Standard assessment tools often miss long-term burden of concussion on older adults

By Ella Webster. This article was initially published in the 11/6/25 edition of our Concussion Update newsletter; please consider subscribing.

A recent systematic review by Lucas Tze Peng Tan and colleagues found that recovery after a mild traumatic brain injury (mTBI) is often incomplete and longer-lasting for older adults, with ongoing symptoms frequently missed by standard assessment tools. To better understand how recovery differs for older adults, the authors systematically reviewed studies examining physical, psychological, and cognitive outcomes in adults aged 65 and older following mTBI. Their review, published in European Geriatric Medicine, included 18 studies with a total of 3,549 participants. Those 18 studies reported that up to 66% of older adults had persistent impairments in activity and participation at six months post-injury. Approximately 24% experienced at least mild depression, and about 9% had moderate-to-severe anxiety. Cognitive recovery was varied, with ongoing deficits in processing speed, memory, and executive function. In these studies, global outcome measures, such as the Glasgow Outcome Scale–Extended, often fail to capture these domain-specific impairments.

The authors searched for publications in Medline/PubMed, Embase, and Cochrane Library through October 6, 2024, to select observational studies that reported recovery outcomes in adults 65 and older after mTBI. They assessed study quality using the QUIPS tool, a standardized framework used to assess risk of bias in prognostic studies (studies that examine the influence of specific predictive or risk factors on an outcome).

In older adults, “mild” TBI is not often truly mild. Many patients face prolonged and incomplete recovery across physical, cognitive, and psychological domains. Traditional outcome measures used by the studies in this systematic review may substantially underestimate this burden in the geriatric population. Future research should include adults 80 years and older, use multidimensional outcome measures tailored to geriatric cohorts, and extend follow-up beyond one year to guide more customised rehabilitation strategies.