Three octogenarian women suffered severe blunt trauma because of a car crash. The first patient was 81 years old. She had an instable dens fracture, multiple rib fractures, a haematopneumothorax and multiple extremity fractures. The second patient was 82 years old and was diagnosed with a flail chest because of multiple rib fractures, pelvic fractures, and thoracic spine fractures. Before the crash, she already needed help for her daily functioning. The third patient, 84 years old, developed a bradycardia at the site of the crash. In the hospital she was diagnosed with multiple rib fractures, a sternum fracture and a pneumothorax. After appropriate treatment, the second patient had no prospect of recovery and the care was primarily aimed at comfort, until she died. The other two patients remained in a rehabilitation clinic for months after the accident. The necessary approach to first trauma care, ICU care and rehabilitation differs between young and octogenarian patients. These octogenarian female patients constitute a special group of patients because of their frailty. Due to demographic developments and the changes in trauma care, such patients will be treated more often and further in the care chain. During the ICU stay they will require extensive support because of their frailty. The patient's own efforts will also be tremendous. The balance between quality of life adjusted years won and the toll paid by the patient has to be guarded with great care.