Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

被引:312
作者
Gardner, Raquel C. [1 ,2 ,3 ]
Dams-O'Connor, Kristen [4 ]
Morrissey, Molly Rose [5 ,6 ]
Manley, Geoffrey T. [3 ,5 ,6 ]
机构
[1] Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA
[2] San Francisco VA Med Ctr, San Francisco, CA USA
[3] Univ Calif San Francisco, Weill Inst Neurosci, San Francisco, CA 94143 USA
[4] Icahn Sch Med Mt Sinai, Dept Rehabil Med, New York, NY 10029 USA
[5] Univ Calif San Francisco, Dept Neurosurg, Brain & Spinal Injury Ctr, San Francisco, CA USA
[6] Zuckerberg San Francisco Gen Hosp, San Francisco, CA USA
关键词
epidemiology; function; geriatric; older adult; traumatic brain injury; GLASGOW COMA SCALE; ACUTE SUBDURAL-HEMATOMA; EMERGENCY-DEPARTMENT VISITS; SEVERE HEAD-INJURY; OLDER-ADULTS; ELDERLY-PATIENTS; INPATIENT REHABILITATION; INTRACRANIAL HEMORRHAGE; UNITED-STATES; RISK-FACTORS;
D O I
10.1089/neu.2017.5371
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood (geriatric TBI) rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.
引用
收藏
页码:889 / 906
页数:18
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