Injuries in Elderly Patients21

It is not uncommon for elderly patients to have difficulty understanding the nature of the injury, its implications, the significance of each treatment option, or the instructions given for postoperative posturing or treatment. Prescription glasses are much more likely to cause eye injury in the elderly than in young people (see Chap. 1.7).

Male preponderance is seen below the age of 70 years, with the male: female ratio varying between 2.5 to 1 and 7.4 to 1. The ratio declines after age 60 years, and it actually reverses over 80 years.

• A disproportionally high rate of injuries are ruptures (see Chap. 1.7), caused mostly by fall at home (Table 2.16.3). Fall is over ten times more common in those over 60 years than in those who are under 60 years.

21 All data are from the USEIR unless otherwise noted.

It appears that an eye has a lower threshold to rupture from the same impact if the person is old vs young.

• "Fall at home" is so typical an injury in the elderly that prevention naturally comes to mind. Simple but very useful ideas include rearranging the furniture,22 making the bathtub less slippery, or fixating the rugs to the floor.

• Age is an independent risk factor for the development of glaucoma in eyes with contusion or open globe injury (see Chap. 2.18).

• Compared with younger people, significantly more of the injured eyes in the elderly population have a preexisting condition^3 which had adversely affected the visual acuity before the injury. The history of open globe surgery (see Chap. 2.12) is an additional, independent risk factor for poor outcome24.

• Even if controlled for a preexisting condition adversely affecting vision, the outcome of a serious injury is statistically significantly worse in the adult population (Table 2.16.4). This finding is especially striking since the number of surgeries was higher in the elderly cohort than in those under 60 years of age.

• Elderly people have a higher risk for endophthalmitis development, especially if the lens is injured (see Chaps. 2.13, 2.17).

• The risk of eye injury in an MVC, whether or not the air bag has deployed, is about double for a serious eye injury if the person is 65 years old vs those between 16 and 35 years [52].

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