Is Geriatric Trauma Really Increasing -- Or Are We Just Counting It Differently?

There is a frequent phrase uttered in the trauma world:

“Geriatric trauma is increasing.”

But there is an important question that trauma programs should ask before we accept that statement at face value:

Are we actually seeing more geriatric trauma? Or are we simply seeing better identification and capture of these patients in trauma registries?

As a researcher, I've been pondering that question for a few years, especially as trauma registry inclusion criteria, reporting practices, and trauma activation practices have evolved. In searching for the answer, I realize the answer is not as clear as we would like to believe.

Yes, The Older Population Really Is Growing

There is no question that the denominator is changing. The U.S. Census Bureau estimates that between 2010 and 2020, the population age 65+ increased from 40.3 million to 55.8 million, a 38.6% increase. By 2020, adults 65+ represented 16.8% of the U.S. population, or approximately one in six Americans. By the end of the 2020s, all Baby Boomers will have reached age 65.

So if we see more adults aged 65 and older in society, some increase in geriatric trauma should be expected simply because there are more people in the age groups.

But that doesn't fully answer the question.

So Are There Actually More Geriatric Trauma Patients?

The available evidence suggests yes. The numerator is also increasing.

A national study by Jiang et al. (2020) analyzed annual U.S. National Trauma Data Bank (NTDB) reports from 2005–2015. The number of geriatric trauma patients reported to the NTDB increased by approximately 18%-30% over that period. They concluded that geriatric trauma is increasing as the population ages.

Another analysis of NTDB data by Konda et al. (2020) found that from 2005-2016, the proportion of trauma patients ages 65–74 increased from 5.6% to 10.2% and the proportion of trauma patients over age 84 nearly doubled, from 5.3% to 9.9%.

It is important to note that in the Konda study, the authors also noted that the overall number of trauma patients in the NTDB increased substantially during the study period.

Multiple other national and trauma-center studies support these trends indicating that both the number of geriatric trauma patients and the proportion of geriatric trauma patients have increased.

This is an important distinction, leading some experts to state that the composition of the trauma population is changing. Think about a trauma population as a pie; the pie is getting bigger (more trauma) and the geriatric population is getting a bigger slice of the pie.

It is important to note that geriatric trauma is not simply replacing younger trauma; it is growing faster and therefore accounting for an increasing share of the trauma population. At the same time, the composition of trauma is changing. Falls are becoming increasingly prominent, while motor-vehicle occupant injuries have declined as a proportion of trauma in recent NTDB data. (Source)

But Here's Where It Gets Interesting

Remember, the trauma registry did not always consistently capture these older adults. Historically, inclusion of isolated hip fractures in trauma registries was inconsistent. A 2014 systematic review noted that 48% of trauma centers contributing to NTDB excluded patients with isolated hip fractures. The 2019 NTDS and subsequent ACS 2020 FAQs clarified that traumatic isolated hip fractures meeting the other NTDB inclusion requirements were not excluded and should be reported.

So were some of these patients always being treated in hospitals but inconsistently captured by trauma registries? Almost certainly.

Trauma registries are not population-based injury surveillance systems. They are built around specific inclusion criteria that change from from time to time. Trauma activation practices also changed and hospitals have improved in their identification of patients who meet registry criteria.

Consider the older adult who falls at home and sustains a hip fracture. Ten years ago, that patient might have been thought of primarily as an orthopedic or medical patient. Today, many trauma centers recognize and involve the trauma team in the care of older patients with isolated hip fractures and other orthopedic injuries.

So when a hospital reports that its geriatric trauma volume doubled between 2015 and 2025, the next question should be: “Did your registry inclusion criteria change?

So Are We Seeing More Geriatric Trauma?

Yes. There are more older adults, more older adults interacting with the healthcare/trauma system, and more capture of older adults in our trauma registries. Let's break that down.

#1. There are more older people at risk.

• We have more older adults in the community. The U.S. Census Bureau reports that every state increased its absolute number of people age 65+ between 2010 and 2020. The rate of growth varied considerably, but no state was exempt from the demographic shift. (Source)

  
  

• More people are reaching their 80s and 90s. Between 2010 and 2020, the U.S. population age 85 and older increased by 15.6%, while the population aged 65 and older increased 38.6%, largely reflecting the aging of the Baby Boom generation.(Source)

  
  

• As the population shifts into older age groups, the number of people at high risk for falls increases. In 2018, the rate of ED visits for unintentional fall injuries among adults age > 85 was nearly 3.7 times the rate among those 65-74 years. (Source)

  
  

• The consequences of falls become more serious with age. In 2018, the hospitalization rate for fall-related injury among adults aged ≥85 was 3,857 per 100,000 -- nearly seven times the rate among adults aged 65–74 (561 per 100,000). (Source)

  
  

#2. More injured older adults are interacting with the healthcare and trauma system.

• More older adults are using the ED. National data show that older adults have become an increasingly important component of ED utilization. Among adults aged 65 and older, annual ED visits increased 24.5% from 15.9 million in 2001 to 19.8 million in 2009 (Source). Subsequent national data using a broader age definition found that adults aged 60 and older accounted for approximately 29 million ED visits annually in 2014–2017, representing 20% of all ED visits (Source).

  
  

• Trauma activation practices are changing. A 2025 Level I trauma-center study found that revised geriatric activation criteria dramatically increased activations among adults ≥65, particularly older adults who fell while taking antithrombotic medications. Many of the additional activations, however, involved patients with no injuries or minor injuries who did not meet trauma-registry inclusion criteria. (Source)

#3. What we count as "trauma" is also changing.

• More adults may be meeting trauma registry inclusion criteria. Historically, inclusion of isolated hip fractures in trauma registries was inconsistent among trauma centers. With changes in NTDS criteria, some increase in geriatric trauma in registry data may reflect changes in case ascertainment and inclusion, as well as a real increase in injuries.
  

• Registry abstraction and case-finding practices vary. Advances in registry software, electronic case-finding, and EHR integration have the potential to improve identification of eligible trauma patients, although registry infrastructure and case-finding practices also vary considerably. A 2025 survey of state trauma registries found that 72% still relied on manual data abstraction and 60% lacked integration with electronic health records. (Source)

All of this leads to the conclusion that we are indeed seeing more geriatric trauma. But we need to be precise about what "more" means.

The Bottom Line

The evidence supports a real increase in the number of geriatric trauma patients appearing in trauma data, but the magnitude of that increase cannot be attributed solely to an increase in the underlying incidence of injury. Population aging, the increasing burden of falls and other injuries among older adults, changes in trauma activation practices, and differences in registry inclusion and case ascertainment all contribute to the number of geriatric trauma patients appearing in trauma data.

Consequently, an increase in the number of geriatric trauma patients appearing in trauma data likely reflects two things. A real increase in the burden of injury AND changes in how injured older adults are identified and counted.

So when someone asks if geriatric trauma is increasing, make sure you are clear in your definitions and making appropriate comparisons across time and age groups.