Summary: 13% of older adults are diagnosed with a traumatic brain injury (TBI), often due to a fall to ground level. The study found that wealthier, healthier and more active older adults have a higher risk of head injury, contrary to previous findings in younger populations. This research highlights the need for appropriate post-TBI care and preventative measures.
Highlights:
- 13% of older people are diagnosed with head trauma, often following a fall.
- Wealthier and healthier older adults are at higher risk of head injury.
- TBI can lead to serious illnesses like dementia and cardiovascular disease.
Source: UCSF
Some 13% of older adults are diagnosed with a traumatic brain injury (TBI), according to a study conducted by UC San Francisco and the San Francisco VA Health Care System. These injuries are usually caused by falls from the ground.
The researchers followed about 9,200 people enrolled in Medicare, whose average age was 75 at the start of the study, and found that unlike other studies of younger people, being being female, white, healthier, and wealthier was associated with a higher risk of head injury.
The study is published in Open JAMA Network on May 31, 2024.
The researchers, led by first author Erica Kornblith, PhD, of the UCSF Department of Psychiatry and the San Francisco VA Health Care System, tracked TBI Medicare claims of participants enrolled in the Health Study and retirement, a long-term study on a representative sample. older Americans.
Although head trauma can be treated successfully, these injuries increase the risk of developing a number of serious illnesses, including dementia, Parkinson’s disease and seizures, as well as cardiovascular disease and psychiatric disorders like depression and anxiety.
“The number of people 65 and older with head injuries is incredibly high,” said lead author Raquel Gardner, MD, formerly of the UCSF Department of Neurology and San Francisco Health Care System. Francisco VA.
“We need evidence-based guidelines to inform post-discharge care of this very large Medicare population, as well as more research on post-TBI dementia prevention and repeat injury prevention. »
The researchers sought to identify factors that made some patients more vulnerable than others, over a follow-up period of up to 18 years.
Previous studies of head injuries found that men, non-whites, and those from lower socioeconomic status were more likely to be diagnosed with head injuries. But the current study found that women and white people were overrepresented among the 1,148 participants with TBI.
While 58% of HRS participants were female and 84% were white, among those with traumatic brain injury the figures were 64% and 89%. Additionally, 31% of people with TBI were in the highest wealth quartile, while 22% were in the lowest quartile.
Activities of healthier older adults may put them at higher risk
Participants who were diagnosed with head injury were less likely, at the time of study enrollment, to have lung disease and to have difficulty with activities of daily living, such as bathing, walk and get out of bed. They were also more likely to have normal cognition.
“It is possible that our results reflect that adults who are healthier, wealthier and more active are more capable or more likely to engage in activities that carry TBI risk,” said Kornblith, who is also affiliated at the Weill Institute for Neuroscience at UCSF.
“Although most head injuries in older adults occur from falls to ground level, if you are wheelchair-bound or bedridden, you are not as likely to suffer traumatic injuries,” she said. added. “It is also possible that participants with cognitive impairment are more limited in their activities and are less likely to fall.”
But the results may mask the true incidence of injuries, since the data only reflects TBI cases in which patients were diagnosed and received care. A 2007 study found that 42% of respondents to an online survey had not sought medical attention after a head injury.
“We know that older adults who experience falls, the largest segment of Americans with traumatic brain injury, as well as low-resource adults – including those subject to racial and ethnic microaggressions in a setting medical – are less likely to seek care,” Kornblith said. said. “It is possible that our data did not capture the true burden of head injuries in this population.”
The study results could raise questions at a time when physical activity is vigorously recommended to reduce or slow the development of dementia.
“The overall evidence still overwhelmingly favors the neuroprotective nature of physical activity,” said Gardner, who now works at the Sheba Medical Center in Israel. “However, it is essential to take steps to optimize safety and mitigate falls. These measures should change over the lifespan, as an individual accumulates physical or cognitive disabilities, or both.
Co-authors: Kristine Yaffe, MD, of UCSF, the San Francisco VA Health Care System, and the Northern California Institute for Research and Education; Grisell Diaz-Ramirez and W. John Boscardin, PhD, of UCSF and the San Francisco VA Health System.
Funding: Alzheimer’s Association Fellowship 21-851520 and U.S. Department of Veterans Affairs Career Development Grant 1 IK2 RX003073-01A2, National Institute on Aging Grant R35 AG071916, Grant W81XWH-18-PH/TBIRP-LIMBIC I01CX002096 from VA/Department of Defense and National Institute on Aging grant R01 NS110944.
Disclosures: Yaffe received grant funding from the U.S. Department of Defense during the study.
About this research news on TBI and aging
Author: Suzanne Leigh
Source: UCSF
Contact: Suzanne Leigh – UCSF
Picture: Image is credited to Neuroscience News
Original research: Free access.
“Incidence of head injuries in a longitudinal cohort of older adults” by Erica Kornblith et al. Open JAMA Network
Abstract
Incidence of head injuries in a longitudinal cohort of older adults
Importance
Traumatic brain injuries (TBI) occur at a higher rate in older adults and increase the risk of cognitive impairment and dementia.
Goals
Update existing TBI surveillance data to capture non-hospital settings and explore how social determinants of health (SDOH) are associated with TBI incidence in older adults.
Design, setting and participants
This nationally representative longitudinal cohort study evaluated participants over 18 years, from August 2000 to December 2018, using Health and Retirement Study (HRS) data and dates of Medicare claims. Analyzes were conducted from August 9 to December 12, 2022. Participants were aged 65 years or older in the HRS with Medicare-linked survey data without head injury prior to HRS enrollment. They were residing in the community at the time of enrollment, but were retained in HRS if they were subsequently institutionalized.
Exhibitions
Basic demographic, cognitive, medical, and SDOH information from HRS.
Main results and measures
Incident
TBI was defined using inpatients and outpatients International Classification of Diseasess, Ninth Or Tenth revision, diagnosis codes received on the same day or within one day as the emergency department (ED) visit code and computed tomography (CT) or magnetic resonance imaging (MRI) code, after the baseline HRS interview. A cohort with TBI codes but without emergency department visits or CT or MRI scans was derived to capture out-of-hospital diagnoses.
Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sampling weights. Fine-Gray regression models estimated associations between covariates and head injury, with death as a competing risk. Imputation taking into account the results and the complex survey design was carried out according to race and ethnicity, sex, education level and percentiles 1, 50 and 100 of the index of regional deprivation. The other exposure variables were set at their weighted average.
Results
Of the 9,239 eligible respondents, 5,258 (57.7%) were female and 1,210 (9.1%) were black, 574 (4.7%) were Hispanic, and 7,297 (84.4%) were white .
The mean (SD) age at baseline was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received a diagnosis of incident TBI with an emergency room visit and a same-day CT code, 964 (10.2%) received a incident TBI diagnosis and an ED code, and 1,148 (12.9%) received a TBI code with or without an ED visit and CT scan code.
Compared to respondents without incident head injury, respondents with head injury were more likely to be female (absolute difference, 7.0 (95% CI, 3.3-10.8); P.< 0.001) and White (absolute difference, 5.1 (95% CI, 2.8-7.4); P.< 0.001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 (95% CI, 2.8-9.3); P.= 0.001), higher education (absolute difference, 3.8 (95% CI, 0.9-6.7); P.< 0.001) and wealth (absolute difference, 6.5 (95% CI, 2.3-10.7); P.= 0.01) and be free of lung disease at baseline (absolute difference, 5.1 (95% CI, 3.0-7.2); P.< 0.001) or functional impairment (absolute difference, 3.3 (95% CI, 0.4-6.1); P.= 0.03).
In multivariate adjusted models, lower education level (subdistribution hazard ratio (SHR), 0.73 (95% CI, 0.57-0.94); P.= 0.01), black race (SHR, 0.61 (95% CI, 0.46-0.80); P.< 0.001), national ranking of area deprivation index (SHR 1.00 (95% CI 0.99-1.00); P.= 0.009) and male (SHR, 0.73 (95% CI, 0.56-0.94); P.= 0.02) were associated with belonging to the non-TBI group. Sensitivity analyzes using a broader definition of TBI yielded similar results.
Conclusions and relevance
In this longitudinal cohort study of older adults, nearly 13% experienced incident head injury during the 18-year study period. For older adults seeking care for head injury, race and ethnicity, gender, and SDOH factors may be associated with incidence of head injury, seeking medical care for head injury adulthood, or both.