Traumatic brain injury (TBI) and mortality in older adults with and without pre-injury dementia
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Incidence of traumatic brain injury (TBI) is rising in older adults. Dementia is a common comorbidity and may worsen post-TBI outcomes, but its effects
have not been studied.
Objective: To compare all-cause mortality following TBI or non-TBI trauma (NTT) and quantify the impacts of age, deprivation, and dementia.
Design: Population-based retrospective cohort study
Setting: Linked primary and secondary care electronic health records (EHRs) from the Secure Anonymised Information Linkage (SAIL) Databank
Subjects: Adult residents in Wales aged 18-100 with hospitalised TBI or NTT recorded between January 2000-December 2022.
Methods: Cox proportional hazard models were used to estimate survival within 1, 6, and 12 months of hospitalised TBI/NTT in those with and without pre-injury dementia diagnosis. Groups were propensity-matched by age, sex, and morbidities. Models were stratified by age, sex, and deprivation.
Results: 23,428 TBIs (n=18,940) and 589,169 NTTs (n=421,259) were identified. TBIs were associated with higher mortality than NTT at all timepoints. Older age was associated with higher mortality after TBI, with 16.9% one-month mortality in patients aged 65-79, and 31% in patients aged 80-100.
In TBI patients, 30-day mortality was significant irrespective of dementia. 6- and 12-month mortality were higher in those with than without pre-injury dementia diagnosis.
Conclusions: TBI is associated with higher all-cause mortality than NTT, particularly in older age. Among those with TBI, patients with pre-injury dementia had particularly high chronic mortality. There is an urgent need to understand the reasons for poor outcomes in older adult TBI populations, especially those with dementia.
have not been studied.
Objective: To compare all-cause mortality following TBI or non-TBI trauma (NTT) and quantify the impacts of age, deprivation, and dementia.
Design: Population-based retrospective cohort study
Setting: Linked primary and secondary care electronic health records (EHRs) from the Secure Anonymised Information Linkage (SAIL) Databank
Subjects: Adult residents in Wales aged 18-100 with hospitalised TBI or NTT recorded between January 2000-December 2022.
Methods: Cox proportional hazard models were used to estimate survival within 1, 6, and 12 months of hospitalised TBI/NTT in those with and without pre-injury dementia diagnosis. Groups were propensity-matched by age, sex, and morbidities. Models were stratified by age, sex, and deprivation.
Results: 23,428 TBIs (n=18,940) and 589,169 NTTs (n=421,259) were identified. TBIs were associated with higher mortality than NTT at all timepoints. Older age was associated with higher mortality after TBI, with 16.9% one-month mortality in patients aged 65-79, and 31% in patients aged 80-100.
In TBI patients, 30-day mortality was significant irrespective of dementia. 6- and 12-month mortality were higher in those with than without pre-injury dementia diagnosis.
Conclusions: TBI is associated with higher all-cause mortality than NTT, particularly in older age. Among those with TBI, patients with pre-injury dementia had particularly high chronic mortality. There is an urgent need to understand the reasons for poor outcomes in older adult TBI populations, especially those with dementia.
Date Issued
2025-12-04
Date Acceptance
2025-10-24
Citation
Age and Ageing, 2025, 54 (12)
ISSN
0002-0729
Publisher
Oxford University Press
Journal / Book Title
Age and Ageing
Volume
54
Issue
12
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
Identifier
10.1093/ageing/afaf341
Subjects
traumatic brain injury
trauma
falls
dementia
all-cause mortality
older people
Publication Status
Published
Article Number
ARTN afaf341