The elderly population is the fastest-growing age group in the United States, and the number of people older than 65 years old is expected to reach 90 million by 2050. As a result, health care systems are preparing for a massive influx of diseases and conditions associated with old age, including traumatic brain injury (TBI). Elderly people are the second-most likely age group to sustain a TBI, typically due to high incidence of fall-related injuries among this population. Compared to other age groups, elderly people also suffer the worst outcomes after TBI, usually because their injuries are more severe, they typically suffer from other health comorbidities, and they are more likely to take multiple medications that can inhibit the treatment and recovery process. Given the significant health care implications of these upcoming demographic changes, health care providers are highly motivated to better understand the risk factors and outcomes associated with TBI in old age.
A team of researchers conducted a study of treatment outcomes and mortality among elderly people with TBI. They were particularly interested in the role of age-related treatment bias, which occurs when physicians unconsciously or unintentionally treat older patients differently than their younger patients, typically leading to reduced quality of treatments and services among older age groups. This study aimed to determine if age-related treatment bias plays a role in management intensity after TBI, which is the type and intensiveness of various treatment components for a health condition. For TBI, high management intensity typically involves intracranial pressure (ICP) monitoring, ventilator treatment, and neurosurgery. The researchers wanted to know if older adults were more or less likely to receive intensive management for TBI and how this management may affect their long-term health outcomes.
The research team used the Oslo TBI Registry of Neurosurgery to study medical records from 1,571 adults who sustained a TBI between 2015 and 2018, gathering patient age, injury severity, and management intensity. After analyzing the data, they determined that:
- Elderly patients (older than 65 years) were more likely to die of their injuries within 30 days of TBI.
- People who received low management intensity were more likely to die of their injuries.
- Elderly patients were less likely to receive intensive management, regardless of TBI severity.
Based on these findings, the researchers suggest that poor outcomes among elderly patients may be due in part to unconscious treatment biases. They hypothesized that physicians may unwittingly create a self-fulfilling prophecy; that is, they are predisposed to believe that elderly patients will have poor outcomes irrespective of treatment, so they choose less intensive management options, in turn leading to poorer outcomes among elderly people. Accordingly, the researchers encouraged physicians to reflect on and remain aware of their potential age-related biases, and to consider that elderly patients’ outcomes may improve with more aggressive TBI management regimens.
Skaansar O, Tverdal C, Rønning PA, et al. Traumatic brain injury: The effects of patient age on treatment intensity and mortality. BMC Neurology. (October 2020).