TY - JOUR
T1 - Mild Traumatic Brain Injury in Older Adults
T2 - Recovery Course and Insights on Early Predictors of Outcome
AU - Thuss, Nikki S.
AU - Bittencourt, Mayra
AU - Balart-Sánchez, Sebastián A.
AU - Spikman, Jacoba M.
AU - Maurits, Natasha M.
AU - van der Naalt, Joukje
PY - 2024/12/6
Y1 - 2024/12/6
N2 - Mild traumatic brain injury (mTBI) is a growing health concern in the context of an aging population. Older adults comprise a distinct population, with an increased vulnerability for mTBI due to comorbid diseases and age-associated frailty compared with the adult population. The aim of this study was to assess the recovery course and determinants of outcome in a large cohort of older patients with mTBI. For this study, 154 patients aged ≥60 years with mTBI admitted to the Emergency Department were investigated in a prospective observational cohort (ReCONNECT study). Demographics and injury characteristics (computed tomography scan, Glasgow Coma Scale) were determined on admission. Early determinants of outcome were assessed at 2 weeks post-injury (e.g., early post-traumatic complaints and emotional distress) with validated questionnaires. Quality of life (QoL) was determined at 3 months with the World Health Organization Quality of Life Scale—Shortened Version. Functional outcome was determined at 3 (early) and 6 months (long term) post-injury with the Glasgow Outcome Scale Extended (GOSE). Logistic regression analyses identified predictors of outcome with dichotomized GOSE scores as dependent variable (incomplete recovery was defined by GOSE ≤ 7 and complete recovery by GOSE 8). Complete recovery was observed in 42% of patients at 3 months post-injury without significant sex differences. More early post-traumatic complaints were present in patients with incomplete recovery, compared with patients with complete recovery (p < 0.001). Scores on overall QoL, general health-related QoL and all subdomains were lower for patients with incomplete recovery compared with patients with complete recovery (p < 0.05). Incomplete recovery at 3 months post-injury was predicted by increased physical frailty and early post-traumatic complaints (Nagelkerke R2 = 0.25). At 6 months post-injury, 53% of patients had complete recovery with higher frequency in males (60%) compared with females (42%) (p = 0.025). None of the investigated variables significantly predicted long-term outcome at 6 months post-injury (Nagelkerke R2 = 0.14), which might be explained by the changing cohort characteristics over time due to age-related morbidity. Our results demonstrate that almost half of older patients with mTBI show complete recovery with complaints and physical frailty as predictors of outcome at 3 months post-injury. Recovery still improves after 3 months and further follow-up is necessary to identify other factors that are associated with long-term outcomes in this specific category of patients with mTBI. The recovery course in older patients with mTBI is dynamic and further research on factors associated with long-term outcomes in this specific patient population is imperative to enhance treatment strategies.
AB - Mild traumatic brain injury (mTBI) is a growing health concern in the context of an aging population. Older adults comprise a distinct population, with an increased vulnerability for mTBI due to comorbid diseases and age-associated frailty compared with the adult population. The aim of this study was to assess the recovery course and determinants of outcome in a large cohort of older patients with mTBI. For this study, 154 patients aged ≥60 years with mTBI admitted to the Emergency Department were investigated in a prospective observational cohort (ReCONNECT study). Demographics and injury characteristics (computed tomography scan, Glasgow Coma Scale) were determined on admission. Early determinants of outcome were assessed at 2 weeks post-injury (e.g., early post-traumatic complaints and emotional distress) with validated questionnaires. Quality of life (QoL) was determined at 3 months with the World Health Organization Quality of Life Scale—Shortened Version. Functional outcome was determined at 3 (early) and 6 months (long term) post-injury with the Glasgow Outcome Scale Extended (GOSE). Logistic regression analyses identified predictors of outcome with dichotomized GOSE scores as dependent variable (incomplete recovery was defined by GOSE ≤ 7 and complete recovery by GOSE 8). Complete recovery was observed in 42% of patients at 3 months post-injury without significant sex differences. More early post-traumatic complaints were present in patients with incomplete recovery, compared with patients with complete recovery (p < 0.001). Scores on overall QoL, general health-related QoL and all subdomains were lower for patients with incomplete recovery compared with patients with complete recovery (p < 0.05). Incomplete recovery at 3 months post-injury was predicted by increased physical frailty and early post-traumatic complaints (Nagelkerke R2 = 0.25). At 6 months post-injury, 53% of patients had complete recovery with higher frequency in males (60%) compared with females (42%) (p = 0.025). None of the investigated variables significantly predicted long-term outcome at 6 months post-injury (Nagelkerke R2 = 0.14), which might be explained by the changing cohort characteristics over time due to age-related morbidity. Our results demonstrate that almost half of older patients with mTBI show complete recovery with complaints and physical frailty as predictors of outcome at 3 months post-injury. Recovery still improves after 3 months and further follow-up is necessary to identify other factors that are associated with long-term outcomes in this specific category of patients with mTBI. The recovery course in older patients with mTBI is dynamic and further research on factors associated with long-term outcomes in this specific patient population is imperative to enhance treatment strategies.
KW - elderly
KW - mild traumatic brain injury
KW - older patients
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=85212249005&partnerID=8YFLogxK
U2 - 10.1089/neu.2024.0220
DO - 10.1089/neu.2024.0220
M3 - Article
C2 - 39639809
AN - SCOPUS:85212249005
SN - 0897-7151
JO - Journal of Neurotrauma
JF - Journal of Neurotrauma
ER -