Trauma and the Elderly

Elderly people who are aged 60 years or greater have been found to have an increase in mortality following an isolated traumatic brain injury or TBI. The prognosis, on the other hand, of those that survive their injuries has not been studied. In one research study, people studied this issue believing that elderly patients would have the same decreased level of functioning when compared to those who didn’t suffer a TBI. They used a head abbreviated injury scale to score the patients’ functioning upon discharge from the hospital and at 6 months post-hospitalization.

A total of 235 patients were enrolled with 44 found to be 65 years or older. The mechanisms of energy were many and included assaults, falls, motor vehicle collisions, pedestrian accidents and other types of injury. Falls were more common in the elderly population than among younger people. The average Glasgow Coma Scale score was 12.8. Older patients had a Glasgow coma scale that was greater at 14.1 when compared to younger patients, who had an average Glasgow coma scale of 12.5. Equal numbers of patients went to the intensive care unit or needed the services of a neurosurgeon.

Outcome measures were determined on those elderly people who had a Glasgow coma scale of between 13 and 15. More of the elderly were discharged to rehabilitation facilities. The mean FIM score was 10.4 for the elderly versus 11.4 in young people. A total of 68 percent of the elderly were discharged with total recovery and 89 percent of young people were discharged with total recovery.

At 6 months after the injury, the difference was narrowed but the mean Functional Independence Measure, or FIM score was still better for the young people when compared to older people. The researchers concluded that both the elderly and the young were discharged in generally good to excellent health. Older patients took longer to get better and were in the hospital and rehabilitation centers for longer. The FIM scale of the elderly was statistically different when compared to the younger population but the difference was actually quite small and reflected only small differences in functionality between the two populations.

It was clear that there were measurable improvements in the functional status of both groups during the first six months. What this means is that there is a very good correlation between those getting better and those who received intensive physical therapy during the first six months following their injury. This holds true for both the elderly and the young. Efforts should also be made to keep these patients alive following their injury, even though their Glasgow coma scale is low. The patients should be aggressively treated for their traumatic brain injury and follow up on their functionality should go up to 12 months to assure that the maximum level of functionality is achieved.

The elderly tend to do more poorly than the young person but not so poorly that they shouldn’t be managed in similar ways to young people. In the end, the differences in functionality are small and the elderly have a good chance of returning to near normal levels.

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