Limitation of Treatment Orders

Admission to hospital is usually necessary even with apparently minor injuries.
In treating the complex elderly trauma there may be instances where the appropriateness of treatment may be questioned. Factors such as age, hypotension, and injury severity can significantly increase the risk of mortality. Clinicians must consider the futility of such resuscitation and where possible discuss this with the patient or seek the assistance of any advanced care directives or similar legal documents. Age alone should not be the sole determinant of limitations of care.1
Age significantly increases mortality from injury and more aggressive care can improve survival where it is in the best interests of the patient. 5
An older person may have had a partner for decades, this person should be involved in decision making about their care. Concern for the wellbeing of an uninjured partner is valid as they may have been under the care of the trauma victim.
There is the possibility that an elderly person may die in the ED or while being transported. Conversations and decisions about things such as resuscitation, advance care plans and patient’s wishes need to take place with sensitivity and compassion. An important discussion will be around the older person’s right to refuse active treatment of injuries and concentrate on palliative goals of comfort.  This must be delicately handled but clearly communicated to all treating clinicians.