Cognitive-communication difficulties following traumatic brain injury sustained in older adulthood: a scoping review.

Abstract

Older adults are a peak incidence group for traumatic brain injury (TBI). However, empirical evidence on TBI in older adults is often limited to extrapolated findings from studies involving younger adults. While cognitive-communication deficits are an established consequence of TBI with substantial impact on social outcome for younger adults, little is known about the nature of cognitive-communication changes experienced by older adults following a new-onset TBI. In order to inform evidence-based service delivery and support older adults who sustain TBI, it is important to understand how these difficulties manifest in older adults. To review the empirical literature to determine the nature and breadth of research that has addressed the influence of older age on cognitive-communication outcomes following TBI sustained in older adulthood. A scoping review framework was used. Five electronic databases (Medline, PsycINFO, Embase, CINAHL and Scopus) were searched to locate peer-reviewed studies addressing cognitive-communication following TBI sustained at ≥ 55 years. Given the absence of dedicated investigations within the search yield, studies were included where at least 30% of participants were aged ≥ 55 years at injury, and age was a stated focus of the investigation. A total of 2468 unique records were identified and reduced to 225 after title and abstract screening. Full-text review revealed only three studies that met the criteria. Collectively these studies included adults aged 55-93 years at injury. Two studies focused on age as a predictor for acute cognitive-communication difficulty, and one on the impact of age on facial emotion recognition in the chronic stages of injury. None of the studies had a dedicated focus on cognitive-communication outcomes for older adults who sustained a TBI within the defined period of older adulthood. This scoping review produced limited results and insufficient evidence to inform rehabilitation for older adults. Indeed, very little is known about cognitive-communication outcomes for older adults who sustain a TBI. This review highlights the need, in the context of an ageing population, for research within this area to be prioritized. What this paper adds What is already known on the subject Empirical evidence to support the management of post-TBI cognitive-communication difficulties in adults predominantly stems from studies with young adults. However, the broader TBI literature suggests that outcome for older adults requires specific consideration due to its distinct nature and occurrence during a stage of life when there is the potential for subtle change to the processes of cognition and communication as part of typical ageing. What this paper adds to existing knowledge This scoping review identifies that research related to cognitive-communication outcomes for older adults who have sustained a TBI is very much in its infancy. Overarching statements about post-TBI cognitive-communication outcomes for older adults cannot be drawn, nor can it be determined if outcomes for older adults differ from younger adults. What are the potential or actual clinical implications of this work? The lack of research in this area means that tangible guidance cannot be provided to clinicians working with older adults following TBI to support evidence-based practice for cognitive-communication. This scoping review strongly supports the need for further research in this area.