Preexisting conditions in older adults with mild traumatic brain injuries

ABSTRACT

Objective

This study examined the prevalence of preexisting conditions that could affect premorbid brain health, cognition, and functional independence among older adults with mild traumatic brain injury (MTBI), and the relationship between preexisting conditions, injury characteristics, and emergency department (ED) discharge location (home versus continued care).

Methods

Older adults (N = 1,427; 55–104 years-old; 47.4% men) who underwent head computed tomography (CT) after acute head trauma were recruited from the ED. Researchers documented preexisting medical conditions retrospectively from hospital records.

Results

Multiple preexisting conditions increased in frequency with greater age, including circulatory and nervous system diseases and preexisting abnormalities on head CT. Psychiatric and substance use disorders (SUDs) decreased in frequency with greater age. Among participants with uncomplicated MTBI and GCS = 15, preexisting nervous system diseases and preexisting CT abnormalities were associated with higher odds of continued care for all participants, whereas psychiatric disorders and SUDs were only associated with higher odds of continued care among participants <70 years-old. Preexisting circulatory diseases, loss of consciousness, and amnesia were unassociated with discharge location.

Conclusions

Preexisting medical conditions that could affect brain and cognitive health occur commonly among older adults who sustain MTBIs. These conditions can confound research examining post-injury outcomes within this age group.

KEYWORDS:

• Brain concussion
• head injuries, closed
• aged
• computed tomography
• comorbidity

Acknowledgments

The authors thank research assistants Anne Simi and Marika Suopanki-Ervasti for their contribution to the data collection.

Disclosure statement

The authors have no conflicts of interest to report. Dr Luoto has received research funding from the Emil Aaltonen Foundation, the Maire Taponen Foundation, the Finnish Brain Foundation, and the Science Fund of the City of Tampere. Grant Iverson, Ph.D. has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He serves as a scientific advisor for BioDirection, Inc., Sway Operations, LLC, and Highmark, Inc. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and salary support as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Heinz Family Foundation, the Mooney-Reed Charitable Foundation, and the Spaulding Research Institute.

Additional information

Funding

This study was financially supported by the Finnish State Research Funding.