trauma in the elderly

I love old people. I always have, but in my nursing career I chose trauma (because obviously I love that, too). So naturally, when I started working this job in trauma, I've been interested in trends of trauma in the elderly. I started taking this interest serious enough that I looked into ways of getting more involved with the elderly and investigate data our hospital. The data I gathered is what I presented at the AANP conference last year and then submitted an article on, also. Well, it appears my interest in trauma in the elderly is catching on at my hospital. One of our fellows did a presentation on trauma in the elderly and everybody wanted me to be there. As long as I am working that day, I try to go to conference every week, so really I would have been there anyway. But it occurred to me that my interest in this topic must be well-known, or it wouldn't be that important I be there.

Anyways, I, of course, found the presentation very interesting. One thing that I found very interesting was regarding head trauma. Now, I know I did a relatively recent blog about head bleeds, so it's going to look like I have big thing for head bleeds. I don't really have a specific interest in it; it's more because head bleeds are a common sequela of trauma. And this injury is very much seen in the elderly. There is usually a lot of discussion about elderly being on anti-coagulants (like coumadin, plavix, etc.) and its associated risk for head bleeds. But not all elderly that get a head bleed from trauma are on anti-coagulants (although, yes, it is more likely when they are taking those meds). But, it is also more common for elderly overall to get a head injury compared to their younger counterparts.

Ah, so here comes the part I find interesting. I guess I had just never connected the dots, but as we age we lose cortical brain volume. Most of us probably know that, or least knew that at one point. There is a 15-20% reduction between the 5th and 10th decade of life, such that the elderly brain only occupies 82% of the cranial vault (whereas it's 92% for younger brains). Above is a normal head CT, but with obvious volume loss. But while the brain shrinks, the dura remains adherent to the skull, increasing the subdural space and the tension on vessels (parasagital and branching veins). Studies show elderly are 3 times more at risk for a subdrual hematoma (SDH) and now it makes sense why that type specifically!