Another research barrier is that frail older adults may be unable to complete outcome assessments. This has been overcome in other lines of geriatric research through reliance on proxy informants and study partners. Older adults with TBI are likely to have an informant (eg, spouse, care giver) and a similar approach could be utilized.
Although a relatively new focus in all types of research, innovative follow-up methods, such as home and telemedicine visits, have the potential to increase follow-up rates and generalizability of results. Older adults with TBI may have physical disabilities, perhaps even from the same fall that led to TBI, and this makes involvement in research studies even more difficult. Only by combining methods commonly used in geriatric research with those already used in TBI studies can the research community achieve generalizability to real-world older adults with TBI, develop better diagnostic and prognostic tools to guide care, design inclusive trials, and optimize outcomes.
Working with older adults with TBI is extremely rewarding and is a critical area of study that will become more important as the population ages. That being said, many providers don’t know where to begin or how to unpack the multitude of medical comorbidities existing alongside the TBI. Also, many individuals with new onset TBI will have a history of remote TBI and it can be challenging to ascertain how these histories interrelate. As a result, it is important to distinguish an individual aging with a TBI versus an individual with a new onset TBI later in life. Add to that the variability that occurs with “normal” aging, and the possibility that a neurodegenerative process may develop, and it’s understandable that this population is viewed as daunting by many.
Clinical endeavors, such as comprehensive, multidisciplinary fall and TBI clinics, are invaluable and increasing in number. Geriatric research, particularly on Alzheimer disease and related dementias, has an extensive track record and application of similar techniques to research on older adults with TBI will help move the field forward.
Older adults with TBI deserve the same advocacy and focused study, as sports- and military-related TBI. As individualized medicine and precision medicine continue to be heralded as the path forward, a “one-size-fits-all” approach to the conceptualization, diagnosis, and management of TBI in older adults will be viewed as increasingly antiquated and unacceptable.
Dr Narapareddy is a Neuropsychiatry Fellow, Ms Richey is Research Coordinator, and Dr Peters is Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
The authors report no conflicts of interest concerning the subject matter of this article.
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