Depreitere Bart, Becker Clemens, Ganau Mario, Gardner Raquel C, Younsi Alexander, Lagares Alfonso, Marklund Niklas, Metaxa Victoria, Muehlschlegel Susanne, Newcombe Virginia F J, Prisco Lara, van der Jagt Mathieu, van der Naalt Joukje
Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
Digital Geriatric Medicine, Medical Clinic, Heidelberg University, Heidelberg, Germany.
Lancet Neurol. 2025 Feb;24(2):152-165. doi: 10.1016/S1474-4422(24)00454-X.
The age-specific incidence of traumatic brain injury in older adults is rising in high-income countries, mainly due to an increase in the incidence of falls. The severity of traumatic brain injury in older adults can be underestimated because of a delay in the development of mass effect and symptoms of intracranial haemorrhage. Management and rehabilitation in older adults must consider comorbidities and frailty, the treatment of pre-existing disorders, the reduced potential for recovery, the likelihood of cognitive decline, and the avoidance of future falls. Older age is associated with worse outcomes after traumatic brain injury, but premorbid health is an important predictor and good outcomes are achievable. Although prognostication is uncertain, unsubstantiated nihilism (eg, early withdrawal decisions from the assumption that old age necessarily leads to poor outcomes) should be avoided. The absence of management recommendations for older adults highlights the need for stronger evidence to enhance prognostication. In the meantime, decision making should be multidisciplinary, transparent, personalised, and inclusive of patients and relatives.
在高收入国家，老年人创伤性脑损伤的年龄特异性发病率正在上升，主要原因是跌倒发生率增加。由于颅内出血的占位效应和症状发展延迟，老年人创伤性脑损伤的严重程度可能被低估。老年人的管理和康复必须考虑合并症和虚弱状况、既往疾病的治疗、恢复潜力降低、认知衰退的可能性以及避免未来跌倒。年龄较大与创伤性脑损伤后较差的预后相关，但病前健康状况是一个重要的预测因素，良好的预后是可以实现的。尽管预后不确定，但应避免无根据的虚无主义（例如，基于老年必然导致不良预后的假设而过早做出放弃治疗的决定）。缺乏针对老年人的管理建议凸显了需要更有力的证据来改善预后。与此同时，决策应是多学科的、透明的、个性化的，并应让患者及其亲属参与其中。
