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Challenges in the Elderly

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Management of Severe Traumatic Brain Injury

Abstract

Elderly patients with TBI differ from younger subjects in many respects, including pre-injury health and functioning, medications and risk for complications. There are also anatomical and physiological differences, which have an impact on the clinical course. Despite the rapid increase in the number of geriatric TBIs, strong evidence about treatment guidelines is severely lacking. Individual decisions become possibly even more pronounced in this age group, requiring careful consideration of multiple issues.

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References

  • Albrecht JS, Liu X, Smith GS, Baumgarten M, Rattinger GB, Gambert SR, Langenberg P, Zuckerman IH. Stroke incidence following traumatic brain injury in older adults. J Head Trauma Rehabil. 2015;30(2):E62–7.

    Article  Google Scholar 

  • Ascherio A, Schwarzschild MA. The epidemiology of Parkinson’s disease: risk factors and prevention. Lancet Neurol. 2016;15(12):1257–72.

    Article  Google Scholar 

  • Brazinova A, Mauritz W, Leitgeb J, Wilbacher I, Majdan M, Janciak I, Rusnak M. Outcomes of patients with severe traumatic brain injury who have Glasgow coma scale scores of 3 or 4 and are over 65 years old. J Neurotrauma. 2010;27(9):1549–55.

    Article  Google Scholar 

  • Brazinova A, Mauritz W, Majdan M, Rehorcikova V, Leitgeb J. Fatal traumatic brain injury in older adults in Austria 1980-2012: an analysis of 33 years. Age Ageing. 2015;44(3):502–6.

    Article  Google Scholar 

  • Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, Peeters W, Feigin V, Theadom A, Holkovic L, Synnot A. Epidemiology of traumatic brain injury in Europe: a living systematic review. J Neurotrauma. 2018. [Epub ahead of print]. https://doi.org/10.1089/neu.2015.4126.

  • Catapano JS, Chapman AJ, Horner LP, Lu M, Fraser DR, Fildes JJ. Pre-injury polypharmacy predicts mortality in isolated severe traumatic brain injury patients. Am J Surg. 2017;213(6):1104–8.

    Article  Google Scholar 

  • Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41.

    PubMed  PubMed Central  Google Scholar 

  • Cifu DX, Kreutzer JS, Marwitz JH, Rosenthal M, Englander J, High W. Functional outcomes of older adults with traumatic brain injury: a prospective, multicenter analysis. Arch Phys Med Rehabil. 1996;77(9):883–8.

    Article  CAS  Google Scholar 

  • Dams-O’Connor K, Gibbons LE, Bowen JD, McCurry SM, Larson EB, Crane PK. Risk for late-life re-injury, dementia and death among individuals with traumatic brain injury: a population-based study. J Neurol Neurosurg Psychiatry. 2013;84(2):177–82.

    Article  Google Scholar 

  • Dang Q, Simon J, Catino J, Puente I, Habib F, Zucker L, Bukur M. More fateful than fruitful? Intracranial pressure monitoring in elderly patients with traumatic brain injury is associated with worse outcomes. J Surg Res. 2015;198(2):482–8.

    Article  Google Scholar 

  • De Bonis P, Pompucci A, Mangiola A, D’Alessandris QG, Rigante L, Anile C. Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist? J Neurosurg. 2010;112(5):1150–3.

    Article  Google Scholar 

  • De Bonis P, Pompucci A, Mangiola A, Paternoster G, Festa R, Nucci CG, Maviglia R, Antonelli M, Anile C. Decompressive craniectomy for elderly patients with traumatic brain injury: it’s probably not worth the while. J Neurotrauma. 2011;28(10):2043–8.

    Article  Google Scholar 

  • Delaney JW, Downar J. How is life support withdrawn in intensive care units: a narrative review. J Crit Care. 2016;35:12–8.

    Article  Google Scholar 

  • Evans DC, Cook CH, Christy JM, Murphy CV, Gerlach AT, Eiferman D, Lindsey DE, Whitmill ML, Papadimos TJ, Beery PR 2nd, Steinberg SM, Stawicki SP. Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma patients. J Am Geriatr Soc. 2012;60(8):1465–70.

    Article  Google Scholar 

  • Fann JR, Ribe AR, Pedersen HS, Fenger-Grøn M, Christensen J, Benros ME, Vestergaard M. Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study. Lancet Psychiatry. 2018;5(5):424–31.

    Article  Google Scholar 

  • Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018;35:889. https://doi.org/10.1089/neu.2017.5371. [Epub ahead of print].

    Article  PubMed  PubMed Central  Google Scholar 

  • Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury. Arch Phys Med Rehabil. 2010;91(1):43–50.

    Article  Google Scholar 

  • Green RE, Colella B, Christensen B, Johns K, Frasca D, Bayley M, Monette G. Examining moderators of cognitive recovery trajectories after moderate to severe traumatic brain injury. Arch Phys Med Rehabil. 2008;89(12 Suppl):S16–24.

    Article  Google Scholar 

  • Hamill V, Barry SJ, McConnachie A, McMillan TM, Teasdale GM. Mortality from head injury over four decades in Scotland. J Neurotrauma. 2015;32(10):689–703.

    Article  Google Scholar 

  • Harvey LA, Close JC. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury. 2012;43(11):1821–6.

    Article  Google Scholar 

  • Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, O’Keeffe T, Tang A, Vercruysse G, Fain MJ, Friese RS, Rhee P. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014;149(8):766–72.

    Article  Google Scholar 

  • Joseph B, Orouji Jokar T, Hassan A, Azim A, Mohler MJ, Kulvatunyou N, Siddiqi S, Phelan H, Fain M, Rhee P. Redefining the association between old age and poor outcomes after trauma: the impact of frailty syndrome. J Trauma Acute Care Surg. 2017;82(3):575–81.

    Article  Google Scholar 

  • Kinoshita T, Yoshiya K, Fujimoto Y, Kajikawa R, Kiguchi T, Hara M, Wakayama A, Yoshimine T. Decompressive craniectomy in conjunction with evacuation of intracranial hemorrhagic lesions is associated with worse outcomes in elderly patients with traumatic brain injury: a propensity score analysis. World Neurosurg. 2016;89:187–92.

    Article  Google Scholar 

  • Kowalski RG, Haarbauer-Krupa JK, Bell JM, Corrigan JD, Hammond FM, Torbey MT, Hofmann MC, Dams-O’Connor K, Miller AC, Whiteneck GG. Acute ischemic stroke after moderate to severe traumatic brain injury: incidence and impact on outcome. Stroke. 2017;48(7):1802–9.

    Article  Google Scholar 

  • Kumar RG, Juengst SB, Wang Z, Dams-OʼConnor K, Dikmen SS, OʼNeil-Pirozzi TM, Dahdah MN, Hammond FM, Felix ER, Arenth PM, Wagner AK. Epidemiology of comorbid conditions among adults 50 years and older with traumatic brain injury. J Head Trauma Rehabil. 2018;33(1):15–24.

    Article  Google Scholar 

  • Lilley EJ, Williams KJ, Schneider EB, Hammouda K, Salim A, Haider AH, Cooper Z. Intensity of treatment, end-of-life care, and mortality for older patients with severe traumatic brain injury. J Trauma Acute Care Surg. 2016;80(6):998–1004.

    Article  Google Scholar 

  • Maas AI, Lingsma HF, Roozenbeek B. Predicting outcome after traumatic brain injury. Handb Clin Neurol. 2015;128:455–74.

    Article  Google Scholar 

  • Mak CH, Wong SK, Wong GK, Ng S, Wang KK, Lam PK, Poon WS. Traumatic brain injury in the elderly: is it as bad as we think? Curr Transl Geriatr Exp Gerontol Rep. 2012;1:171–8.

    Article  Google Scholar 

  • McCredie VA, Alali AS, Xiong W, Rubenfeld GD, Cuthbertson BH, Scales DC, Nathens AB. Timing of withdrawal of life-sustaining therapies in severe traumatic brain injury: impact on overall mortality. J Trauma Acute Care Surg. 2016;80(3):484–91.

    Article  Google Scholar 

  • Menzel JC. Depression in the elderly after traumatic brain injury: a systematic review. Brain Inj. 2008;22(5):375–80.

    Article  Google Scholar 

  • Mitra B, Cameron PA, Gabbe BJ, Rosenfeld JV, Kavar B. Management and hospital outcome of the severely head injured elderly patient. ANZ J Surg. 2008;78(7):588–92.

    Article  Google Scholar 

  • Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF, Miller BL, Guskiewicz KM, Berger MS, Kramer JH, Welsh-Bohmer KA. Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. J Neurosurg. 2016;124(2):511–26.

    Article  Google Scholar 

  • Robertsen A, Førde R, Skaga NO, Helseth E. Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian Regional Trauma Center. Scand J Trauma Resusc Emerg Med. 2017;25(1):44.

    Article  Google Scholar 

  • Souter MJ, Blissitt PA, Blosser S, Bonomo J, Greer D, Jichici D, Mahanes D, Marcolini EG, Miller C, Sangha K, Yeager S. Recommendations for the critical care management of devastating brain injury: prognostication, psychosocial, and ethical management: a position statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2015;23(1):4–13.

    Article  Google Scholar 

  • Taussky P, Hidalgo ET, Landolt H, Fandino J. Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma. World Neurosurg. 2012;78(3–4):306–11.

    Article  Google Scholar 

  • Uomoto JM. Older adults and neuropsychological rehabilitation following acquired brain injury. NeuroRehabilitation. 2008;23(5):415–24.

    Article  Google Scholar 

  • Yap SG, Chua KS. Rehabilitation outcomes in elderly patients with traumatic brain injury in Singapore. J Head Trauma Rehabil. 2008;23(3):158–63.

    Article  Google Scholar 

  • You W, Feng J, Tang Q, Cao J, Wang L, Lei J, Mao Q, Gao G, Jiang J. Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study. BMC Anesthesiol. 2016;16(1):35.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland

    Teemu Luoto

  2. Department of Emergency and Internal Medicine, Skåne University Hospital, Lund, Sweden

    Thoralph Ruge

  3. Department of Internal Medicine, Skåne University Hospital, Lund, Sweden

    Thoralph Ruge

  4. Department of Clinical Sciences, Lund University, Malmö, Sweden

    Thoralph Ruge

Authors
  1. Teemu Luoto
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  2. Thoralph Ruge
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Corresponding author

Correspondence to Teemu Luoto .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway

    Terje Sundstrøm

  2. Department of Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden

    Per-Olof Grände

  3. Department of Neurosurgery, Tampere University Hospital, Tampere, Finland

    Teemu Luoto

  4. Department of Neurosurgery, Odense University Hospital, Odense, Denmark

    Christina Rosenlund

  5. Department of Operation and Intensive Care, Halmstad Hospital, Halmstad, Sweden

    Johan Undén

  6. Department of Clinical Medicine K1, University of Bergen, Bergen, Norway

    Knut Gustav Wester

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Luoto, T., Ruge, T. (2020). Challenges in the Elderly. In: Sundstrøm, T., Grände, PO., Luoto, T., Rosenlund, C., Undén, J., Wester, K. (eds) Management of Severe Traumatic Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-39383-0_3

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  • DOI: https://doi.org/10.1007/978-3-030-39383-0_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-39382-3

  • Online ISBN: 978-3-030-39383-0

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