Geriatric Trauma/ACS Committee

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.
  
  
• Develop a research agenda that supports the mission.
• 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.
  
  
• Educate the public about the most common causes of injury and acute surgical illness in the elderly.
  
  
• Promote injury prevention measures specific to the elderly.

I am honored to serve as chairperson of this committee for the AAST. On behalf of myself and Vice-Chair Vanessa Ho, we would like to thank the members of this committee for their energy, enthusiasm, and commitment. 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 bjoseph@arizona.edu.

1. 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.
2. 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.
3. 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.
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. Journal of Trauma and Acute Care Surgery 1990;30:1096–101 [discussion: 1101–3].
6. http://www.traumanurses.org/_resources/documents/events/conference/2015/STN2015EvidenceBasedOralAbstracts.pdf
7. CDC Data and Statistics (WISQARS^TM): 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. Journal of Trauma and Acute Care Surgery 2014; 77: 202–208.
9. 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, Palliative Care Ad Hoc 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  to this roster. 

Inaugural Event, Planned by the Injury Prevention and Geriatric Committees: Injury affects all persons of all ages from all walks of life. However, decreasing injury and optimizing outcomes is the commitment of the entire Trauma community. Understanding that falls are a significant cause of morbidity and mortality in the older population, the American Association for the Surgery of Trauma represented by the Injury Prevention and Geriatric Committees have taken a major step and created the “Stop the Falls” Community Outreach. This important collaborative event will take place as a pre-session to the 2023 AAST Annual Meeting on Tuesday, September 19, 2023 at the Anaheim Senior Citizens Club, in Anaheim CA.

A multidisciplinary team of physicians, nurses, prehospital providers, among others, will provide information on fall risk, mechanisms and fall prevention techniques. Included in the event will be an interactive session that consist of a Tai Chi demonstration and Bingo, Prizes, give-a-ways and Lunch. We are excited about the event honored to work with together with the Anaheim Senior Citizens Club, the Anaheim Fire and Rescue and representatives from UCI Health Level 1 Trauma Center without whom this could not occur.

Research

• Multi-Institutional Trials
  • The AAST Geriatrics Committee has several ongoing Multi-Institutional Trials live on the website which are recruiting or near-completion, including Interpersonal Violence in the Elderly and Multi-Center Validation of the Trauma Specific Frailty Index in Geriatric Trauma Patients MITs which are in development with our committee include Nutrition in the Geriatric Trauma Patient and Delirium in the ICU. 

Education

• Lunch Sessions 
  • "360 Care of the Older Adult EGS Patient"; Presented at the 2023 Annual Meeting
  • "Practicing Outside the Box: How to Develop a Multidisciplinary Approach for the Care of Geriatric Surgical Patients";
    Presented at the 2022 Annual Meeting
  • "Surgical Futility in the Elderly: First Do No Harm"; Presented at the 2022 Annual Meeting

Coalition Activities

• 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