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Unique considerations in the assessment and management of traumatic brain injury in older adults

Depreitere, Bart ; Becker, Clemens ; Ganau, Mario ; Gardner, Raquel C. ; Younsi, Alexander ; Lagares, Alfonso ; Marklund, Niklas LU orcid ; Metaxa, Victoria ; Muehlschlegel, Susanne and Newcombe, Virginia F.J. , et al. (2025) In The Lancet Neurology 24(2). p.152-165
Abstract

The age-specific incidence of traumatic brain injury in older adults is rising in high-income countries, mainly due to an increase in the incidence of falls. The severity of traumatic brain injury in older adults can be underestimated because of a delay in the development of mass effect and symptoms of intracranial haemorrhage. Management and rehabilitation in older adults must consider comorbidities and frailty, the treatment of pre-existing disorders, the reduced potential for recovery, the likelihood of cognitive decline, and the avoidance of future falls. Older age is associated with worse outcomes after traumatic brain injury, but premorbid health is an important predictor and good outcomes are achievable. Although prognostication... (More)

The age-specific incidence of traumatic brain injury in older adults is rising in high-income countries, mainly due to an increase in the incidence of falls. The severity of traumatic brain injury in older adults can be underestimated because of a delay in the development of mass effect and symptoms of intracranial haemorrhage. Management and rehabilitation in older adults must consider comorbidities and frailty, the treatment of pre-existing disorders, the reduced potential for recovery, the likelihood of cognitive decline, and the avoidance of future falls. Older age is associated with worse outcomes after traumatic brain injury, but premorbid health is an important predictor and good outcomes are achievable. Although prognostication is uncertain, unsubstantiated nihilism (eg, early withdrawal decisions from the assumption that old age necessarily leads to poor outcomes) should be avoided. The absence of management recommendations for older adults highlights the need for stronger evidence to enhance prognostication. In the meantime, decision making should be multidisciplinary, transparent, personalised, and inclusive of patients and relatives.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet Neurology
volume
24
issue
2
pages
14 pages
publisher
Lancet Publishing Group
external identifiers
  • pmid:39862883
  • scopus:85215564902
ISSN
1474-4422
DOI
10.1016/S1474-4422(24)00454-X
language
English
LU publication?
yes
id
fbc5fb3e-d9a3-4cc7-ba55-3dfd3ba4d20a
date added to LUP
2025-04-02 13:15:15
date last changed
2025-04-30 14:24:17
@article{fbc5fb3e-d9a3-4cc7-ba55-3dfd3ba4d20a,
  abstract     = {{<p>The age-specific incidence of traumatic brain injury in older adults is rising in high-income countries, mainly due to an increase in the incidence of falls. The severity of traumatic brain injury in older adults can be underestimated because of a delay in the development of mass effect and symptoms of intracranial haemorrhage. Management and rehabilitation in older adults must consider comorbidities and frailty, the treatment of pre-existing disorders, the reduced potential for recovery, the likelihood of cognitive decline, and the avoidance of future falls. Older age is associated with worse outcomes after traumatic brain injury, but premorbid health is an important predictor and good outcomes are achievable. Although prognostication is uncertain, unsubstantiated nihilism (eg, early withdrawal decisions from the assumption that old age necessarily leads to poor outcomes) should be avoided. The absence of management recommendations for older adults highlights the need for stronger evidence to enhance prognostication. In the meantime, decision making should be multidisciplinary, transparent, personalised, and inclusive of patients and relatives.</p>}},
  author       = {{Depreitere, Bart and Becker, Clemens and Ganau, Mario and Gardner, Raquel C. and Younsi, Alexander and Lagares, Alfonso and Marklund, Niklas and Metaxa, Victoria and Muehlschlegel, Susanne and Newcombe, Virginia F.J. and Prisco, Lara and van der Jagt, Mathieu and van der Naalt, Joukje}},
  issn         = {{1474-4422}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{152--165}},
  publisher    = {{Lancet Publishing Group}},
  series       = {{The Lancet Neurology}},
  title        = {{Unique considerations in the assessment and management of traumatic brain injury in older adults}},
  url          = {{http://dx.doi.org/10.1016/S1474-4422(24)00454-X}},
  doi          = {{10.1016/S1474-4422(24)00454-X}},
  volume       = {{24}},
  year         = {{2025}},
}