half are able to stand back up on their own, the other half experience a “long lie” which makes them more likely to experience a steeper decline on their activities of daily living than those who are able to stand back up on their own. furthermore, the medical complications arising from these falls make it so that they become the leading cause of death from injury in populations over 65 years old and fifth overall cause of death. as a result of a fall, older adults can also experience post-fall anxiety syndrome. this fear of falling was present in 60 percent of community dwelling geriatric populations, and was demonstrated by their reduction in levels of activity; 15 percent of which severely restricted their mobility out of fear of having another fall. this further contributes to morbidity because it can contribute to cognitive impairment, depression, isolation, increase in rates of obesity, and further mobility impairment. burns the geriatric population is at increased risk for burn injury. while geriatric burns account for less than 5% of burns in developing countries, nearly 20% of burns in developed countries are experienced by the geriatric population. these burn injuries tend to occur at home—particularly in the kitchen or the bathroom—and most commonly consist of flame and scald burns. importantly, geriatric patients are at increased risk for downstream complications. this is in part due to limited mobility, decreased ability to react rapidly to threats, and pre-existing medical problems such as vision impairment and medication side effects. additionally, due to the natural processes of aging, the skin of geriatric patients has impaired mechanisms to protect against burns, including impaired neurosensory sensitivity, skin permeability, and regeneration capacity. these impairments lead to deeper wounds, prolonged wound healing, and lower potential for complete recovery. treatment implications fluid resuscitation and pain control are key components of burn treatment. in the geriatric population, extra care must be paid to provide appropriate fluids, as age is significantly associated with increased volume requirement in the first 48 hours post-injury. additionally, geriatric patients are often not provided with adequate pain control management, in part due to a misconception that pain decreases with age (there is no evidence to support this claim). appropriate pain management is critical for recovery, and must consider patients' co-morbidities, organ functions, and current medications. skin-grafting is another important form of treatment for burns. however, age is a risk factor for unsuccessful grafting due to the natural thinning of the skin that occurs with age. other risk factors for failed skin relevant to the geriatric population for unsuccessful skin grafting include being over age 55, peripheral vascular disease, diabetes mellitus, and related problems of limb ischemia. outcomes studies suggest that few geriatric patients return to their previous state of health following burn injury. long-term consequences in this population include exacerbation of pre-existing conditions, decreased mobility, loss of independence, worsened nutrition, pain, and psychological sequelae including depression. trauma team activation one significant problem in the acute assessment of geriatric trauma patients is under-triage. trauma team activation (tta) must be done liberally due to limited costs and resources. therefore, the criteria for tta is established by the american college of surgeons and individual trauma centers. the criteria used to identify patients with a greater need for high level care include vital signs (systolic blood pressure below 90 mmhg or heart rate above 120 bpm), level of consciousness, and mechanism of injury. however, elderly patients with severe trauma often do not meet the standard tta criteria due to normal age-related changes and reduced physiologic capacities. for example, older adults have a less profound tachycardic response to hemorrhage, pain, or anxiety following trauma. this explains why mortality increases in the elderly above a heart rate of 90 bpm, an association not observed until heart rate of 130 bpm in younger patients. similarly, in older adults, systemic vascular resistance is increased, which may result in baseline hypertension. in the setting of shock, expected declines in blood pressure may not occur, leading to misinterpretation of the geriatric patient's condition. this supports why mortality significantly increases with systolic blood pressure below 110 mmhg in older adults but not until 95 mmhg in younger patients. this is why several centers and studies support using older age as a tta criterion as a means to reduce mortality in this population, regardless of the mechanism of injury.