Traumatic Brain Injury in the Elderly
As a result of demographic change, traumatic brain injury (TBI) in the elderly population is a difficulty which will occur increasingly. A report on the epidemiology of TBI and its pathophysiology (e.g., diffuse axonal injury) will give insight in the dev
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Verena Röckelein, Michael Buchfelder, and Andrea Kleindienst
19.1 Epidemiology and Pathology 19.1.1 Epidemiology Traumatic brain injury (TBI) is defined as a consequence of force exposure resulting in operational deterioration and/or brain damage as well as an optional contusion or trauma of the callosity, the cranium, the vessels, and/or the dura [1]. As postulated by the World Health Organization (WHO), by the year 2020, TBI might be the main cause of disability and death [2]. As demographic change directs to an increased life expectation, we therefore will also face an increasing number of TBI in the elderly (Fig. 19.1). Furthermore, due to physical changes in context of aging, this subgroup is more likely to sustain TBI. In fact, there is an association between age and TBI-related hospital admissions [3]. Referring to the United States, there are 1.4 million cases of TBI per year, of which 155, 000 patients are 65 years or older [4]. From a geographical point of view, moderate to severe forms of TBI are more common in the agrarian population than in urban environment [5]. A multiplicity of work groups all over the world, consisting of expert physicians and neurosurgeons, has established various more or less country-specific guidelines on the management of TBI [1, 6–11]. Unfortunately, these guidelines currently
V. Röckelein • M. Buchfelder, MD, PhD Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany e-mail: [email protected]; [email protected] A. Kleindienst, MD, PhD (*) Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany Department of Neurosurgery, Klinikum Amberg, Amberg, Germany e-mail: [email protected] © Springer International Publishing Switzerland 2017 M. Berhouma, P. Krolak-Salmon (eds.), Brain and Spine Surgery in the Elderly, DOI 10.1007/978-3-319-40232-1_19
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Fig. 19.1 Estimated number of future TBI patients >65 years based on data of a German University Department of Neurosurgery©
available do not provide recommendations that are validated for elderly TBI patients explicitly [1, 6–11]. In the following, the “elderly” patient is defined as being 65 years or older.
19.1.2 Main Causes of Traumatic Brain Injury A population-based study in New Zealand of 2013 revealed falls to be the most common mechanism for TBI (38 %), followed by mechanical forces (21 %), transport accidents (20 %), and assaults (17 %) [5]. Wee et al. from Singapore declare motor vehicle accidents (48.8 %) to be the main reason for TBI (48.8 %), followed by falls (42.5 %) [12]. Factors that result in fall injuries in patients aged 65 years and older are physical and behavioral conditions (73.4 %), medication (8.4 %), personal (7.6 %), environment (7.1 %), and equipment or facility (3.5 %) [13]. Another risk factor for falls in patients with oral anticoagulation is the existence of at least one comorbidity [14]. In In
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