Psychological Considerations of Injury Management in Older Adults

Older adults suffer the same sorts of injuries as younger ones, however due to age-related processes are susceptible to more significant complications as a result of these injuries.  These complications include the psychological, in addition to the physical.  As mental health care practitioners, we must be sensitive to the emotions and psychological trauma elderly patients may be experiencing as they sustain and heal their wounds.

An elderly patient with no previous psychiatric history may nevertheless be suffering from varying symptoms associated with mild psychiatric conditions. Depression and anxiety in particular, reflect symptoms from which patients may already be suffering from at the time of their injury.  These symptoms may blossom into full psychiatric disorders when older adults may appreciate having less resiliency in their ability to heal than they possessed in their youth. Sadness, Anxiety and Depression may increase an uncomfortable awareness of their own mortality. With pain, death becomes more of an existential issue, as it appears creeping around the corner. If an older adult sustains an injury from which we in the Medical profession predict will be healed, it is of the utmost importance to communicate this unequivocally to these patients.

If the injury was sustained while in a nursing facility, it will be necessary to reestablish a trusting relationship between the professional staff and patient.  Iatrogenic injuries to which nursing home residents are particularly susceptible will cause the patient to feel especially vulnerable, and become suspect of their health care providers. Pressure ulcers, burns, abrasions, and falls sustained while taking residence at a nursing facility will potentially cause the patient to become unduly hyper vigilant and displeased with their surroundings, especially if that patient may have very well been reluctant to take residence in a given nursing facility. Competency from medical professionals and truthful communications will help patients deal with their fear and frustration.

Pain must be managed with great care, as the physical comfort of the patient is paramount.  A pain specialist may need to be consulted if the patient has failed to show improvement with conventional interventions. Pain is as much a psychological condition as it is a physical one. It is not a simple sensation like perceiving the brightness of a light bulb, but is a complex emotion full of ineffable complexities like patriotism or love (Deltito, 1984). Beecher’s classic World War II observations documented that spontaneous complaints of pain and requests for morphine were less among wounded soldiers than among civilians with roughly equivalent surgical wounds. He attributed the soldiers’ diminished painful suffering to the context in which the wounds occurred and the meaning of being wounded under these circumstances. To these men, being wounded meant being evacuated from the battlefield, being shipped home, and not dying during the war. Therefore, few of the messages from their wounded flesh were translated into painful suffering (Beecher, 1956). The perceived “outcome” of an injury will dictate the intensity of pain experienced.

In the cases of severe injuries, where disfigurement is the expected outcome, the patient may benefit from early entry to support groups where others who have undergone traumatic injury may provide solace to the patient. Older adults are frequently faced with what they may perceive as a diminishing physical appearance, and a disfiguring injury may intensify those feelings already present. A support group is a terrific place for older adults to share their thoughts and concerns regarding how their injury has impacted their life, and find comfort knowing they are not alone in the way they feel.

Should a patient with a wound or injury be manifesting a full syndrome psychiatric disorder such as Depression, they need to be treated vigorously. The use of antidepressants with full augmentation enhancements such as Abilify, Thyroid Supplementation, or Transcranial Magnetic Stimulation (TMS) is usually indicated. Often practitioners incorrectly see Depression in older adults as inevitable. Aging is not a cause of depression.

The expression that was commonplace in my time working at the Arizona Burn Center, was “be a survivor, not victim.” With the proper care and attention to all issues surrounding injury (physical and psychological), we can help our patients to survive their injuries rather than be victimized by them.

You may reach Dr. Shapiro at (203)321-5063

Have a Comment?