Trauma in the aging country
Ageing is one of the most serious social issues, not only in Japan, but across the globe. The proportion of the population aged over 65 years in Japan was 12% in 1990, 24% in 2010, and will increase to 40% by 2060. Japanese government reported that the proportion of people aged over 70 years was about 20% in 2018. The rate of ageing has been increasing exponentially not only in Japan, especially in Asian countries. It is estimated that by 2050, the proportion of elderly people over 65 years of age will make up 16% of the global population, whereas children aged less than 5 years will be 7%. Under this circumstance, the major etiology of trauma has been changed from high energy trauma by traffic accidents in younger generation to low energy trauma by fall and tumble in elder generation.
The number of ambulance transport is increasing year by year and reached 5,738,664 in 2017 in Japan. Among them, general injury 15.4%, traffic accident 8.1%, suicide attempt 0.6%, worker’s accident 0.9%, sports injury 0.7%, violence 0.5%, acute illness accounts for 64.3% and other. The number of general injuries including fall and tumble has been increasing from 11.4% of 1995, whereas the number of traffic accident has been decreasing and less than half from 19.6% of 1995. At the same time, ambulance transport aged over 65 years has been increasing from 23.4% in 1889 to 61.8% in 2017.
The number of deaths caused by fall or tumble has been increasing from 6,517 in 2006 to 7,929 in 2015, on the other hand, the number of deaths by traffic accident has been decreasing from 8,179 in 2006 to 5,201 in 2015.
According to Japan Neurotrauma Data Bank (JNTDB) 2015, The number of severe traumatic brain injury (TBI) patients over 65 years has been increasing from 30.5% in 1998 to 51.7% in 2015. In 2015, 24.7% of sever TBI was caused by fall and tumble and 51.3% was caused by traffic accident under 65 years, but 54.8% by fall and tumble and 33.7% by traffic accident over 65 years. About the outcome of severe TBI, good neurological outcome is 48.6% under 65 years and only 14.6% over 65 years. The mortality is 26.6% under 65 years and 43.8% over 65 years. Among the patients over 65years, 17% of them used antiplatelet drug before injury, 9% used anticoagulant and 5% used both because of their combined illness such as atrial fibrillation. These patients had a tendency of progressive intracranial hemorrhage and high mortality and morbidity.
At Trauma and Resuscitation Center of Teikyo University Hospital, 14% of major trauma patients used anticoagulant, about half used vitamin K antagonist and half used direct oral anticoagulant. The recent trauma patients tend to have combined illness and be fragile according to their age. We should consider the new strategies for the trauma prevention and care for the geriatric victims in the aging country.