The TBI Epidemic: Issues in Older Patients Quiz

Rates of emergency department visits for mild TBI were 386 per 100,000 among those aged 65-74 years old; 777 per 100,000 among those aged 75-84; and 1,205 per 100,000 among those older than 84.

Source: Albrecht JS, Hirshon JM, McCunn M, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834064/ Increased rates of mild traumatic brain injury among older adults in US emergency departments, 2009-2010. J Head Trauma Rehab. 2016;31:E1-E7.

The highest rates observed were among persons aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7).

Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths: United States, 2007 and 2013. MMWR Surveill Summ. 2017;66:1-16.

After adjustment for demographics and medical and psychiatric comorbidities, adjusted hazard ratios for dementia were 2.36 (95% CI, 2.10-2.66) for mild TBI without loss of consciousness (LOC), 2.51 (95% CI, 2.29-2.76) for mild TBI with LOC, 3.19 (95% CI, 3.05-3.33) for mild TBI with LOC status unknown, and 3.77 (95% CI, 3.63-3.91) for moderate to severe TBI.

Barnes DE, Byers AL, Gardner RC, et al. Association of mild traumatic brain injury with and without loss of consciousness with dementia in US military veterans. JAMA Neurol. 2018;75:1055-10.

As a result, there is an urgent need to develop better geriatric-specific prognostic models and evidence-based TBI treatments and management guidelines to identify older patients who would benefit most from aggressive versus conservative management as well as to optimally tailor treatment, rehabilitation, and prevention strategies for this patient population.

Gardner RC, Dams-O’Connor K, Morrissey MR, Manley G. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions.J Neurotrauma. February 15, 2017; Epub ahead of print.

For example, 16,519 (17%) beneficiaries were diagnosed with anxiety and 269 (0.3%) were diagnosed with PTSD following TBI.

Albrecht JS, Peters ME, Smith GS, Rao V. Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury. J Head Trauma Rehab. 2017;32:178-184.