Older adults admitted to intensive care with traumatic brain injury experience inferior mobility outcomes: a service evaluation

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Fiona Howroyd 1 2, James Hodson 1, Niharika A Duggal 2, Zubair Ahmed 1 2, Jonathan Weblin 1

1 University Hospitals Birmingham NHS Foundation Trust, 2 Department of Inflammation and Ageing, University of Birmingham

Clinical Quality

CQ - Patient Centredness

Major Trauma

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Abstract

Introduction

The incidence of traumatic brain injury (TBI) in older adults requiring admission to the intensive care unit (ICU) is increasing. Early ICU mobilisation is recommended, however, the effect of age on mobilisation practices after TBI remains poorly understood. This service evaluation aimed to describe ICU mobilisation activity and outcomes by age in patients with TBI.

Methods

A single-centre retrospective service evaluation was conducted, including all adults admitted to the ICU with TBI between January 2022 and November 2024 (CARMS ID-22399). Demographics, ICU admission characteristics, and functional outcomes were extracted from electronic health records. Mobilisation outcomes included the Manchester Mobility Scale (MMS) and time to first mobilisation (sitting on the edge of the bed or higher; MMS≥2)

Results

A total of 353 patients were included (274 males), of whom 38.8%, 37.1% and 24.1% were aged <40, 40-64 and ≥65 years, respectively. ICU mortality increased with age (16.1% vs. 40.0% for <40 vs ≥65 years, p<0.001), with a corresponding reduction in in-hospital mobilisation rates (82.5% vs. 50.6%, p<0.001). Where mobilisation was achieved, the time to first mobilisation decreased with age (14 days for <40 vs. 8 days for ≥65 years, Spearman’s rho: -0.116, p=0.008). In patients surviving to ICU discharge, levels of mobility at this time did not vary significantly with age (Spearman’s rho: -0.091, p=0.143), with low mobility levels regardless of age (MMS 1-2 in 53.0% vs. 57.1% for <40 vs ≥65 years). By hospital discharge, mobility levels declined significantly with age (rho: -0.201, p=0.001), with MMS 7 achieved in 63.5% of patients aged <40 vs. 37.2% ≥65 years.

Conclusion

Older adults (≥65 years; male and female) represent approximately one quarter of ICU admissions with TBI at our institution and experience inferior mobility outcomes. These findings highlight the need for ICU early mobilisation strategies tailored to older adults.