First Aid for the Elderly

What You Need to Know for Those with More Life Experience

fractured hip x-ray
A broken hip is when the head of the femur (round part) breaks off. WILLSIE / Getty Images

Getting older is both a blessing and a curse. It's a blessing because the alternative is to stop getting older. For now, there's only one way to do that and it's not a good option.

The curse part has to do with all the ways our bodies break down with age. Thin skin, brittle bones, slower movement and all those aches and pains conspire to make it seem as though we are all just one stumble away from catastrophe.

Never fear! You didn't get old by being frail.

The trick is to know how things are different in those of us with more life experience and know what you can do to avoid injury or treat it. Everyone ages differently and there are plenty of senior citizens who look like they're 40 and move like they're 30. The younger you feel and move (walking speed is the number one indicator of health in the elderly) the less likely you'll need the tips in this article. If extreme mountain biking is your weekend hobby, chances are you won't need special wound care for skin tears.

On the other hand, if you find yourself bruising easily or bleeding from what seemed like a simple brush against the couch, read on to see how to handle these special challenges.

Thin Skin

As we age, our skin becomes thinner and less cohesive between layers, meaning that the top layer (epidermis) is less connected to the second layer (dermis).

You can feel this change in the way the top layer of skin sort of slides around more easily. Sun exposure has a lot to do with the damage, and you can feel the change more obviously by comparing areas of the body that are regularly exposed to the sun with areas that are not.

Thin skin is easier to damage with very little effort.

What we would normally call an avulsion is often called a "skin tear" when it happens in folks with very delicate skin. No one is going to die from a skin tear, but the damage can be significant and look quite scary. Skin tears are much more common on the arms than anywhere else (arms have a lot of exposure, to both sun and to bumping things). Blood vessels in the dermis (veins that are often visible as blue lines) become much more brittle with thin skin and can burst with minimal pressure, causing bruises.

How to treat injuries with thin skin:

  1. Be gentle. Thin skin that's already torn will peal away like the skin of a peach if you're not careful. Replace any skin flaps that are hanging on. Even torn, the best cover for raw, open wounds is the skin that was there originally. If it's completely torn away, don't put it back on. In that case, there won't be any blood vessels to feed the flap and keep it alive.
  2. Don't use tape! Adhesives are the enemy of thin skin. Dry, thin skin adheres very well to tape and then it will not come off. Cover any wounds with synthetic skin, which looks and feels very similar to plastic wrap. It's not the same thing, so be sure to use the proper first aid supplies. To hold everything in place, especially on an arm or leg, use a non-adherent wrap. An elastic bandage will work, but there are bandages on the market that adhere only to themselves, not to any other surface. Those are perfect for this type of wound.
  1. Keep it clean. Water is the best medicine for skin tears. Rinsing with plain tap water is the way to clean this type of injury. It should be cleaned once a day and re-wrapped to allow it to heal properly.

Thin skin won't tolerate stitches. The skin is unable to hold onto the suture material and will just tear more--like a piece of perforated binder paper. Scarring isn't really an issue with this type of skin. It might scar, but that just means it healed, which is what we want. Keep the wound clean and closed with the help of non-adhesive wraps, then give it plenty of time.

Brittle Bones

A broken bone is a broken bone, whether it's on an 8 year old or an 80 year old. The difference between the two is that an 8 year old bone has a tendency to tear apart like a green branch off of a young tree, while an 80 year old bone is more likely to snap.

Fracture treatment in the elderly isn't any different than in younger patients. It's just easier to break them in the first place.

How to treat broken bones:

  1. Don't move the patient. A patient in a dangerous situation might have to be moved for his or her own safety, but barring that, don't move the patient.
  2. Immobilize the injury. To best splint a potential fracture, immobilize the bone at the injury site and immobilize the joints proximal and distal to the suspected fracture (the joints above and below it). For instance, a potentially broken forearm should be splinted, as well as the elbow and wrist on that same arm.
  3. Ice the injury. Treat a potential fracture with cold compresses for no more than 20 minutes at a time immediately after the injury. Never put ice directly on the skin--always make sure there's a layer of cloth between the ice and the skin. Use the 20/20 rule: 20 minutes on and 20 minutes off.
  4. Wrap it with a compression bandage (like an ACE bandage). Compression helps with the swelling.
  5. Elevate the injured limb, if possible. For best results, get the injury above the level of the heart. If you can't get it that high, no problem. Just make sure your broken ankle isn't dangling beneath you. The more it hangs low, the more swollen it becomes.
  6. Get to a doctor. You'll need an x-ray, so if your doctor can't do that for you, you'll need to go to a clinic or an emergency department that can.

All bones get more brittle with age, but some are more troublesome. Bones that cause problems as they get more brittle are the hips, the humerus (upper arm bone), radius (one of the forearm bones) and the ribs. Skull fractures are also more likely in the elderly than in younger adult patients.


Falls that a younger adult patient would endure without much more than a bruised ego can lead to devastating fractures in older adults. Hips are especially delicate in the elderly, due mostly to their shape and location. Hip fractures occur at the head of the femur, the large bone in the thigh. The head of the femur is a small, round ball attached to the main body of the femur with a thin neck. Falling onto the hip can put great pressure on it, resulting in a broken femoral neck.

Hip fractures have a distinct look in the vast majority of cases. It's possible to have a hip fracture without the classic signs, but if the signs are there, the hip is almost definitely broken. Signs of a hip fracture include:

  • The broken leg is shorter than the uninjured leg.
  • The broken leg is externally rotated, meaning the injured leg wants to rest with the knee and toes pointing away from the good leg.
  • It hurts really, really bad. And it's tender when you touch it.

A broken hip means you'll have to call an ambulance. Don't try to move the leg or put any weight on it. You'll need an x-ray and probably wouldn't mind some pain medication.

Preventing falls is much better than trying to get treatment once you've fallen and broken something. Make sure there aren't any loose rugs on the floor. Install rails or handles in the bathroom and shower. Above all, stay active, which is the best medicine for everything above.


Afilalo J, et al. "Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery." J Am Coll Cardiol. 2010 Nov 9;56(20):1668-76. doi: 10.1016/j.jacc.2010.06.039. PubMed PMID: 21050978.

Verma SK, et al. "Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States." PLoS One. 2016 Mar 15;11(3):e0150939. doi: 10.1371/journal.pone.0150939. eCollection 2016. PubMed PMID: 26977599; PubMed Central PMCID: PMC4792421.

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