Survival of Older Adults with TBI Influenced More by Injury Than Age

April 19, 2022

April 19, 2022
Contact: Ellen Mullally

In recent years, the incidence of traumatic-brain injury (TBI)-related emergency department visits, hospitalizations, and deaths has increased among older adults. According to a new study published in the April issue of JAMDA, survival and other issues after a TBI in older adults were influenced more by severity of injury rather than age itself.

In Traumatic Brain Injury in Older Adults: Characteristics, Outcomes and Considerations: Results from the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial, the authors found that of 2,028 patients >65 years of age, 339 presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score of <9 was the main predictor of mortality. CT worsening, cerebral edema on initial imaging, GCS <9, and older age (>75) were identified as predictors of receipt of palliative interventions. An Injury Severity Score (ISS) of <24 was associated with a favorable outcome and a higher likelihood of discharge to pre-injury residence.

“Increasing age did not influence overall mortality rate; in fact, there was a trend toward decreased mortality in the oldest-old age group,” the authors said. “Our results differ from previous reports, possibly due to the fact that our cohort of older adults is a ‘pure TBI’ group with minimal injury to other organ systems.”

The utilization of palliative care in trauma centers remains variable across the nation, the authors observed. In the JAMDA study, the prevalence of palliative intervention in the moderate/severe TBI group was 58-72%, significantly higher than the national rate of about 35%. The authors said that their study was able to identify predictors of receipt of palliative interventions in older adults. These include older-old age (≥75), cerebral edema on initial CT scan, and intracranial lesion worsening on repeat imaging in the first 72 hours post-admission. At the same time, the authors noted, there appears to be a subset of oldest-old adults who attain a favorable recovery even in instances of significant TBI.

The study was conducted by researchers at the R. Adamas Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD; Department of Trauma Services, Inova Fairfax Medical Campus, Falls Church, VA; Department of Surgery, Ascension Via Christi Hospital, Wichita, KS; Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, University of Kansas Medical Center, Kansas City, KS; and several others.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.