Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications

Abstract

Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three-quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes. Keywords traumatic brain injury; head injury; geriatric; trauma; injury; epidemiology; outcomes; functional statusThe Centers for Disease Control and Prevention has termed traumatic brain injury (TBI) the "silent epidemic," 1 and within this silent epidemic, there is a seemingly silent population: older adults with TBI. Older age is a variable known to negatively influence outcome after TBI, 2-4 but analyses illuminating why this is the case, as well as information regarding ageappropriate care of elderly patients with TBI are sparse. Furthermore, despite the fact that geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, 5 the presence of comorbidities, 6,7 sex, 8 and other factors such as cerebral perfusion pressure (CPP) 9 on recovery after illness or injury, these variables remain understudied in older adults with TBI. The relative neglect of these variables in neuroscience research may partially explain why predicting outcomes and providing care in the older adult population with TBI remains so problematic. The current "one size fits all" approach to

The Cerebral Extracellular Release of Glycerol, Glutamate, and FGF2 Is Increased in Older Patients following Severe Traumatic Brain Injury

“…Traumatic brain injury (TBI) in older adults is a significant public health issue, with, for example, adults in the US aged 75 and older having the highest rates of TBI-related hospitalization and death (Thompson et al, 2006). Unfortunately, increasing age is strongly associated with a poor prognosis both in experimental trauma models and following TBI in humans (Livingston et al, 2005;Onyszchuk et al, 2008;Rothweiler et al, 1998;Sendroy-Terrill et al, 2010;Susman et al, 2002).…”

“…T raumatic brain injury (TBI) is a significant problem in senior citizens, with old age being associated with a poor recovery from brain injury (Hukkelhoven et al, 2003;Livingston et al, 2005;Thompson et al, 2006). The poorer prognosis has prompted some investigators to advocate a more conservative approach in elderly patients with moderate and severe TBI (Gan et al, 2004).…”

An Autopsy Study of Pattern of Fatal Cranio-Cerebral Injuries Due to Blunt Force Trauma at Medicolegal Centre of A Tertiary Healthcare Centre

“…It has been reported that falls are the most common cause of TBI in older adults since approximately 10% of falls in older people result in injuries such as TBI as per Thompson et al 31 . Other studies have confirmed that falls were the leading mechanism of TBI for older adults, accounting for 51% of cases as per Langlois et al 32 .…”

Lower Extracellular Glucose Level Prolonged in Elderly Patients With Severe Traumatic Brain Injury: A Microdialysis Study

“…TBI is responsible for more than 80,000 emergency department visits by persons aged 65 years or older each year in the United States, and this group has the highest rates of TBI-related hospitalization and death. 29) The Japan Neurotrauma Data Bank found significant differences in mortality rates between patients aged 65-69 years and patients aged 70-74 years. 31) Elderly individuals, 65 years of age or older, account for a disproportionate number of TBI cases and have a staggering incidence of morbidity and mortality.…”