The geriatric puzzle. Assessment challenges of elderly trauma patients.

Assessing elderly patients is like putting together a jigsaw puzzle. In the case described, it's entirely possible that the patient stumbled and fell, bumping his head and bruising his chest. His confusion is probably secondary to dementia, and his vital signs indicate a lack of serious injury. However, it's just as likely that the patient is hypotensive and unable to mount a compensatory tachycardia, has an expanding subdural hematoma, multiple rib fractures with a hemothorax and a ruptured spleen. And it could be worse. His diabetes could be out of control. He could suffer from chronic congestive heart failure, and his living will could be sticking out of his pocket. As the elderly population increases in number, their medical and social issues grow as well. The onus is on us, as healthcare providers, to learn about the aging population and the special problems they present so that we can continue to improve the quality of care we deliver.