According to the US Census Bureau, the number of individuals aged 65 and older (who in 2006 totaled 35 million) will increase to 70 million by 2030 and to more than 86 million, or 1 in five persons, by 2050 (1-4).
Our current geriatric population has fewer disabilities and more active lifestyles than previous generations, which increases their risk of injury. In 1990, it was estimated that by 2050, 40 percent of all trauma patients would be 65 years old or older (5). The true number is likely to be higher as some major trauma centers have already exceed 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 emergency general surgery practices, the increasing geriatric and elderly population constitutes a significant proportion of the admissions and operative procedures and a disproportionate rate of complications and mortality risk (8,9). This changing landscape presents a huge challenge to acute care surgeons everywhere.
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. Our work products have been designed to directly address the priorities of not only of the committee’s mission, but also those laid out in the AAST Strategic Plan.
- 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 (AGS), the Geriatric Trauma Coalition (GeriTraC) was started by the AAST Geriatric Trauma Committee in 2015 to bring together stakeholder organizations to improve care for older, injured patients. Under the leadership of Drs. Robert Barraco, Zara Cooper, and Bellal Joseph, the coalition laid the groundwork for a number of important initiatives including work on a collection of evidence-based reviews that will be co-authored by GeriTraC work groups and members of the Geriatric Trauma Committee.
- In collaboration with EAST, the Acute Care Surgery Committee now has representation on the American Geriatrics Society’s Geriatrics-for-Specialists Initiative (AGS-GSI). Dr. Sasha Adams serves as the AAST representative.
- Develop a research agenda that supports the mission.
- The Geriatric Traumatic Brain Injury MITC: Over 3,000 patients have been enrolled in over forty-three centers. We have two prepared two presentations for the AAST Annual Meeting, and two more have been recently submitted to other major meetings.
- The Geriatric Frailty MITC is actively recruiting. Further information can be obtained through this committee or Dr. Bellal Joseph.
- The Geriatric Nutrition MITCs is actively recruiting. Further information can be obtained through this committee, or through Dr. Sasha Adams or Dr. Ty Putnam.
- The Geriatric Inter-personal Violence/Elder Abuse MITC is actively recruiting. Further information can be obtained through this committee, or through Dr. Rosemary Kozar or Dr. D’Andrea Joseph.
- The Geriatric Rib Fractures MITC is being developed by Dr. Alicia Mangram.
- The Geriatric TBI review article, authored by the members of the committee, was published in JTACS in 2018.
- The R21/R33 grant was submitted to the National Institute of Aging for a Geriatric Trauma Research Center under the leadership of Dr. Bellal Joseph through GeriTraC.
- In collaboration with members of the Critical Care Committee, and under the leadership of Dr. Karen Brasel, Drs. Orlando Kirton, Jay Yelon, and Ty Putnam are conducting a review of major critical care papers to evaluate their relevance to, and participation of, geriatric acute care surgery patients.
- 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 that promote maximal functional recovery of the elderly.
- A lunch session focused on successful strategies for managing geriatric injury is on the program for the Annual Meeting in Dallas this year.
- A session on geriatric perioperative emergency general surgery management will be part of the Emergency General Surgery Update at the American College of Surgeons Annual Congress this year.
- A panel session on geriatric trauma and management will be part of the program at the American College of Surgeons Annual Congress this year.
- In conjunction with GeriTraC, five evidence-based reviews are in production by members of the Geriatric Trauma Committee. In addition, a “Green Paper” is in production to delineate topics about which there is currently a relative paucity of literature, as future areas of potential investigation.
- Several geriatric-specific ACS modules have been developed by members of the committee on delirium, falls and syncope, and anticoagulation and reversal.
- An additional module on medication dosing and pharmacology in elderly patients is also in development.
- Educate the public about the most common causes of injury and acute surgical illness in the elderly.
- Under the leadership of and hard work by Drs. Jody DiGiacomo, Jennifer Hubbard, Orlando Kirton, and Vanessa Ho, several prepared lectures have been created for use by the membership to give lectures on rib fractures, hip fractures, and delirium.
- Promote injury prevention measures specific to the elderly.
- In collaboration with the Injury Prevention Committee, Dr. Carrie Simms is leading a group in writing a white paper on geriatric fall prevention.
I am honored to serve as chairperson of this committee for the AAST. On behalf of myself and Vice-Chair Jody DiGiacomo, 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 email@example.com.
- US Bureau of the Census. 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.
- Hashmi A, Ibrahim-Zada I, Rhee P et al. Predictors of Mortality in Geriatric Trauma Patients: A Systematic Review and Meta-analysis. Journal of Trauma and Acute Care Surgery 2014;76:894–901.
- Vincent GK, Velkoff VA, U.S. Census Bureau. The Next Four Decades the Older population in the United States: 2010 to 2050. Population Estimates and Projections P25-1138. Washington, DC: U.S. Dept. of Commerce, Economics and Statistics Administration, U.S. Census Bureau; 2010. Available from http://purl.access.gpo.gov/GPO/LPS126596.
- 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.
- MacKenzie EJ, Morris JA Jr, Smith GS, et al. Acute Hospital Costs of Trauma in the United States: Implications for Regionalized Systems of Care. Journal of Trauma and Acute Care Surgery 1990;30:1096–101 [discussion: 1101–3].
- 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/.
- 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. Journal of Trauma and Acute Care Surgery 2014; 77: 202–208.
- Deiner S, Westlake B, Dutton RP. Patterns of Surgical Care and Complications in Elderly Adults. Journal Am Geriatr Soc 2014; 62: 829–835.
Collaborations within AAST
The Geriatric Trauma/ACS Committee continues to have collaborations with the Acute Care Surgery Committee, Prevention Committee, and the Critical Care Committee in which members of each committee participate in conference calls with the other committees to assure that efforts in areas of mutual interest are being coordinated. We recently added the Palliative Care Ad Hoc Committee to this roster.
Examples of such joint activities include:
- Joint submission for sessions the 2020 Annual Assembly
- Joint MITC proposals
- An injury prevention white paper submitted for publication
- Joint projects creating best practices for geriatric EGS topics
- Multi-institutional trials
- Frailty MITC enrolling
- Geriatric Nutrition MITC soon to start
- Elder abuse /IPV MITC soon to start
- Palliative Care MITC being drafted
- Rib fracture MITC being drafted
- A “green paper” in draft/outline form to serve as an update on the gaps in research in Geriatric Injury and what progress has or has not been made since the 2015 White Paper by Kozar, et al.
- Creation of a Best Practices document for management of acute emergency surgical conditions in geriatric patients. In collaboration with ACS, we hope to start soon with gallbladder disease as first topic.
- Joint session with Palliative Care Ad Hoc Committee at Annual meeting
- Developed ACS modules with specific geriatric content.
- Delirium in elderly patients
- Falls and syncope
- Anticoagulation and reversal
- Medication dosing and pharmacology in elderly patients
- “Canned” lectures on Geriatric Hip Fractures, Geriatric Rib Fractures, and Delirium
- Geri-TraC. R21/R33 NIA grant submitted by Geri-TraC. Scored but not funded. Being resubmitted through CNTR. Will need to discuss transfer of Geri-Trac to CNTR if funded. If not funded, will need to discuss future support for Geri-Trac
- First 3 years are feasibility as well as infrastructure development.
- Years 4 and 5 are the critical years where we will be able to do MIT Prospective randomized interventional trials.
- American Geriatrics Society (AGS) Geriatrics-for-Specialists Initiative (AGS-GSI)/Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists (SEGUE)
- Sasha Adams serves as AAST’s representative
- ACS Quality in Geriatric Surgery Certification. Members involved at the College keeping committee informed although verifications on hold due to COVID