Medicolegal Evaluation of Elderly Trauma Patients

Objective: The human body loses flexibility and durability from the pathophysiological changes of aging; therefore, trauma and the risk of injury increase in geriatric individuals. Elderly patients who have been admitted to health centers with trauma and injury require a serious treatment approach. Materials and Methods: A total of 15851 victims who were admitted to Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice between 01/01/2011 and 31/12/2011 were retrospectively evaluated, and 207 of them, who were trauma patients aged 65 years and over, were included in this study. All cases were evaluated according to the cause of the injury, localization of the trauma, bone fractures and type of medical treatment. Results: Two hundred nineteen of the total 15851 forensic patients were 65 years and older. Of these 219 cases, 207 (94.5%) had been exposed to trauma. Of these 207 cases, 138 (66.7%) were male, and 69 (33.3%) were female. The most common types of trauma were physical assault (n=136) and motor vehicle accidents (n=56) , which occurred at rates of 65.7% and 27.1%, respectively. For the trauma victims, head injury was the most commonly affected body region. Ninety-seven patients were treated conservatively (46.9%) , and 43 patients were treated surgically (20.8%) . Traumatic bone injury (31%) was detected in 64 patients. Conclusion: The results of our study indicate that most of the geriatric victims were admitted to the medical centers with traumatic causes. Thus, it is necessary to increase our social sensitivity to trauma and the ways in can be prevented in the geriatric age group.


Introduction
The World Health Organization (WHO) defines geriatric age as 65 years and older (1). The elderly population accounts for 7.7% of the overall population in 2013, which is estimated to increase to 10.2% in 2023 in Turkey (2).
The health of the elderly is seriously affected in traumatic situations. When elderly individuals are exposed to trauma, their risk of injury is higher than that of young individuals who experience a similar severity of trauma (3). Trauma is the fifth most common cause of death in the elderly population, and 28% of geriatric trauma patients die from trauma (4)(5)(6). In addition, the physiological and metabolic changes of aging reduce an individual's ability to cope with traumatic stress. For this reason, longer treatment durations and higher complication rates are observed in the elderly (7-9). Criminal issues, such as abuse in the geriatric population, are also important risk factors in terms of the mortality and morbidity. Therefore, elderly patients who are referred to medical centers should be examined using a multidisciplinary approach. The aim of this study was to determine the demographic and etiologic characteristics of elderly forensic patients.

Adli Tıp Bülteni
T h e B u l l e t i n o f L e g a l M e d i c i n e w w w . a d l i t i p b u l t e n i . c o m A d l i T ı p B ü l t e n i , 2 0 1 6 ; 2 1 ( 1 ) : 2 3 -2 5 . Sonuç: Çalışmamız, geriatrik adli olguların çoğunluğunun t r a v m a t i k n e d e n l e r i l e t ı b b i m e r k e z l e r e b a ş v u r d u ğ u n u göstermektedir. Bu sonuçlar, geriatrik yaş grubunda önlenebilir travma nedenleri konusunda sosyal duyarlılığın artmasını sağlayacaktır.

Materials and Methods
In this study, we retrospectively evaluated 207 geriatric trauma patients who were admitted to the Bursa Branch of the Council of Forensic Medicine of the Ministry of Justice in 2011.
The information obtained from the legal reports was used. The patients' age, gender, trauma type, location of trauma, treatment modalities used in the healthcare services and presence of bone fractures were evaluated. Reported fractures were confirmed with radiologic investigations. Categorical data were compared between the genders and age groups using Fisher's exact test or chi-square tests, as needed.  situations, a careful examination should be performed (11,12).

Discussion
According to studies conducted in Canada, estimates of the prevalence of elder abuse have ranged from 4% to 10% (13).
Prevalence studies in the United States estimate that more than one million elderly persons are victims of abuse annually, and up to 25% have been physically abused (14). In our study, we determined twenty-one (9.5%) physical abuses in the geriatric age group (n=219), and were detected (15.4%) among physical assault victims (n=136).
Though motor-vehicle accidents and falls were the most frequent causes in the other studies conducted on elderly forensic cases (15,16), the most common types of traumas in our study of elderly forensic patients were physical assaults and motor-vehicle accidents. Because the risk of falls increases with aging, a lower proportion of individuals over 74 years of age may have decreased the proportion of falls in our study.
Furthermore, there was a significant increase in the fall rate with aging.
Another study suggested that the head (%35.3) and extremities (38.7%) were the most commonly injured parts of the body (17).  Despite the female dominance in the general elderly population, there was a male dominance (2:1) in our study. This finding suggests that the risk of involvement in an elder criminal case is higher in males. In contrast to our study, a study performed by Bilgin et al indicated that the ratio of males to females was nearly 1:1 (n=40 vs. 41, respectively) (15).
However, in another study published by Kandiş et al, 155 of the 224 cases were males, and 69 were females (16).

Conclusion
The most common sites of injury were the head and extremities. Assaults and motor vehicle injuries were the main causes of injury. To meet the needs of an aging society, more action is needed in the future to prevent assaults, motor vehicle accidents and fall injuries and to minimize the incidence of injury, abuse, and neglect among the elderly.