Geriatric traumatic brain injury – What we know and what we don’t

The issue of geriatric trauma is a significant and growing concern among trauma surgeons. The outcomes of geriatric patients with traumatic brain injury are worse than younger cohorts and the number of traumatic brain injury (TBI)-related hospitalizations and fatalities in elderly patients will continue to increase as the world’s population ages. Although guidelines for the treatment of TBI have been established, they do not address the challenges of managing TBI in older patients. Issues of anticoagulation reversal, confounding of clinical exam by premorbid conditions, and optimal timing and frequency of imaging remain poorly studied. Additionally, current guidelines for optimal management of blood pressure, intracranial monitoring, cerebral perfusion pressure and operative management fail to address the unique concerns in the geriatric patient. Prognostication of acceptable outcomes in older patients with TBI is more challenging compared to younger cohorts and require early palliative care approaches targeted to the geriatric patient. Geriatric-specific research is sorely needed in nearly all aspects of TBI care. Given the paucity of data available, this non-systematic review seeks to outline the unique considerations of the geriatric patient with TBI and highlight what is currently unknown about the best way to care for elderly patients with TBI