Traumatic Brain Injury in Older Adults

Traumatic brain injury (TBI) is a major health problem for older adults, accounting for 80,000 emergency department visits yearly in people aged 65 years and older. More disconcertingly, older adults have universally worse outcomes for TBI than younger adults with the same or similar injury.

For many years, these outcomes have been chalked up to old age, which is unhelpful in devising specific treatments or prevention strategies for the disease.

Dr. Hilaire Thompson, a professor at the UW School of Nursing, is examining why TBI affects older adults differently and what older adults (and their families and caregivers) can do to prevent TBI. Initially Thompson thought that co-morbidities, or other existing medical conditions likely to be present in an older adult, would account for worse TBI outcomes. But her research showed that co-morbidities did not account for major differences.

“If co-morbidities couldn’t account for older adults’ poor TBI outcomes, I wondered if the issue was on the other side of the bed,” Thompson said. “Could provider bias be part of older adults’ worse TBI outcomes?”

Thompson authored a study that evaluated age’s role in intensity of care for TBI patients. The large, multi-hospital study found definitively that there is a lower intensity of care provided to older adults with TBI. Younger patients received a variety of interventions not provided to older patients, such as specialty care consultations. In fact, the study found that patients 75 to 84 years of age were almost 1.4 times as likely to die from the same severity of injury as a younger patient. While many factors may be at play in these findings, what care is provided could be playing a role.

Thompson said “One way to change this is to provide education regarding ageism in health care, and how stereotypes of older adults may influence provider decision-making and negatively impact outcomes.” As important, patients and their families can advocate for their injured family members by asking questions and being engaged in shared decision-making with clinicians so that they get the best treatment available.

Regardless of age, effective treatment of TBI is limited. The key, Thompson said, is preventing TBI. Falls, by an overwhelming majority, are the leading cause of TBI for adults over 65 years of age.

In Thompson’s study about co-morbiditites, one major correlation stood out: the link between alcohol abuse and TBI. One thing older adults can do to prevent TBI is to control their alcohol intake as aging effects the body’s ability to metabolize (or get rid of) it. The article specifically calls for screening and interventions to help prevent TBI in older adults who abuse alcohol.

Another way to prevent TBI is regular exercise.

“The best thing you can do is exercise,” Thompson said. “Exercise improves muscle tone, balance and coordination, all of which come into play preventing falls.”

However, exercise isn’t possible for some older adults.

To help older adults who can’t exercise but want to take an active role in preventing falls, Thompson and an interdisciplinary team at the UW have devised a computer-based training that could improve executive function and balance. They will be studying the program’s effectiveness in the coming year. This technology could supplement exercise and benefit older adults with barriers to exercise. The program is provided to participants in their home via the internet, and works by targeting brain activities associated with falls like response time.

What is it about aging that makes a head injury so much more devastating for older adults? Dr. Thompson is determined to find out—and has current funding from the National Institutes of Health for a major study comparing TBI in older adults and young adults. This study could lead to new insights about the disease, and recommendations for better treatment.