Elsevier

Injury

Volume 43, Issue 11, November 2012, Pages 1821-1826
Injury

Traumatic brain injury in older adults: characteristics, causes and consequences

https://doi.org/10.1016/j.injury.2012.07.188Get rights and content

Abstract

Introduction

Traumatic brain injury is of particular concern in the older population. We aimed to examine the trends in hospitalisations, causes and consequences of TBI in older adults in New South Wales, Australia.

Methods

TBI cases from 1 July 1998 to 30 June 2011 were identified from hospitalisation data for all public and private hospitals in NSW. Direct aged standardised admission rates were calculated. Negative binomial regression modelling was used to examine the statistical significance of changes in trend over time.

Results

There were 12,564 hospitalisations for TBI over the 13 year study period. Hospitalisation rates for TBI among the older population increased by 7.2% (95% CI 6.4–8.0, p < .0001) per year from 19.3/100,000 to 72.2/100,000. Males had a consistently higher hospitalisation rate. Just under one third of all hospitalisations were for adults aged 85 years and over. Traumatic subdural haemorrhage (42.9%), concussive injury (24.1%) and traumatic subarachnoid haemorrhage (12.7%) were the most common type of injury. Falls were the most common cause of TBI (82.9%). Rates of fall-related TBI increased by 8.4% (95% CI 7.5–9.3, p < .001) per year, whilst non-fall related head injury increased by 2.1% (95% CI 0.9–3.3, p < .0001) per year. The majority of falls were as a result of a fall on the same level and occurred at home. 13% of hospitalisations resulted in death, and the majority occurred in those who sustained a traumatic subdural haemorrhage.

Conclusions

The rapid increase in hospitalised TBI is being predominantly driven by falls in the oldest old and the greatest increase predominantly in intracranial haemorrhages, highlighting the need for future research to quantify the risk versus benefit of anticoagulant therapies.

Introduction

Traumatic brain injury (TBI) is an important cause of injury-related hospitalisation, disability, and death worldwide. It is of particular concern in the older population as functional recovery following an acute insult to the brain is often limited and can signal the end of independent living.1, 2

A review of all age groups in Australia reported that hospitalisation rates for all cause TBI remained stable from 1999 to 2005; with 22,700 hospitalisations in 2004/2005.3 However, more recent data suggests significant increases in the rate of hospitalisation for fall-related traumatic head injury, that is both fracture and non-fracture injuries, in older adults in the Australian setting4, 5 and internationally.6, 7, 8, 9

In light of the differing reported patterns of TBI with time, and in the context of the national falls guidelines10 and a state wide falls prevention plan,11 we undertook a study aimed to examine the trends in hospitalisations, causes and consequences for all causes of TBI in older adults in New South Wales (NSW) Australia.

Section snippets

Methods

Hospitalisations for adults aged 65 years and older who received inpatient care for a traumatic brain injury at a public or private hospital in New South Wales (NSW), Australia, between 1 July 1998 and 30 June 2011, were identified from the NSW Admitted Patient Data Collection (APDC).

TBI cases were selected using a principal diagnosis of ‘intracranial injury’ (ICD-10-AM: S06)12 and the type of TBI classified using the 4th character level of the ICD-10-AM coding. Only principal diagnosis codes

All TBI aged 65 years and older

Over the 13 year period, there were 12,564 hospitalisations for traumatic brain injury in persons 65 years and older. Of these 6356 (50.6%) were male. There was a higher proportion of males than females aged 55–79 years admitted to hospital, from 80 years and older there were more admissions for females than males. There has been a 214% increase in the annual number of hospitalisations over the study period, from 523 in 1998/99 to 1644 in 2010/11.

The age-standardised hospitalisation rate for

Discussion

To our knowledge this is the first population-based study to look specifically at the causes, circumstances and consequences of TBI in older people over time and by age group in the Australian setting. It provides evidence that there has been a rapid increase in both the number of hospitalisations and age-standardised hospitalisation rates for TBI in older adults in NSW over the last 13 years. This increase cannot be explained by the ageing of the NSW population alone which increased by 29%

Conclusion

This study provides evidence of a dramatic increase number and rates of hospitalisations for traumatic brain injury in NSW over the past decade. The observed increase is being driven predominantly by falls in the oldest old including a disproportionate number from residential aged care facilities. The greatest increase in injury type is in intracranial haemorrhages. More research is required to better understand why we are seeing this change over time and particularly to look at the potential

Conflict of interest statement

There were no conflicts of interest.

Acknowledgements

Lara Harvey was supported by the NSW Ministry of Health. We thank the Centre for Epidemiology and Research at the NSW Ministry of Health for providing the APCD data from the Health Outcomes and Information Statistical Toolkit (HOIST) analysed in this study. The HOIST system refers to a data access, analysis and reporting facility established and operated by the Centre for Epidemiology and Research, Population Health Division, NSW Ministry of Health.

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