Response to Burns in the Elderly: What is Pathophysiology and What is Physiology?

The authors Jeschke et al. (2015) have collected an impressive dataset describing pathophysiological reactions to burns in elderly versus adult burn patients. The leading observationwas that elderly burn patients experience ahighermortality rate thanadults or children. Furthermore,whereas mortality rates were reduced for other age categories, outcome for elderly patients did not improve much over recent years. However, Lionelli et al. (2005) found a reduced mortality in patients over 75 years in a retrospective review between 1972 and 2000 and Wearn et al. (2015) showed in their retrospective review thatmortality in the elderly did significantly improve in medium size burns (10–20% TBSA) in recent years. The reasons for a relatively poor outcome for elderly burn patients remain largely unknown, and therefore, it is difficult to determine areas for improvement of this outcome. This is a reason for concern, since the group of elderly people is increasing, and therefore, it is likely that the group of elderly burn patients will also grow in the years to come. Jeschke et al. (2015) have determined a great number of abnormalities in elderly patients with burns, with respect to metabolic, inflammatory and wound healing characteristics. Clinically, elderly burn patients experienced more premorbid conditions and longer hospital stay compared to adults with burns. The interpretation of these abnormalities, however, is less straightforward. An important question is: Which parameters are related to the burn event, which are a consequence of the elderly age of the patients and which might be related to premorbid conditions? From other literature it is known that more diabetic and prediabetic conditions are present in the elderly (Somerset et al., 2014; Murphy et al., 2011) and that these conditions were found to be correlated to higher glucose levels as well as higher mortality post burn injury. However, also the level of full thickness burns was higher in these patients.