Head Injury Mortality in a Geriatric Population: Differentiating an “Edge” Age Group with Better Potential for Benefit than Older Poor-Prognosis Patients

Abstract

A comparison of outcomes between different modes of head-injury treatment in the elderly has important bearing on questions of cost-effectiveness and medical ethics. Here, we have examined rates of mortality in elderly head-trauma victims to determine whether it is valid to differentiate an "edge" age group of younger elderly patients, 65-74 years of age, from older elderly patients, considering possible benefit from intensive treatment and surgical intervention. We collected data from 1926 cases of head trauma and separated them into three age groups: 14-64 years, 65-74 years, and 75 years or older. We then compared these groups with respect to cause of injury, severity of injury, and whether or not treatment included either admission to an Intensive Care Unit (ICU) or surgical intervention. We found that road traffic accidents were the major cause of head injury in the younger age group, whereas in the elderly falls predominated. Mortality was higher in the elderly in all the head injury severity subgroups. Young subjects with a Glasgow Coma Scale (GCS) score of less than or equal to 8 tended to benefit from ICU treatment whereas patients 75 and over did not, regardless of their severity of injury. For these patients who were in the 65-74 age group, the data suggested that some benefit was likely. Patients 75 and older were significantly less likely to survive surgical intervention than younger patients. We conclude that it is valid to treat patients in the age group 65-74 years as a separate group from those patients 75 and older. Patients in this younger subset of the elderly may benefit from ICU treatment or surgical intervention. However, the patients in our older subset of elderly patients clearly did not, and they had a significantly higher risk of surgical mortality.

Vertigo and dizziness in elderly patients with neurological disorders

“…In this group of patients the frequency of fall was significantly lower than the numbers reported in other studies (3)(4)(5)(6)(7)(8) . This may be attributed to the health care, social and economical status among this population.…”

“…This percentage is significantly lower than that of other studies, which vary from 45 to 65% (2)(3)(4)(5) . A possible explanation for this might be that these patients belong to a social group with easy access to health care, and they are more concerned with their health conditions than most of the general population.…”

“…In healthy elderly people, however, these disorders are less frequent when compared with those with vascular, metabolic or degenerative diseases, or with neurological conditions that affect the central vestibular pathways (1) . Vestibular disorders in elderly patients are clinically important, and have drawn attention of many investigators (2)(3)(4)(5)(6)(7)(8)(9) .…”

Geriatric Traumatic Brain Injury in Hungary and Eastern Europe

“…When Bouras et al [31] stratified their 1929 elderly patients into three groups by age, they have found that the group over 75 years did not benefit from ICU treatment, and had a significantly lower chance to survive the surgical intervention [31]. Utomo and coworkers [32••] also found that gTBI patients had significantly worse outcome over the age of 75 years.…”

Prevalence of and factors associated with head impact during falls in older adults in long-term care

“…[1][2][3][4][5] Traumatic brain injury accounts for 32% of hospital admissions and more than 50% of deaths from falls in older adults. 1,[6][7][8] Furthermore, the incidence and ageadjusted rate of fall-related traumatic brain injury is increasing, 1,9 especially among people older than 80 years, among whom rates have increased threefold over the past 30 years.…”