Patient-centered, individualized care after "mild" traumatic brain injury in older adults: The PRECODE study

Objective

The incidence of “mild” traumatic brain injury (mTBI) in patients is increasing due to a growing number of older persons. Protective responses during falls are less effective in older adults than in younger individuals, resulting in a higher risk of unprotected head impacts.

Methods

This prospective cohort study offered patients with mTBI (Glasgow Coma Scale score 13–15) an in-depth interview and a comprehensive assessment to identify modifiable risk factors and understand causal pathways. Potentially problematic medications, environmental risk factors, and deficits in vision, cognition, balance, and strength were assessed. Based on these findings, individualized fall-prevention recommendations aligned with international fall prevention guidelines were provided and reviewed at a follow-up visit eight weeks later. The study used a mixed-methods design guided by established clinical guidelines.

Results

Patients expressed appreciation for participation in the study and demonstrated strong engagement throughout the assessment process, which lasted two hours or longer. At least one major modifiable risk factor was identified in every patient, frequently more than one. Notably, these risk factors had not been documented in discharge letters from previous hospital stays following mTBI. Most required follow-up communication with general practitioners and, in some cases, specialists, and could not be addressed by patients independently. The most frequently identified modifiable risk factors were problematic medications (dose and substance), followed by balance impairments, environmental hazards, and vision problems.

Conclusion

Patients with mTBI constitute a heterogeneous population that require personalized and stratified management strategies. Findings from this pilot study identified several key domains for targeted intervention, including syncope-related care pathways, identification and management of fall-risk–inducing drugs, treatment of dynamic balance impairments, coping strategies for vision deficits, and environmental adaptations led by occupational therapists. Next steps include planning a multicentre trial to evaluate the feasibility and effectiveness of these individualized recommendations.