The impacts of ageing-related changes on prehospital trauma care for older adults: challenges and future directions.

The ageing global population presents growing challenges for prehospital trauma care, particularly in addressing the complex needs of older adults. This narrative review explores the impacts of ageing-related anatomical and physiological changes on trauma care in the prehospital setting, with a focus on the challenges they pose for paramedic assessment, triage, and decision-making. These changes affecting the nervous, cardiovascular, respiratory, musculoskeletal, and renal systems that reduce physiological resilience and increase vulnerability to trauma, especially when compounded by frailty, polypharmacy, and comorbidities. The review highlights significant limitations in current trauma triage tools, which often lack sensitivity for identifying serious injuries in older adults and fail to incorporate frailty assessments. Although some protocols, such as the Ohio Trauma Triage Protocol, include geriatric adaptations, traditional tools continue to underperform, contributing to undertriage and suboptimal outcomes. Validated frailty assessment tools, including the Clinical Frailty Scale (CFS), Programme on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7), and Identification of Seniors at Risk (ISAR), offer promising potential for improving triage accuracy but are not yet routinely used in prehospital practice. Key gaps identified include insufficient paramedic education on ageing-related conditions, limited awareness of age-specific clinical presentations, and a lack of training in applying geriatric assessment tools. To address these issues, the review recommends integrating frailty screening into EMS triage, enhancing geriatric-specific training, and raising paramedic awareness of the physiological and clinical implications of ageing. Future research should investigate paramedics' behaviours, decision-making processes, and the feasibility of implementing frailty-based triage in the field. These strategies are essential to advancing prehospital trauma care and improving outcomes for the growing population of older trauma patients.