In the setting of trauma, timely identification and early intervention in shock is critical for achieving quality patient outcomes. In older adult trauma patients (age > 65 years old) detection of a deteriorating condition can be delayed due to several factors that obscure the clinical picture. The purpose of this study is to educate providers on evidence-based concepts that will enable them to more effectively identify a deteriorating condition, leading to better patient outcomes. This study uses a systematic literature review employing a manual selection of quality assessed articles. The review identifies the most pertinent physiologic changes of aging that affect the initial assessment and treatment in trauma, focusing on the cardiovascular, respiratory, renal, and hematologic systems. It also illustrates the importance of a specialized secondary survey in these patients, including laboratory values, home medication lists, trends in vital signs, urine output, and changes in mental status.