Download PDF: Clinical Communiqué March 2022 Edition
In this edition
Welcome to the March 2022 edition of the Clinical Communiqué. Whereas our previous edition focussed on paediatric patients and the difficulties in assessing symptoms and signs in the younger age-group, this edition looks at some of the specific challenges clinicians face in assessing older patients.
We present two case summaries of falls in the older patient that resulted in chest or head injuries. In each case, the extent of injury was not fully appreciated until it was too late. This occurred in one case because a radiological investigation was not ordered that would have identified areas of concern, and in the other, because a clinician was not aware of the significance of the presentation and the associated risks of complications in that age group of older patients. In addition to the case summaries, are two case vignettes, that reiterate how common falls in the older person are, with important messages about primary and secondary prevention of falls in the older person.
Our expert commentary has been written by Dr Glenn Arendts, a specialist emergency physician with extensive clinical and research experience in the care of the older person. Dr Arendts holds prominent roles in the development of best practice guidelines for the management of acute geriatric syndromes at local, national, and international levels. Bringing attention to the size and complexity of the problem, he provides practical measures to deal with the low signal/high noise scenario of a fall in the older patient. He astutely highlights the importance of retiring a commonly used phrase to reduce the risk of anchoring bias in the clinical care of these patients.
The best management strategy for falls in the older person is to prevent the falls from occurring. The February 2022 edition of the Residential Aged Care Communiqué provides a comprehensive overview of this area of work by presenting another two cases of falls in residential aged care settings, followed by expert commentaries that skilfully enunciate the need for a multifactorial approach to falls prevention.
The number of falls a person has increases with age and with their level of frailty. Older adults are more susceptible to injury from lesser mechanisms of trauma than younger adults. Once a patient falls, the odds of preventable mortality increase with age. The presence of frailty, increasing age, and fall frequency, act synergistically to form a potent combination of risks. This edition looks at the health consequences of falls in the older person – specifically the importance of appropriate investigation, diagnosis, and multidisciplinary treatment of older trauma patients. Recognition of the risks of anticoagulant medication, trauma call criteria that incorporate age, lower thresholds for advanced imaging, and early involvement of specialists in treating older trauma patients are important factors in reducing preventable harm.
Major trauma in the older adult population is on the rise. In Victoria in the 2019-20 period, the most common cause (35%) of hospitalised major trauma was falls from a low height (<1m) and 80% of those hospitalisations were adults over the age of 65 years. More than half of that group (54%) sustained a head injury. Falls were the most common cause of all injury deaths (46.1%). It is imperative that as clinicians, we pay close attention to our patients that are at risk of falling, or who have suffered a fall. This is an area of medicine where small changes in our processes could result in substantial improvements to health outcomes for older adults.