thank the members of this committee for their energy, enthusiasm, and commitment. I would also like to thank the administrative staff at AAST, especially Jermica Smith and Sharon Gautschy, for their assistance and expertise that allows the committee to carry out its crucial mission. If anyone is interested is assisting with any of these activities, or has ideas for other initiatives, please don’t hesitate to contact me at dstein@umm.edu.

     

    1. US Census Bureau. US Administration on Aging [on-line]. Older Population by Age, 1900–2050. [August 11, 2005]. Available at aoa.gov/prof/Statistics/online_stat_data/AgePop2050.asp.
    2. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76:894-901.
    3. Vincent GK, Velkoff VA, US Census Bureau. The next four decades the older population in the United States: 2010 to 2050: Population estimates and projections P25-1138. Washington, DC: US Dept. of Commerce, Economics and Statistics Administration, US Census Bureau; 2010. Available from http://purl.access.gpo.gov/GPO/LPS126596.
    4. Flanagan SR, Hibbard MR, Riordan B, Gordon WA. Traumatic brain injury in the elderly: diagnostic and treatment challenges. Clin Geriatr Med. 2006;22(2):449-468.
    5. MacKenzie EJ, Morris JA Jr, Smith GS, et al. Acute hospital costs of trauma in the United States: Implications for regionalized systems of care. J Trauma Acute Care Surg. 1990;30:1096–101 [discussion: 1101–3].
    6. http://www.traumanurses.org/_resources/documents/events/conference/2015/STN2015EvidenceBasedOralAbstracts.pdf
    7. CDC Data and Statistics (WISQARSTM): Cost of Injury Reports Data Source: NCHS Vital Statistics System for Numbers of Deaths. http://wisqars.cdc.gov/8080/costT/.
    8. Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample – 2001 to 2010. J Trauma Acute Care Surg.2014; 77: 202–208.
    9. Deiner S, Westlake B, Dutton RP. Patterns of surgical care and complications in elderly adults. J Am Geriatr Soc. 2014;62: 829–835.