6-Month Recovery after Mild Traumatic Brain Injury in Older Adults: A TRACK-GERI Study

Area of Science:

• Geriatric Traumatology
• Neuroscience
• Clinical Outcomes Research

Background:

• Older adults (≥65 years) represent a rapidly growing demographic affected by traumatic brain injury (TBI).
• Limited real-world data exists on 6-month functional outcomes for older adults following mild TBI (mTBI).

Purpose of the Study:

• To delineate 6-month functional outcomes in older adults post-mTBI, stratified by age and pre-injury cognitive status.
• To assess the efficacy of the Glasgow Outcome Scale-Extended (GOSE) as a clinical trial endpoint for geriatric mTBI.

Main Methods:

• A prospective cohort study involving older adults with mTBI at two U.S. trauma centers.
• Functional outcomes (GOSE) were evaluated at 2 weeks and 6 months, with inverse probability weighting to manage attrition bias.
• Comparison of GOSE changes with Activities of Daily Living (ADL) and Functional Activities Questionnaire (FAQ) using reliable change index.

Main Results:

• Among 253 mTBI participants (mean age 77.3 years), 14% died by 6 months; 73% achieved home independence (GOSE 5+), and 17% complete recovery (GOSE 8).
• Younger-old adults and those without pre-injury cognitive impairment demonstrated significantly better outcomes (e.g., lower mortality, higher home independence) compared to the oldest-old and those with pre-injury dementia.
• The GOSE captured more reliable change than ADL or FAQ, indicating its utility, though all measures assess complementary domains.

Conclusions:

• Favorable functional outcomes are common in younger, cognitively healthy older adults post-mTBI, but vulnerable subgroups face risks of chronic disability.
• The GOSE is effective for measuring meaningful change in this population, complemented by ADL and FAQ assessments.
• Findings highlight the need for age-specific prognostication and inclusive geriatric TBI research and clinical trial designs.