Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

Abstract

This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.

Keywords: epidemiology; function; geriatric; older adult; traumatic brain injury.

FIG. 1.

Annual incidence of traumatic brain injury (TBI) emergency department (ED) visits, hospitalizations, and deaths 2002–2013 by age. Annual incidence of TBI-related ED visits, hospitalizations, and deaths per 100,000 U.S. population are shown for the periods 2002–2006 (A), 2007 (B), and 2013 (C). Over time, incidence of TBI has shown the greatest increase among adults ≥75 years of age, with most of this increase attributed to increased ED visits. Data adapted from the Centers for Disease Control.^,

FIG. 2.

Major mechanisms of traumatic brain injury (TBI) by age (2007–2010). Falls are shown in black; motor vehicle accidents (MVA), in dark gray; and other mechanisms, in light gray. Mechanism of TBI among older adults is predominantly falls whereas mechanism among younger individuals is predominantly MVA.

FIG. 3.

Sex and race of adults with traumatic brain injury (TBI) by age (2007–2010). The demographics of TBI shift toward increasing prevalence of white race (dark gray bars) and female sex (black bars) with increasing age such that by age 85 years+ the majority of patients with TBI are female.