Traumatic Brain Injury in Older Adults: Epidemiology, Etiology, Rehabilitation, and Outcomes

Abstract

Purpose: Traumatic brain injury (TBI) is a major public health problem, affecting millions of people worldwide each year. TBI presents as a major cause of death and disability in older adults, which is significant in the setting of older adults living longer. Falls are the leading cause of TBI in older adults, and normal sensory, motor, and cognitive changes that occur with aging increase the risk of falling. Multiple medical and cognitive comorbidities put older adults at increased risk for sustaining a TBI, and complicate recovery. Preexisting comorbid conditions, such as hypertension, diabetes, and heart disease, when combined with polypharmacy and aging effects compound the risks, severity, and outcomes following TBI. This clinical focus article addresses the normal effects of aging, the epidemiology of aging, and the relationship of aging to risks, consequences, and prognosis following TBI in older adults. In addition, discussion focuses on medical care and treatment, acute and chronic consequences, and assumptions and controversies in approaches to management of acute TBI in this population. The processes for assessment and treatment of cognitive communication during rehabilitation are explained in detail, including specific measures and strategies for both the acute and chronic phases of rehabilitation. Conclusions: Outcomes following TBI in older adults include persisting cognitive and functional limitations that often require some level of support. However, studies have shown that there are elderly patients with severe TBI who benefit from rehabilitation and may have more favorable outcomes. Determining prognosis after TBI is challenging relative to long-term functional consequences, due to the aging process. Therefore, the best intervention for TBI in older adults is prevention of TBI. As the aging population continues to increase in the United States, the need to design and implement evidence-based, cost-effective measures that focus on prevention of the leading causes of TBI in older adults becomes more urgent.