Older adults with traumatic brain injuries – epidemiology, management and outcomes from a Level 1 Trauma Centre

Abstract Background Traumatic brain injury (TBI) is increasingly prevalent in older adults, with high rates of emergency department visits, hospitalisations, and mortality. These outcomes often lead to assumptions of futility and treatment inertia. However, many older patients benefit from active management and rehabilitation. Barriers to optimal care include under-representation of older adults in TBI research and the absence of evidence-based geriatric TBI guidelines. This study aimed to examine the epidemiology, management, and outcomes of TBI in adults over 75 at a major trauma centre. Methods Data was collected on all patients aged >75 admitted with TBI between June 2023 and December 2024. Results During this eighteen months, ninety-two patients met inclusion criteria, the mean age was 84 years old. There were 42 females and 50 males; 36 had suffered a polytrauma. The most common mechanism of injury was a fall from standing height (N=47), followed by a fall down the stairs (N=16), road traffic accidents (N=4), one fall from a window, and one animal trampling. The average hospital stay was 14 days. Of these patients, 38 were discharged home, 16 to rehabilitation, 6 to long-term care, and 11 transferred back to the referring hospital. In-hospital mortality was 21% (N=19). Thirteen patients underwent surgery, while 79 were managed conservatively. Only 60% (N=46) received a falls assessment. Of those who survived the initial injury, 20% (N=14) died within one year, resulting in an overall one-year mortality rate of 36%. Conclusion Older adults with TBI represent a vulnerable and high-risk group with significant mortality, a mortality higher than hip fractures. Despite this, care gaps remain—particularly in post-injury falls assessment. Addressing these gaps through the development of geriatric-focused trauma pathways and specialised care models is essential for improving outcomes in this growing patient population.