Key Points

 

  • 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.
     
  • Older adults admitted to acute care with a severe brain injury have a poor prognosis with few being discharged with a good functional outcome.
     
  • Age and Glasgow Coma Scale scores are independent predictors of poor functional outcome, and good recoveries decline sharply with age.
     
  • Older adults who sustain a TBI recover more slowly, as measured by the Disability Rating Scale, than younger individuals.
     
  • Sustaining a TBI in later years can have a significant effect on overall functioning as measured by the Functional Independence Measure.
     
  • Age-related cognitive decline and neurological damage resulting from a brain injury have a cumulative negative effect and may produce cognitive deficits.
     
  • Cognitive impairment pathologies such as dementia (unrelated to TBI) and TBI related cognitive decline often exist as co-morbid conditions among older adults.
     
  • The APOE4 allele is an independent predictor for poor clinical outcome, both physically and cognitively.
     
  • Older adults are often treated more conservatively (less intensely) in acute care post-TBI.
     
  • Decompressive craniotomy is typically not performed on patients older than 50 years, despite that a modest number of older adults have benefitted from the surgery.
     
  • There appears to be a discrepancy in discharge destination between older and younger individuals post inury; a greater number of older adults are discharged to long term care facilities or nursing homes while younger adults often return home.
  • The effectiveness of rehabilitation interventions specifically for the older TBI population have not been studied.
     
  • Older adults with TBI have a longer length of stay in rehabilitation when compared to younger adults.