Older patients with traumatic brain injury don’t fare as well as their younger counterparts when it comes to outcomes after treatment, according to a recent study.
The research, “Traumatic Brain Injury in an Aging Population,” was conducted in Italy. The study was recently published in the Journal of Neurotrauma.
http://online.liebertpub.com/doi/full/10.1089/neu.2011.1995
“An aging population creates new challenges in TBI treatment,” the study says in it conclusion. “Patients admitted to the ICU are older, with co-morbidities, and with specific types of intracranial lesions. Early rescue, surgical treatment, and intensive care of these patients may produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39 percent of cases aged 60–69 years, without an excessive burden of severely disabled patients. Late mortality after ICU discharge calls for further investigation.”
The research followed 1,366 patients admitted to three neuro-ICUs, and 44 percent of the cases were 50 years of age or older. The general health of the older patients coming in was worse than the younger ones, which is no surprise.
“Some 604 patients had emergency removal of intracranial masses, with extradural hematomas more frequent in young cases and subdural hematomas more frequent in older patients,” according to an abstract of the study.
To gauge the outcomes, they were classified according to the Glasgow Outcome Scale (GOS) six months post-trauma, as favorable (GOS score 4–5), or unfavorable (GOS score 1–3).
The research found there were favorable outcomes for 50 percent of the patients, but the proportions of unfavorable outcomes grew higher with age.
“Mortality was the main cause of unfavorable outcomes six months after injury in older patients,” the abstract said. “Logistic regression analysis indicates that several parameters independently contributed to outcome, including the motor component of the Glasgow Coma Scale (GCS), pupils, CT findings, and early hypotension. Additionally, the odds ratios were very high for age and health status before TBI. Patients admitted to the ICU are increasingly older, have co-morbidities, and have specific types of intracranial lesions.”
In sum, the study determined that “early rescue, surgical treatment, and intensive care of these patients may produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39 percent of cases aged 60–69 years, without an excessive burden of severely disabled patients.”
If one reads the details of the study, it found that the proportion of unfavorable outcomes increased with age, as expected.
“Relatively few patients were left in a vegetative state, and the figures remained constant over the age groups; however, severe disability was 12 percent for those less than 60 years of age, but 18 percent for older patients,” the study said. “Mortality was the main cause of unfavorable outcomes six months after injury in older patients. Few patients younger than 50 years of age discharged alive from an ICU die in the following months, whereas the proportion of persons older than 50 who die after leaving the ICU is much higher.”
The study said, “It is likely that the combination of existing co-morbidities (e.g., diabetes and cardiac failure), with the long-term consequences of TBI (e.g., bed-ridden, inadequate nutrition, or recurrent infections), contributed to late mortality.”
According to the study, “The odds ratios are very high for age and health status before TBI: the probability of an unfavorable outcome for persons older than 59 years is six times that for younger patients. Pre-existing diseases cause approximately the same probability of unfavorable outcome.”
In addition to just suffering from more illness than those younger than them, older patients take prescription drugs that make them more vulnerable if they suffer a TBI.
“Medications such as anticoagulants and antiplatelet agents, frequently used in older persons, may worsen cerebral damage after trauma,” the study said. ” It remains to be established whether the worse outcome after TBI in the elderly is due mainly to concomitant diseases or to increased vulnerability of the central nervous system. Various series, however, indicate age as an independent predictor of worse outcome, after adjusting for covariates including co-existing diseases.”
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