Systematic Review and Meta-analysis of Outcome after Mild Traumatic Brain Injury in Older People

Abstract

Objective: Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate–severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains – cognition, psychological health, and life participation. Methods: Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. Results: By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. Conclusions: Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.

Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study

“…In CENTER-TBI, older adults do not seem to have higher proportions of depression and anxiety than TBI adults in general [49] . This is consistent to previous studies, which found that older adults report less psychological distress than younger adults [14] . However, the proportion of patients with severe depression and anxiety symptoms is higher than in the general population without TBI [ 50 , 51 ].…”

“…Research on outcome following TBI in older adults has predominantly focused on subgroups of TBI severity and functional outcome [14] . In CENTER-TBI, we found that age and injury characteristics were associated with lower functional outcome but were not significant predictors of mental HRQoL and psychological symptoms when controlled for other important factors.…”

“…Nevertheless, previous TBI studies have often excluded older adults, especially those with pre-existing psychiatric and neurological problems [13] . While results from younger adult studies suggest a strong relationship between pre-injury characteristics and outcome after TBI, evidence from older adult cohorts is needed [14] . Chronic health complaints are also associated with increased healthcare utilization and costs [15] .…”

“…Previous HRQoL studies included small sample sizes and few studies included both generic and disease-specific measures of HRQoL [19] . In some studies, individuals showed a higher risk for emergence of psychiatric disorders including depression, anxiety and posttraumatic stress disorder (PTSD) after TBI [20] , whereas in other studies older adults reported less psychological distress and less symptoms of depression and anxiety than younger adults [14] . Nonetheless, a systematic review on psychiatric assessments after TBI, concluded that psychological outcomes were insufficiently addressed in the emerging group of older TBI patients [20] .…”

“…Since the number of older adults with TBI is substantial and has been increasing, it is important to investigate characteristics and outcomes in the older TBI population [21] . A recent systematic review on outcomes following mild TBI in older adults suggested "cautious optimism" in terms of long-term functional recovery and psychological health [14] . Better understanding of health care utilization and health outcomes of older people after TBI might help clinicians to set treatment goals.…”