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Review
. 2021 Dec 2:1:100849.
doi: 10.1016/j.bas.2021.100849. eCollection 2021.

Functional outcome, dependency and well-being after traumatic brain injury in the elderly population: A systematic review and meta-analysis

Rebeca Alejandra Gavrila Laic  1 , Liedewij Bogaert  2 , Jos Vander Sloten  1 , Bart Depreitere  3
Affiliations
Review

Functional outcome, dependency and well-being after traumatic brain injury in the elderly population: A systematic review and meta-analysis

Rebeca Alejandra Gavrila Laic et al. Brain Spine. .

Abstract

Introduction: Traumatic brain injury (TBI) rates in the elderly are increasing worldwide, mainly due to fall accidents. However, TBI's impact on elderly patients' lives has not been thoroughly investigated.

Research question: This systematic review and meta-analysis aims at describing post-TBI incidence of functional decline, dependency, nursing home admission, reduced quality of life and depression in the elderly.

Materials and methods: A systematic literature search was performed in PubMed, EMBASE, Web Of Science, BIOSIS, Current Contents Connect, Data Citation Index, MEDLINE, SciELO, Cochrane library and CINAHL. Study selection was conducted by two independent reviewers. Meta-analysis was performed using a random-effects model.

Results: Twenty-seven studies were included in the qualitative synthesis and twenty-five in a random-effects meta-analysis. The prevalence of unfavorable functional outcomes after TBI was 65.2% (95% CI: 51.1-78.0). Admission to a nursing home had a pooled prevalence of 28.5% (95% CI: 17.1-41.6) and dependency rates ranged between 16.9% and 74.0%. A reduced quality of life was documented throughout follow-up with SF12/36 scores between 35.3 and 52.3/100.2.6-4.8% of the patients with mild TBI reported depressive symptoms. A large heterogeneity was found among studies for functional outcomes and discharge destination.

Discussion and conclusion: In conclusion, elderly patients have a significant risk for functional decline, dependency, nursing home admission and low quality of life following TBI. Moreover, more severe injuries lead to worse outcomes. These findings are important to provide accurate patient and family counseling, set realistic treatment targets and aim at relevant outcome variables in prognostic models for TBI in elderly patients.

Keywords: Dependency; Depression; Elderly; Quality of life; Systematic review; Traumatic brain injury; meta-Analysis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Prisma flow diagram.
Fig. 2
Fig. 2
Meta-analysis results for unfavorable functional outcomes.
Fig. 3
Fig. 3
Funnel plot for the studies used in the unfavorable functional outcomes meta-analysis.
Fig. 4
Fig. 4
Mean rates of unfavorable functional outcomes for the different TBI severities at different follow-up time points.
Fig. 5
Fig. 5
Meta-analysis results for nursing home admissions.
Fig. 6
Fig. 6
Funnel plot for the studies used in the nursing home admissions meta-analysis.
Fig. 7
Fig. 7
Mean MCS and PCS scores for the different TBI severities at different follow-up time point.
See this image and copyright information in PMC

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