Young L, Ahmad H
The Canberra Hospital, ACT, Australia.
Aust N Z J Surg. 1999 Aug;69(8):584-6. doi: 10.1046/j.1440-1622.1999.01637.x.
Australia's population is ageing. Statistics predict that by the year 2021, 17.8% of our population will be over the age of 65 years. These statistics are reflected in most Western nations. The elderly represent an increasing proportion of emergency department patients. They are generally more acute on presentation, they get admitted more frequently, and account for an increasing proportion of admissions to intensive care units. The elderly trauma patient will increasingly consume more resources than patients from any other age group. There are significant differences in physiology and response to trauma between the elderly patient and the young. Airway compromises, a decrease in lung compliance, a change in cardiovascular haemostasis and the prevalence of pre-existing disease all contribute to increase morbidity and mortality in a patient with an already limited physiological reserve. Many studies demonstrate an increased mortality in hospitalized elderly trauma patients. For those who die from traumatic insult, death is mainly due to multiorgan system failure. The long-term functional outcome of the elderly trauma patient has been investigated by a number of authors. One study showed that only 8% of survivors returned to independent living 1 year post-polytrauma. Another more encouraging study showed that 89% of survivors of blunt multiple trauma after 38 months were independent and living at home. Ethical issues have been raised regarding the appropriateness of care for the severely injured elderly patient given today's ever-shrinking hospital finances and bed shortages. Today's environment is very challenging as frequently, the clinician is forced to make an economic decision on who will take the last critical care bed, which is a far from optimal situation.
澳大利亚人口正在老龄化。统计数据预测，到2021年，我国17.8%的人口将超过65岁。大多数西方国家也都有类似的统计数据。老年人在急诊科患者中所占比例越来越大。他们就诊时病情通常更严重，住院频率更高，在重症监护病房住院患者中所占比例也越来越高。老年创伤患者将比其他任何年龄组的患者消耗更多的资源。老年患者与年轻患者在生理和对创伤的反应方面存在显著差异。气道梗阻、肺顺应性降低、心血管止血变化以及原有疾病的患病率都会导致生理储备本就有限的患者发病率和死亡率增加。许多研究表明，住院老年创伤患者的死亡率有所上升。对于那些因创伤性损伤死亡的患者，死亡主要是由于多器官系统衰竭。许多作者对老年创伤患者的长期功能预后进行了研究。一项研究表明，多发伤患者伤后1年仅有8%的幸存者恢复到能够独立生活。另一项更鼓舞人心的研究表明，钝性多发伤患者伤后38个月，89%的幸存者能够独立生活并在家中居住。鉴于如今医院资金不断缩减和床位短缺，对于重伤老年患者的护理是否恰当引发了伦理问题。如今的环境极具挑战性，因为临床医生常常被迫做出经济决策，决定谁将使用最后一张重症监护病床，而这远非理想状况。
