It is widely accepted that individuals over 65 experience differences in recovery. Key research has shown that individuals 56 years of age and older also experience very different outcomes following major trauma compared to those who are younger. Several studies have demonstrated that older individuals (those 56 years of age or older) have higher mortality rates (up to 62%) at discharge from acute care regardless of injury severity (Mosenthal et al. 2002; Susman et al. 2002; Kuhne et al. 2005; Bouras et al. 2007; Spaniolas et al. 2010). While the literature generally lumps all individuals over 65 years of age as one group, studies have shown that there may in fact be key differences among this age bracket in recovery and outcomes. Bouras et al. (2007) examined mortality rates of older adults with TBI who were stratified into age groups (14-64, 65-74, and 75 or more years of age) and found that mortality rates were significantly different between the two oldest age brackets, with the oldest seniors faring worse than the younger seniors. Further, Kuhne et al. (2005) found mortality peaked at the age of 75. One explanation for higher mortality rates from brain injuries or secondary shock in older adults may be due to the vulnerability of brain vessels with advancing age (Marxheimer 1998).
It has been consistently shown that age, Glasgow Coma Scale (GCS) scores, and injury severity are three independent predictors of mortality following a TBI. Table 18.1 presents key research that demonstrates the effect of age and GCS on mortality following an acquired brain injury.
Older age is a predictor for mortality following TBI, independent of GCS score or injury severity.
Mortality rates are higher for older adults when compared to younger individuals (<65 years) at all points along the continuum post-injury.