Repetitive Traumatic Brain Injury Among Older Adults.
Aparna Vadlamani Chauhan, Jack Guralnik, Susan dosReis and 3 others
PMID 34320558WHAT IT FOUND
Older adults with a first head injury face a 3% annual risk of a second one.
Epilepsy, dementia, Parkinson's, depression, and atrial fibrillation significantly raise this risk. These factors should trigger aggressive fall prevention and close monitoring for further head trauma.
Key findings
01Of 38,064 older adults with an initial TBI, 4,562 (12%) sustained at least one subsequent TBI during follow-up.
02Epilepsy and Alzheimer's disease and related dementia were strong independent predictors of repetitive TBI, with relative risks of 1.44 and 1.32 respectively.
03The unadjusted incidence rate of repetitive TBI was 3,022 per 100,000 person-years.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used administrative claims data, which do not contain measures of TBI severity, and the proxy used was not validated. There is potential for misclassification if a subsequent visit was actually a follow-up for the initial injury rather than a new event, though a 90-day gap was used to mitigate this. The incidence rates did not account for TBI-related deaths, which may have affected the denominator. Results may not apply to Medicare Advantage beneficiaries, who were excluded from the analysis. The study design is observational, so it identifies associations but cannot prove that these comorbidities directly cause the repetitive injuries.
Declared interests
The study was supported by the National Institutes of Health and the Centers for Medicare and Medicaid Services. No other conflicts of interest were declared.
The easy way to misread this
Do not assume that treating the initial TBI resolves the risk. The 12% recurrence rate and specific predictors like epilepsy and dementia indicate that these patients remain at high risk for years, requiring ongoing vigilance rather than just acute care.