Integrated Health Care Management of Moderate to Severe TBI in Older Patients—A Narrative Review

Schumacher, Rahel; Müri, René M.; Walder, Bernhard

doi:10.1007/s11910-017-0801-7

Cited by 12 publications

(6 citation statements)

References 100 publications

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“…This outcome is unanticipated given the vast array of participating provider typologies, especially those whose clients have neurobehavioral issues. However, this finding lends credence to previous studies where patients and carers report a lack of integrated care resulting in service fragmentation, particularly in the post-acute, community-based setting (Abrahamson et al, 2017;Schumacher et al, 2017).…”

Section: Discussionsupporting

confidence: 81%

A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

O'Donoghue

Meixner

2020

Cogent Psychology

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Across the continuum of care, providers representing multiple professions (i.e., rehabilitation, medical, mental health) influence post-acute care planning for persons with brain injury, yet insufficient evidence informs how decisions are made. The need to understand provider decision-making is paramount, particularly for a person with brain injury whose sequelae necessitates integrated, interprofessional care. Using vignettes drawn from authentic scenarios, this qualitative study investigated case management decisions made by providers serving individuals with varying neurobehavioral needs. Responses to three open-ended scenarios concerning neurobehavioral service provision were collected, coded, and analyzed in accordance with rigorous qualitative conventions. Participants (n = 84) represented an array of organizations serving persons with brain injury. The results revealed two courses of action: dominant and supporting. Although most respondents indicated integrated care as the ideal pathway, their concretized recommendations yielded actions focused on a single referral within the traditional medical model rather than an interdisciplinary approach. While integrated, interprofessional treatment and working across systems are considered optimal, this study suggests that in the current practice

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Section: Discussionsupporting

confidence: 81%

A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

O'Donoghue

Meixner

2020

Cogent Psychology

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“…Older TBI patients are often denied access to specialized rehabilitation [82]. However, a comprehensive review of the literature from our group highlights that older TBI patients have the potential to make significant improvements over time, even though less favorable than younger patients [83].…”

Section: Admission To Rehabilitation After Tbimentioning

confidence: 99%

Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review

Oberholzer

Müri

2019

Medical Sciences

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Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the clinical consequences of the distinct lesions of TBI. In severe TBI, clinical course often follows a typical initial sequence of coma; followed by disturbed consciousness; later, post-traumatic agitation and amnesia; and finally, recovery of function occurs. In the different phases of neurorehabilitation, physicians should be aware of typical medical complications such as paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions. Furthermore, we address questions on timing and on existing evidence for different rehabilitation programmes and for holistic neuropsychological rehabilitation approaches.

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“…In addition the intracranial pressure (ICP) is often lower, and cerebral autoregulation does not function as effectively as in younger patients [ 58 ]. Older patients may not always receive the same aggressive treatment as their younger counterparts and the associated mortality in traumatic brain injury is higher [ 59 – 62 ].It is also important to be mindful that there is an increased incidence of chronic subdural haematomas (cSDH) with patients often presenting days after a minor trauma with a reduced GCS or other neurologic symptoms that can mimic stroke or transient ischemic attacks (TIAs) [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

Eichinger

Robb

Scurr

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. Methods and findings A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. Conclusions Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

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Integrated Health Care Management of Moderate to Severe TBI in Older Patients—A Narrative Review

Cited by 12 publications

References 100 publications

A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review

Challenges in the PREHOSPITAL emergency management of geriatric trauma patients – a scoping review

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