Do you have elderly patients within your care? Have they slipped in the wet areas of the bathroom or by standing on a stool while gardening?
Maybe they’re in pain, but you do not have the eye to notice the signs, or perhaps you do not have enough medical education.
In this article, we will delve into the dangers, signs, and treatments for cracked ribs in your elderly patients.
Cracked and Fractured Ribs in the Elderly: An Overview
Many things can cause rib fractures, from vehicular accidents to accidental slips and falls in the garden or inside the house.
Also, it comes with age. The elderly’s bone density weakens over time, making them prone to rib fractures.
As reported by a medically-reviewed article, older adults can even get a rib fracture from constant coughing.
Moreover, patients sustaining fractures vary in the extent and level of hurting from the rib fracture.
Some patients with hairline rib fractures can easily find their way out of the hospital with just oral analgesics.
However, it is different for older trauma patients with rib fractures or blunt chest trauma. They need critical care considering their morbidity and mortality rates.
Studies conducted by cardiothoracic surgeons showed that compared to younger counterparts, “Elderly patients…had significant morbidity and potential for mortality.”
Symptoms of Cracked Ribs in the Elderly
Doctors look at an injury differently from others, but you can still spot some symptoms of rib fracture in your elderly patient without proper medical education.
However, it’s just supplementary knowledge. The proper assessment of tools, like a multidisciplinary clinical pathway, will depend on doctors.
Nevertheless, the National Health Services in the United Kingdom identified the following symptoms of rib fractures:
- Chest area pains when breathing
- Ribs swelling
- Skin bruising
- Noticeable cracks (feeling and hearing)
Yale Medicine also has its list of symptoms:
- Shortness of breath
- Difficulty in breathing
- High body temperature
- Cough with blood or mucus
- Lightheadedness
At the same time, doctors will do a physical exam and a chest X-ray for further verification and systematic review of the rib fractures.
In other injuries, depending on the severity, doctors may order a CT scan. The CT diagnosis will dictate how the doctor will proceed with the treatment.
Does a Cracked Rib Need Medical Attention?
Yes, rib fractures need medical attention regardless of severity.
There are patients with rib fractures with lower risk factors. Therefore, they will be sent home by doctors with little to no medications. They only need to take care of themselves.
Conversely, geriatric patients with rib fractures have significant risk factors compared to others. This comes with two times the morbidity and mortality rate for them.
These geriatric patients need serious medical attention because they may have the highest risks for respiratory failure, respiratory complications, and pneumonia.
What Happens if You Leave a Broken Rib Untreated?
Leaving an elder with one or more ribs broken and untreated results in short-term and long-term consequences.
Brigham and Women’s Hospital reiterates that elders with an untreated rib fracture will face the short-term consequences of:
- Severe aching while breathing
- Pneumonia
- Death
They can also be pained by the long-term ill effects of untreated rib fracture, such as:
- Chest wall deformity
- Chronic painful sensation
- Decreased lung function
The Dangers of Rib Fractures in the Elderly
An elderly has a weakened bone density. For this, the dangers of a rib fracture can be fatal.
The higher the number of fractures, the higher mortality risks become. An additional rib fracture increases the chances by 19%, with a death odds ratio of 1.19.
In a study by Bulger et al., aside from increased mortality from a blunt chest injury, there’s also a 27% risk for elders with a rib fracture to catch pneumonia.
Elders are also at risk of other respiratory complications. With pre-existing morbidities, an injury can cause death.
Treatment for Broken Ribs in Elderly Patients
Doctors don’t just jump to conclusions — they follow steps for rib fracture management.
The surgeons also emphasized that these geriatric trauma patients need aggressive management. These are the standard procedures that doctors follow:
1. First Aid and Hospitalization
After calling 911, responders will bring your patient to a hospital.
While on transfer, the responders will perform the emergency medicine initial assessment and treatment of the airway, breathing, circulation, disability, and exposure. This is called the ABCDE approach to trauma.
In the hospital, doctors will perform a physical exam to take into account if there’s only a rib or half a dozen ribs fractured.
2. Medical History Taking
Knowing the medical history of patients is essential. It’s used to assess points for pain control of the rib fracture of older adults.
Medical professionals can also use a patient’s history to evaluate and predict mortality.
This will also help doctors have a systematic review of a patient’s blood sugar. This can open up opportunities to control any abnormalities and avoid respiratory complications.
3. Imaging
An X-ray or a CT scan help doctors assess the significant risk of older adults with rib fractures.
It also helps fully understand older adults’ cases to know what treatment to use — to resort to epidural analgesia or simpler alternatives.
However, patients with rib fractures that fulfill the Level 1 Trauma Center standards are no longer required to have a CT scan.
4. Adequate Pain Control
Advanced age means a higher risk for soreness among fractured patients. Also, because of lower painful sensation tolerance and healing rate, there is increased mortality compared to younger adults.
For this, adequate pain management is needed by patients. Doctors may recommend aggressive chest physiotherapy.
Using epidural analgesia to help with breathing is also recommended based on earlier studies with randomized controlled trials.
Pain Medications for Elders With Rib Fractures
Your elder patient who has an increased risk of mortality and in severe aching are administered medications for painful sensations by doctors:
- Gabapentin
- Lidocaine
- Nonsteroidal anti-inflammatory drugs
- Acetaminophen
- Narcotics
- Muscle relaxers
There may also be older adults needing critical care for blunt chest trauma. For these patients, epidural analgesia may be provided.
The Healing Time for Cracked Ribs
Rib fractures can heal within six to twelve weeks, relying on the severity — single or multiple rib fractures.
The process of healing can also happen naturally. That is why doctors will discourage the use of compression wraps. By doing this, your elder patient can avoid acute respiratory failure from respiratory insufficiency.
However, a doctor’s treatment is needed for severe traumatic rib fractures. Sometimes, patients are transferred to a trauma center for the most appropriate pain management.
For elders who are high-risk trauma patients, a more extended hospital stay is expected as they have weaker bones. This causes a number of rib fractures to heal much longer.
The hospital length will depend on the injury severity, the number of rib fracture points, and the patient’s healing time.
Frequently Asked Questions
In this section, we will try to get to the bottom by answering some of your questions.
How Should You Sleep With a Rib Fracture?
Sleeping with a fractured rib is uncomfortable. What more for elders, right?
The most important thing to do is to sleep where the patient is comfortable. You can try letting your patient sleep on their injured side or the other way around.
Letting them sleep on their injury may help limit unnecessary movements and may help them breathe easily.
You can also ask them where they’re comfortable – in bed or on a recliner. Pillows can also aid in their restful sleep.
What Does a Hairline Fracture Rib Feel Like?
Mainly, you would feel a sharp pain in your chest area when you breathe in. Swelling around the affected rib areas are also possible, alongside bruising on the skin.
While you can definitely feel a hairline fracture rib, it can heal even without treatment.
Is a Heating Pad Good for Broken Ribs?
Yes, for as long as you apply the heating pad after the swelling subsides.
Also, DO NOT put it directly on your skin. Use a cloth in between the skin and the heating pad.
Should You Go to the ER for a Broken Rib?
Painful or not, according to medical education, you SHOULD send older adults to the ER If they have these manifestations:
- A blunt upper body trauma
- Painful when you breathe deeply (even typical breathing pattern)
- Escalating painful sensation over injury
- Vomiting
How to Ease Pain From Blunt Chest Trauma/Blunt Chest Wall Trauma?
A blunt trauma injury yields a higher risk factor for older patients — elevating the highest risk for trauma mortality.
Doctors suggest proper breathing exercises for rib fracture pain management. Of course, with the help of physical and occupational therapists.
This can help reduce mortality and lessen the high risk of painful sensations for your elderly patient suffering from a rib injury.
Furthermore, some patients are administered epidural analgesia to release some aching from the trauma injury.
Final Words
Older adults or the elderly with rib fractures do not just deal with injury and trauma from cracked bones. They also deal with their age and other morbidities.
Knowing the dangers, signs, and treatments early on is a better way to help alleviate these patients’ trauma injury and other concerns.
