A study conducted by UC San Francisco and the San Francisco VA Health Care System found that 13% of older adults are diagnosed with traumatic brain injury (TBI), typically caused by falls from ground level. Contrary to studies of younger populations, the research showed that being female, white, healthier, and wealthier was associated with a higher risk of TBI. The study, published in JAMA Network Open, followed about 9,200 Medicare enrollees with an average age of 75 at the start of the study.
TBI can lead to various serious conditions such as dementia, Parkinson’s disease, seizures, cardiovascular disease, depression, and anxiety, even though it can be successfully treated. The study aimed to identify factors that made some patients more vulnerable than others during a follow-up period of up to 18 years. Senior author Dr. Raquel Gardner emphasized the need for evidence-based guidelines to inform post-discharge care of the large Medicare population with TBI, as well as more research on dementia prevention and repeat injury prevention in this group.
While previous TBI studies have shown that males, non-whites, and lower socio-economic status individuals were more likely to be diagnosed with TBI, this study revealed that females and whites were overrepresented among the participants with TBI. Participants with TBI were found to be more likely to be in the higher wealth quartile and have normal cognition. Healthier individuals may engage in activities that carry a higher risk of TBI, such as falls, hinting at the potentially limited opportunities for traumatic injuries in those with cognitive impairment or limited mobility.
The study suggested that the incidence of TBI in older adults may be underestimated, as the data only captured cases where patients sought medical attention. Previous research has shown that a significant portion of individuals with TBI do not seek care, particularly those who are older, lower-resourced, or experience racial and ethnic micro-aggressions in medical settings. This raises questions about the burden of TBI in these populations and the importance of optimizing safety measures to reduce falls, especially as physical activity is recommended to prevent dementia.
Despite the neuroprotective benefits of physical activity, optimizing safety to prevent falls is crucial, especially as individuals accumulate physical or cognitive disabilities over the life course. The study’s findings may prompt further research and policy discussions to improve post-discharge care for older adults with TBI, enhance dementia prevention strategies, and address disparities in seeking care for TBI among different populations. As the number of older adults with TBI remains high, evidence-based guidelines and interventions are needed to support this vulnerable population.