According to current estimates, there are about 30 million licensed drivers in the United States aged 65 and older, but this figure is expected to jump to 57 million by 2030. Studies indicate that drivers aged 65 and older have higher rates of motor vehicle crashes (MVCs) per mile driven. Data also show that older motorists have higher rates of death and serious injury and incur greater costs for acute care and rehabilitation. “MVCs are the second leading cause of injury-related death among adults aged 65 and older,” says Jody A. Vogel, MD, MSc. “As the U.S. population ages, EDs will need to be prepared with appropriate resources and protocols to care for older adult MVC patients effectively.”
Previous research has investigated the care of older adults with MVC-related injuries, but these analyses tend to focus mostly on how pain is managed and the inpatient characteristics of these patients. Few studies have compared ED visits after MVCs by older individuals with data on younger patients. It has been suspected that older MVC patients require more ED resources and are more likely to be admitted to the hospital after these events when compared with younger MVC patients.
Taking a Closer Look
In a study published in the Western Journal of Emergency Medicine, Dr. Vogel and colleagues used a national population-based dataset to describe the epidemiology of ED visits by older adults for MVCs. The study group compared the characteristics of
MVC-related ED visits by older and younger adults in terms of EMS arrival, visit acuity, use of imaging studies, and injury diagnoses. They also compared the likelihood of hospitalization for older and younger MVC patients, adjusting for injury severity.
According to the results, there was an average of 237,000 annual ED visits by older adults for MVCs from 2003 to 2007. About half of MVC patients were transported by ambulance or had high triage acuity (Table 1). “When compared with younger MVC patients, older MVC patients were more likely to have at least one diagnostic imaging study performed,” Dr. Vogel says.
A somewhat surprising finding was that older MVC patients were not significantly more likely than their younger counterparts to arrive by ambulance, have high triage acuity, or have a diagnosis of a head, spinal cord, or torso injury after adjusting for gender, race, and ethnicity. This may be a result of several factors and merits further investigation in the future, according to the study group.
“Determining ways to optimize functional outcomes in older adult MVC patients will be critical.”
Older adult MVC patients were also more likely to be hospitalized than their younger counterparts, even after adjusting for gender, race, ethnicity, and measures of injury severity (Table 2). According to the study, 14.5% of older MVC patients (aged 65 and older) and 6.1% of younger MVC patients (aged 18 to 64) were admitted to the hospital. There was also a trend toward older MVC patients being admitted
to the ICU if they were hospitalized.
Assessing the Implications
“As the U.S. population ages and as older adults continue to drive, EDs will be at the forefront of caring for the increased volume of older adult MVC victims,” says Dr. Vogel. In general, older adults have a greater likelihood for injury and decreased physiologic reserve. These factors may be important to consider when determining triage criteria and decision rules for imaging in older MVC patients.
Dr. Vogel adds that collecting and analyzing data on the current ED management of older adult MVC victims will help facilitate the appropriate allocation of ED resources. This information can be used to develop proper diagnostic and treatment protocols in order to optimize ED care for older adult MVC patients.
In the future, Dr. Vogel says that more investigations are needed to establish successful strategies for facilitating early mobility and rehabilitation for older adult MVC victims. Previous studies suggest that most MVC patients who are older are discharged home, and many of these individuals may have sig-nificant pain. Finding ways to optimize pain control while minimizing adverse events from narcotic medications will be essential in the coming years.
“Overall, determining ways to optimize functional outcomes in older adult MVC patients will be critical,” says Dr. Vogel. “We also need to determine the role of comorbidities, perceived safety of living situations, limited physiologic reserve, and diagnostic uncertainties in older adults who survive these crashes. These factors may influence admission decisions for older patients. Ultimately, this type of information will help clinicians find the most effective strategies to manage these patients.”
Vogel JA, Ginde AA, Lowenstein SR, Betz ME. Emergency department visits by older adults for motor vehicle collisions: a five-year national study. West J Emerg Med. 2013 Feb 22 [Epub ahead of print]. Available at: http://escholarship.org/uc/item/44w191sg#page-1.
Platts-Mills TF, Hunold KM, Esserman DA, et al. Motor vehicle collision-related emergency department visits by older adults in the United States. Acad Emerg Med. 2012;19:821-827.
Scheetz LJ. Life-threatening injuries in older adults. AACN Adv Crit Care. 2011;22:128-139.
Newgard CD. Defining the “older” crash victim: the relationship between age and serious injury in motor vehicle crashes. Accid Anal Prev. 2008;40:1498-1505.
Eberhard J. Older drivers’ “high per-mile crash involvement”: the implications for licensing authorities. Traffic Inj Prev. 2008;9:284-290.