Functional recovery in older adults following mild traumatic brain injury: a systematic review.

AIM: To determine the domain-specific functional, psychological, and cognitive recovery outcomes in older adults aged ≥ 65 years after mild traumatic brain injury.

FINDINGS: Across 18 studies (3549 participants), fewer than half of the older adults regained full functional independence by 6 months, and many had persistent mood symptoms and cognitive deficits up to 1 year. Global tools such as the GOSE reveal wide measurement heterogeneity and an under-recognized burden.

MESSAGE: Mild traumatic brain injury is seldom "mild" in older adults. Geriatrics-tailored, multidimensional assessment and follow-up could improve rehabilitation and guide practice.

PURPOSE: Mild traumatic brain injury (mTBI) in older adults is increasingly common and associated with long-term functional, psychological, and cognitive impairment, especially in those with frailty and multimorbidity. Traditional outcome measures may underestimate the long-term burden in this patient population. This systematic review synthesizes current evidence on domain-specific functional recovery outcomes in older adults with mTBI with emphasis on physical function, depression, and cognition.

METHODS

A systematic search of Medline/PubMed, Embase, and Cochrane Library was conducted through 6 October 2024. Observational studies reporting functional outcomes in older adults ≥ 65 years post-mTBI were included. Study quality was assessed using the Quality of Prognostic Studies (QUIPS) tool.

RESULTS

Eighteen studies (three thousand five hundred forty-nine participants) were included. Persistent impairments in activity and participation were observed in up to 66% at 6 months post-injury. Approximately 24% experienced at least mild depression, and 9% had moderate-to-severe anxiety. Cognitive recovery was heterogeneous, with residual deficits in processing speed, memory, and executive function. Standard global measures such as GOSE frequently failed to detect domain-specific impairments, especially in psychosocial and cognitive domains.

CONCLUSION

Older adults with mTBI frequently experience prolonged and incomplete recovery across multiple domains, which often goes undetected by traditional outcome measures. Given the multidimensional burden observed, comprehensive geriatric assessment and interdisciplinary follow-up could help align care to patient needs. Future research should include adults aged ≥ 80 years, adopt multidimensional tools, and extend follow-up to better guide tailored rehabilitation strategies.