When older adults have suffered a traumatic brain injury (TBI) due to falls and other incidents, survival is linked more to the extent of their overall injuries than to their age, a new study finds. In fact, the oldest adults with recent TBI tend toward decreased mortality — and a subset of these patients have better-than-expected outcomes, investigators reported.

The study is one of the first to examine the characteristics and outcomes of a large cohort of older adults with a brain-scan-verified TBI without severe additional traumatic injury, according to the researchers. They also looked into the prevalence of palliative care among these patients, who ranged in age from 40 years and older.

Study participants with moderate-to-severe injury had a 64% mortality rate that decreased along with older age. 

“Increasing age did not influence overall mortality rate; in fact, there was a trend toward decreased mortality in the oldest-old age group,” Mira Ghneim, M.D., of the University of Maryland Medical Center in Baltimore, explained. “Our results differ from previous reports, possibly due to the fact that our cohort of older adults is a ‘pure TBI’ group with minimal injury to other organ systems.”

Higher mortality was tied to lower scores (less than 9) on the Glasgow Coma Scale (GCS), which describes the level of consciousness after the TBI. 

Palliative care tied to older age

The rate of palliative interventions in the study’s moderate/severe TBI group was 58% to 72%. This is compared to a national rate of 35%, the researchers reported. Patients who received palliative care interventions were more likely to have had cerebral edema on their initial imaging, worsening CT scan results, a GCS score of less than 9 and to be 75 years of age and older.

The best outcomes, meanwhile, were more often found in patients with an Injury Severity Score greater than or equal to 24. These patients were also more likely to be discharged to their pre-injury residences. A small but notable group of the oldest-old adults recovered “better than expected” from severe TBI. More focus should be placed on identifying these patients, the authors concluded.

Falls remain the major cause of TBI in older adults. Fully 82% of the study cohort had had a previous fall, the researchers reported.

Full findings were published in JAMDA.

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