Guns and the golden years

Idealized for relaxation and leisure, reaching the golden years of life has been a romanticized goal after a lifetime of hard work. With the latest census data revealing that people age 65 years and older comprise the fastest-growing sector of the U.S. population, it appears more Americans are entering this stage of life.* In fact, the Centers for Disease Control and Prevention estimate that by 2030, 19 percent of the population will be older than 65 years of age. While the carefree lifestyle of retirement may be an aim for many, others find themselves facing unanticipated challenges related to these years. As the size of this population continues to grow, so too will its presence in the trauma setting. Geriatric trauma has long been recognized as a unique challenge, largely because management of injuries is often confounded by the presence of pre-existing comorbidities related to the natural aging process. These factors can lead to longer hospitalization and a more challenging recovery.

Increasing injury rate in the elderly

While firearm-related injury is more common among the younger population, mortality rates for these injuries are increased in the elderly. In reviewing the National Trauma Data Bank® (NTDB®) datasets from admission years 2007 to 2014, along with the steady increase in firearm-related injuries in patients less than 65 years of age, the data reveal a consistent rise in these injuries among elderly patients (see Figures 1 and 2). Notably, mortality after self-inflicted firearm injury is highest among the elderly.

Figure 1. Total firearm injuries, age <65

Figure 1. Total firearm injuries, age <65

Figure 2. Total firearm injuries, age ≥65

Figure 2. Total firearm injuries, age ≥65

To examine the occurrence of patients injured by firearm in the NTDB research dataset admission years 2007–2014, medical records were searched for “injured by firearm” designation and were then divided into two groups: younger than age 65 (32,884) and older than or equal to 65 (1,149). Of the combined total of 34,033 records, 24,797 records contained a discharge status. In comparing the older group with the younger group, respectively, 355 and 19,095 patients were discharged to home; 150 and 2,214 to acute care/rehab; and 62 and 404 were sent to skilled nursing facilities. Almost 30 percent of the older group (237) died, while just under 10 percent (2,280) of the younger patients died, representing a more than three-fold increase in mortality in the older group (see Figures 3 and 4).

Figure 3.  Hospital discharge status, age <65

Figure 3. hospital discharge status, age <65

Figure 4.  Hospital discharge status, age ≥65

Figure 4. hospital discharge status, age ≥65

It is not surprising that elderly patients do not recover as well after a major injury when compared with their younger counterparts. Physiologic changes that come with aging place additional strain on the body as it attempts to heal, often causing a protracted course for recovery.

On its current trajectory, the U.S. elderly population, as well as those injured in a firearm-related incident, will continue to increase—resulting in, among other deleterious effects, an increased strain on the trauma system. Post-injury care of elderly patients, particularly those with firearm-related injuries, requires careful consideration. Awareness, planning, and early action is likely key to the overall recovery of this sector of the population, and will help them return to their leisurely golden years.

Throughout the year, we will be highlighting these data in brief reports that will be found monthly in the Bulletin. The National Trauma Data Bank Annual Report 2015 is available as a PDF file. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.

Acknowledgment

Statistical support for this article was provided by Chrystal Caden-Price, Data Analyst, NTDB.


*U.S. Census Bureau. The Older Population: 2010. 2010 Census Briefs. November 20, 2011. Available at: www.census.gov/prod/cen2010/briefs/c2010br-09.pdf. Accessed September 15, 2016.

Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Available at: www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf. Accessed September 15, 2016.

Mathews EM, Woodward CJ, Musso MW, Jones GN. Suicide attempts presenting to trauma centers: Trends across age groups using the National Trauma Data Bank. Am J Emerg Med. 2016;34(8)1620-1624.

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