Survival is low among elderly people with intracranial bleeding as a result of traumatic brain injury

Man Fallen After Injury

Traumatic brain injury (TBI) is a common cause of death and disability across all age groups in the United States. People older than 65 years are at particularly high risk of sustaining TBI as a result of fall accidents. Despite health care innovations for treating the complications associated with these injuries, in-hospital mortality among older people with TBI is estimated as high as 13%. As a result, clinicians are motivated to discover new approaches for improving survival and long-term outcomes among older patients with TBI, who are at significantly higher risk than younger patients of dying in the days, weeks, and months following a TBI.

A recent study contributed to this effort by investigating health outcomes in two groups of older patients with TBI. One group consisted of 100 elderly patients (70 to 79 years) and the other consisted of 100 “very elderly” patients (80 years and older) who experienced intracranial bleeding, one of the most common complications associated with head injuries. Researchers already know that elderly patients have poor outcomes compared to young patients, so they were interested to know if outcomes differed between the elderly and the very elderly. After analyzing hospital records from each group of TBI patients, the research team found that:

  • In-hospital mortality was 9% among patients aged 70 to 79 years and 21% among those older than 80.
  • Significantly more (73%) of the younger patients survived for at least 12 months after injury than the older patients (63%).
  • Among patients with severe TBI, the oldest group of patients had the poorest outcomes. All severely injured patients older than 80 years died in the hospital, compared to only 41% of severely injured patients aged 70 to 79 years.
  • All of the elderly patients who survived severe injuries had functional impairments, including cognitive, physical, and neurological deficits.

Fortunately, these findings suggest that survival rates among patients older than 70 are significantly higher than they were in the past—a testament to rapidly evolving clinical interventions for TBI among high-risk patients. However, geriatric patients remain at significantly higher risk of mortality and long-term negative outcomes than younger patients, indicating that older patients may require specialized health care approaches to address fall-related TBI.

Solomon D, Kaminski O, Schrier I, et al. Isolated traumatic brain injury in the very old. Israel Medical Association Journal. (December 2019).

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