Study finds 1 in 8 older Americans suffered a TBI in a representative cohort
By Gabriel Marotti. This article was initially published in the 7/18/24 edition of our Concussion Update newsletter; please consider subscribing.
In a longitudinal study published in JAMA Network Open, researchers discovered that over 18 years, 13% of older Americans suffered a traumatic brain injury (TBI). Researchers Erica Kornblith et al. measured the incidence of TBI over an 18-year period (August 2000 to December 2018) in 9239 community-dwelling seniors who were enrolled in the Health and Retirement Study (HRS) and had linked Medicare data. Although existing literature suggests that males, non-whites, and people with lower socio-economic status may be more likely to be diagnosed with TBI, this study found an “increased rate of TBI was associated with healthy, wealthy, White female individuals.”
In a UCSF press release, journalist Suzanne Leigh notes the TBIs in this study typically occurred due to “falls from ground level.” Further, the activity levels of older adults who are at higher risk of sustaining a TBI may be higher than average, as subjects “who went on to be diagnosed with TBI were less likely when they enrolled in the study to have lung disease and to have trouble with the activities of daily living, like bathing, walking and getting out of bed.” This finding suggests that individuals in the study who sustained a TBI had the ability to carry out basic dynamic movements that some older adults may not be able to do. In the press release, lead author Kornblith notes, “It’s possible that our findings reflect that adults who are healthier, wealthier and more active are more able or likely to engage in activities that carry risk for TBI.” Leigh points out that while physical activity is neuroprotective and may “reduce or slow the development of dementia,” a TBI in an elderly person increases the likelihood of dementia, Parkinson’s, seizures, cardiovascular disease, anxiety, and depression.
The study authors collected Medicare data for two older adult cohorts who were coded for a TBI diagnosis: those who had gone to an emergency department (ED) and had received an MRI or CT scan and those who had gone to a “nonhospital setting,” presumably an outpatient clinic or provider. Further research must be conducted to identify groups that may not have the means to seek medical attention for TBI diagnosis and care. The researchers identify that “lower resourced” and marginalized communities tend to distrust medical care in part because of “the racial and ethnic microaggressions that commonly occur in the medical setting.” People from these communities may be less likely to seek medical care and, subsequently, not receive an official TBI diagnosis. The study authors also add that “older adults who experience falls, the largest segment of US citizens experiencing incident TBI, are also the least likely to seek care.” Hence, the nonreporting by these populations may have played a role in the outcomes of this study. Journalist Suzanne Leigh reinforces the need to identify populations who do not seek medical care for a TBI and how best to provide for them. While the current study’s findings are profound, further research must be conducted on populations that may not have been accounted for in this cohort.
