In 2018, Galina A. Glinik, MD, medical director of trauma at NYU Langone Hospital—Brooklyn, was examining patterns of injuries among recent cases when she noticed a curious trend. In some elderly patients, rib and pelvic fractures had gone undiagnosed at other emergency departments. The pattern was troubling. Hairline fractures can be notoriously difficult to discern on X-rays, but they can do real damage. In some cases, Dr. Glinik notes, they can cause internal bleeding and collateral illnesses, such as, pneumonia. “We realized that when injuries were not fully investigated, some patients were released too early or without being properly assessed,” she says.
That gap inspired Dr. Glinik and her colleague Ian G. Wittman, MD, the emergency department’s chief of service, to join forces with other specialists at the hospital and create a standardized protocol to ensure that these hidden injuries would be promptly diagnosed and treated. Since launching their protocol, called the Geriatric Trauma Program, at NYU Langone Hospital—Brooklyn’s Level I Trauma Center last January, it has since been adopted by NYU Langone Health’s other Level I Trauma Center at NYU Winthrop Hospital on Long Island.
In Sunset Park and other neighborhoods served by NYU Langone Hospital—Brooklyn, care for the elderly is a growing concern as the population ages. In the past decade, the number of local residents age 65 or older has jumped from 8.3 percent to 10.7 percent. Seniors make up some 40 percent of the patients admitted to the hospital’s emergency department, and falls account for about 80 percent of their injuries.
“The elderly are more vulnerable for many reasons,” explains Prashant Sinha, MD, chief of surgery at NYU Langone Hospital—Brooklyn. “They’re weaker, have poor balance, have brittle bones, and take more medications, including blood thinners that make them susceptible to brain bleeds if their head hits the ground. Just from falling out of a chair onto a rug, an 80-year-old might suffer the kind of physiologic damage that a 30-year-old sustains in a car crash.”
Today, when an elderly person arrives in the emergency department after a fall, or if they’re suspected of having sustained a head injury or long bone fracture, the patient is elevated to a status of urgency just below that applied to the most severe traumas. Within minutes, an attending physician in emergency medicine and a member of the trauma team are at the patient’s bedside, performing an evaluation and fast-tracking lab tests and imaging studies. In the first 12 to 16 hours, a multidisciplinary care plan is in place that involves a physical therapist, a social worker, a dietician, and a pharmacist, who ensures that none of the patient’s medications cause drowsiness or dizziness.
Since the program’s inception, the number of geriatric trauma patients has risen from 90 per month to about 130. The time they spend in the emergency department averages four hours—half what it used to be—and fewer of these patients need to be readmitted.
Dr. Wittman emphasizes that this is preliminary data, but he and his colleagues have already received some heartening feedback. “EMS technicians have discretion over where they bring patients,” he explains. “Our growing volume of geriatric admissions is almost certainly due to recognition within our community that we provide exemplary care to the elderly.”