The Trauma Center

Crash Injury Vulnerability of Older Adults



Following a car crash, adults age 65+ are two to three times more likely to die than younger individuals if they experience brain damage. 4

Thoracic System

Thoracic Injury

The most common injuries sustained by older adults in motor vehicle crashes are in the chest region, particularly the ribs. 1

  • Adults age 50+ are more likely to die from thoracic injuries commonly seen following a crash. 2
  • Osteoporosis and other age-related disease can cause the ribs to become brittle, and vulnerable to fracture. 3
Spine and Spinal Cord

Spine and Spinal Cord

Damage to the spine and/or spinal cord is common among older adults, even after trauma of minimal force. Cord injury can occur without a fracture, especially among older adults with arthritis. 5

Musculoskeletal System

Due to age-related changes in the structure and composition of bone, cartilage, and muscle, older adults have an increased likelihood of sustaining a fracture, which can be caused even by low-force trauma. 5- 6

Bleeding Hazard

Risk for bleeding complications is an important concern for older adults who have experienced physical trauma. This risk is due largely to the frequent use of anticoagulant medications (e.g., warfarin) 7 by older adults. 8

Outline of elderly driver

The Frank L. Mitchell Jr., MD Trauma Center is committed to preventing injuries in our community. More than half of deaths from traumatic injury occur before any medical care can be provided. Therefore, preventing these tragedies is critical.

Older drivers face two main types of risks:

  1. Changes in the body due to aging increase the risk for certain types of injuries as well as the body’s ability to recover from injury. For more information on the risk of injury for older drivers, see the figure below (insert medical illustration below).
  2. Medical conditions that impair vision, motor skills, and thinking/memory are more common at older ages than at younger ages. These types of impairments raise the risk of having a car crash.

Retiring from driving can have negative consequences for older adults. We support safe mobility for all people at all ages. The decision to stop driving should be individualized and done with the help of a health care professional, family, and friends. The transition away from driving may be especially difficult for individuals with cognitive impairment, as these individuals may not be aware of their own limitations, and may need assistance in knowing when it is time to stop driving.

This effort is evidence-based and originates from research done in Missouri by older driver scholars to improve the process of transitioning away from driving. We acknowledge the contributions of researchers such as Drs. Thomas Meuser and Marla Berg-Weger in developing many of the concepts and materials that appear on these pages.

The Missouri Department of Transportation, State Farm, and the Eastern Association for the Surgery of Trauma (EAST Foundation) supported development of this website.


  1. Augenstein, J., Digges, K., Bahouth, G., Dalmotas, D., Perdeck, E., & Stratton, J. (2005). Investigation of the performance of safety systems for protection of the elderly. Annual Proceedings / Association For The Advancement Of Automotive Medicine. Association For The Advancement Of Automotive Medicine, 49, 361-369.
  2. Stitzel, J. D., Kilgo, P. D., Weaver, A. A., Martin, R. S., Loftis, K. L., & Meredith, J. W. (2010). Age thresholds for increased mortality of predominant crash induced thoracic injuries. Articles from Annals of Advances in Automotive Medicine / Annual Scientific Conference , 54, 41-50. Retrieved from
  3. Callaway, D. W., & Wolfe, R. (2007). Geriatric trauma. Emergency Medicine Clinics Of North America, 25(3), 837-860. DOI: 10.1016/j.emc.2007.06.005
  4. Shafik, A. M., & Abdou, R. M. (2009). Trauma in geriatrics. Ain Shams Journal of Anesthesiology, 2, 55-57. Retrieved from - January 2009/10.pdf
  5. O’Connor, K. E. & Barishansky, R. M. (2009, April). Geriatric trauma: What to think about before assessing, treating & packaging the elderly. Journal of Emergency Medical Services, Retrieved from
  6. Faulkner, J. A., Larkin, L. M., Claflin, D. R., & Brooks, S. V. (2007). Age-related changes in the structure and function of skeletal muscles. Clinical and Experimental Pharmacology and Physiology, (34), 1091–1096. doi: 10.1111/j.1440-1681.2007.04752.x
  7. Aschkenasy, M. T., & Rothenhaus, T. C. (2006). Trauma and falls in the elderly. Emergency Medicine Clinics of North America, 24, 413–432. doi: 10.1016/j.emc.2006.01.005
  8. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. Circulation 2003; 107:1692–711