Management of Epistaxis in Elderly Patients

Initial Assessment and Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends immediately positioning elderly patients with epistaxis sitting upright with head tilted slightly forward and applying firm sustained compression to the soft lower part of the nose for 10-15 minutes without interruption, which resolves the majority of nosebleeds and is the essential first-line intervention 1, 2
Initial assessment should include evaluation of active bleeding severity and risk of airway compromise from blood entering the oropharynx, as well as hemodynamic stability and ability to protect the airway 1, 3
Elderly patients are at significantly higher risk for severe epistaxis, with those aged 76-85 years being 2.37 times more likely and those over 85 years being 3.24 times more likely to present to emergency departments compared to younger patients 4, 5

The American Academy of Otolaryngology-Head and Neck Surgery suggests that if bleeding persists after 15 minutes of continuous pressure, topical vasoconstrictors such as oxymetazoline or phenylephrine should be applied, followed by continued compression for an additional 5 minutes 3, 6
For identified anterior bleeding sites, chemical cautery or electrocautery should be used after proper anesthetization, with electrocautery being more effective than chemical cauterization 6
Nasal packing with resorbable materials is recommended for elderly patients, especially those on anticoagulants or antiplatelet medications, and anticoagulation or antiplatelet medications should not be discontinued in the absence of life-threatening bleeding 1, 3, 6

The American Academy of Otolaryngology-Head and Neck Surgery advises documenting critical risk factors, including personal or family history of bleeding disorders, current use of anticoagulants or antiplatelet medications, and history of hypertension 5, 6
Patients should be educated on preventive measures, including application of moisturizing or lubricating agents to the nasal mucosa, regular use of saline nasal sprays, and use of humidifiers in dry environments 2, 3, 6
Follow-up requirements include documenting outcome within 30 days or documenting transition of care, and educating patients with nasal packing about post-procedure care and warning signs requiring prompt reassessment 1, 6