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Increasing age is a predictor of worse outcomes in traumatic brain injury(TBI). That is mainly due to a higher likelihood of bleeding in the brain, the presence of other chronic diseases, medication use, and diminished capacity for brain repair with age.

As the population ages in western countries, TBI resulting mainly from falls is on the rise among the elderly, according to an article in Journal of Neurotrauma.

"An aging population creates new challenges in TBI treatment. While younger patients were typically healthy, a larger proportion of older patients prior to TBI had chronic diseases causing serious or severe incapacitating restriction of activity," said the authors of the study.

Nino Stochetti and colleagues from University of Milan and San Raffaele Hospital, Milan, and San Gerardo Hospital, Monza, Italy, reported that one in five patients in a series of adult TBI cases was 70 years of age or older. The researchers describe a series of 1366 adult patients admitted to three neuro-ICUs in which 44% of cases were 50 years of age or older.

The health status before trauma was worse in older patients. In all 604 patients who were 50 years of age or older had emergency removal of intracranial masses, with extradural hematomas more frequent in young cases and subdural hematomas more frequent in older patients.

Age is also associated with co-morbidities, such as diabetes, hypertension, and chronic renal failure, which may worsen outcomes. Also, a high percentage of older people use medications which may worsen cerebral damage after trauma. The aged brain may be more vulnerable to TBI, with less plasticity and repair after injury. In addition, older people often present with alterations in cognition, memory, mood, and motor function, which can hamper rehabilitation after TBI.

The study concluded that early rescue, surgical treatment, and intensive care of these patients might produce excellent results up to the age of 59 years, with favorable outcomes still possible for 39% of cases aged 60-69 years, without an excessive burden of severely disabled patients.