Limitation of Treatment Orders

Admission to hospital is usually necessary even with apparently minor injuries. Trauma may have various triggers, such as cardiac syncope, myocardial infarction or infection. Therefore, even in the absence of major injury, admission to hospital would be appropriate to identify the cause of trauma.

However, in treating the complex older person trauma there may be instances where the appropriateness of invasive treatment may be questioned. Clinicians must consider the best interests of the patient, active advanced care directives and previously communicated goals of care discussions with the patient and family. Equally, age alone should not be the sole determinant of limitations of care.

It must also be remembered that hospital admission does not come without longer term consequences and the link between hospitalisation and subsequent functional decline in the elderly is clear. (29)