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This activity was partially supported by contracts and grants between the National Academy of Sciences and AARP; Abbott Laboratories; Centers for Disease Control and Prevention (contract 75D30121D11240, task order 75D30124F00045); Department of Defense (contract W81XWH22C0033); Department of Veterans Affairs (contract 36C24E22P0005); National Highway Traffic Safety Administration (order 693J924P000014); National Institute on Disability, Independent Living, and Rehabilitation Research (contract 140D0423C0099 through the Department of the Interior); National Institutes of Health (contract HHSN263201800029I, task order 775N98024F00005); American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation; American Association of Neurological Surgeons; American College of Surgeons; American Occupational Therapy Association; American Physical Therapy Association; Brain Injury Association of America; Concussion Legacy Foundation; Emergency Nurses Association; Marcus Foundation; National Association of Emergency Medical Technicians; National Association of State Head Injury Administrators; National College Athletic Association; National Neurotrauma Society; and Toyota Motor North America. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-09962-2
International Standard Book Number-10: 0-309-09962-5
Digital Object Identifier: https://doi.org/10.17226/29099

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Approaches to address unmet research needs in traumatic brain injury among older adults: Proceedings of a Workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/29099.

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WORKSHOP PLANNING COMMITTEE¹

KRISTINE YAFFE (Cochair), University of California, San Francisco

DAVID REUBEN (Cochair), University of California, Los Angeles

HIBAH AWWAD, National Institute of Neurological Disorders and Stroke, National Institutes of Health

LISA BARNES, Rush University Medical Center

KRISTEN DAMS-O’CONNOR, Icahn School of Medicine at Mount Sinai

STUART HOFFMAN, U.S. Department of Veterans Affairs

RACHEL LAZARUS, AARP

LISA OPANASHUK, National Institute of Aging, National Institutes of Health

DANA WALTZMAN, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Staff

CHANEL MATNEY, Workshop Director and Program Officer

GAYATRI SOMAIYA, Senior Program Assistant

KATHERINE BOWMAN, Director, Forum on Traumatic Brain Injury

TRACY LUSTIG, Director, Forum on Aging, Disability, and Independence

SHEENA POSEY NORRIS, Director, Forum on Neuroscience and Nervous System Disorders

CLARE STROUD, Senior Director, Board on Health Sciences Policy

Consultants

ANNA NICHOLSON, Founder and Lead Writer, Doxastic

TAMARA HAAG, Science Writer, Doxastic

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

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FORUM ON TRAUMATIC BRAIN INJURY¹

DONALD BERWICK (Cochair), Institute for Healthcare Improvement

CORINNE PEEK-ASA (Cochair), University of California, San Diego

JOE BONNER, Eunice Kennedy Shriver National Institute of Child Health and Human Development

JOE BRENNAN, Avalon Action Alliance

JAVIER CÁRDENAS, West Virginia University and American Academy of Neurology

JOHN CORRIGAN, Ohio State University and Brain Injury Association of America

JILL DAUGHERTY, Centers for Disease Control and Prevention

RAMON DIAZ-ARRASTIA, University of Pennsylvania Perelman School of Medicine

LAGWYN DURDEN, National Collegiate Athletic Association

COURTNEY EDWARDS, Parkland Health and Emergency Nurses Association

E. WESLEY ELY, Vanderbilt University Medical Center

BRUCE EVANS, Upper Pine River Fire Protection District and National Association of Emergency Medical Technicians

STEVEN FLANAGAN, New York University Grossman School of Medicine and American Academy of Physical Medicine and Rehabilitation

DAVID GOLDSTEIN, U.S. Department of Health and Human Services

GENE GURKOFF, University of California, Davis and National Neurotrauma Society

ODETTE HARRIS, Stanford University School of Medicine and VA Palo Alto Health Care System

RICHARD HODES, National Institute on Aging

STUART HOFFMAN, Department of Veterans Affairs

FREDERICK KORLEY, University of Michigan

WALTER KOROSHETZ, National Institute of Neurological Disorders and Stroke

RACHEL LAZARUS, AARP

KATHY LEE, Department of Defense

JULIE MALLOY, American Occupational Therapy Association

TARA JO MANAL, American Physical Therapy Association

GEOFFREY MANLEY, University of California, San Francisco, and Zuckerberg San Francisco General Hospital

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

LUCA MARINELLI, GE HealthCare Technology & Innovation Center

CHRISTINA L. MASTER, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia

BETH MCQUISTON, Abbott Laboratories

CATE MILLER, Administration for Community Living

CHRIS NOWINSKI, Concussion Legacy Foundation

TESSIE OCTOBER, Eunice Kennedy Shriver National Institute of Child Health and Human Development

DAVID OKONKWO, University of Pittsburgh School of Medicine

TOLU O. OYESANYA, Duke University School of Nursing

MAYUR B. PATEL, Vanderbilt University Medical Center and American College of Surgeons Committee on Trauma

LESLIE PRICHEP, BrainScope Company, Inc.

TERRY RAUCH, Department of Defense

JOEL SCHOLTEN, Department of Veterans Affairs

SHELLY TIMMONS, Medical College of Wisconsin and American Association of Neurological Surgeons

DARIO VILLARREAL, Toyota Motor North America

GAMUNU WIJETUNGE, National Highway Traffic Safety Administration

REBECCAH WOLFKIEL, National Association of State Head Injury Administrators

KRISTINE YAFFE, University of California, San Francisco

Forum Staff

KATHERINE BOWMAN, Forum Director

CHANEL MATNEY, Program Officer

GAYATRI SOMAIYA, Senior Program Assistant

CHRISTIE BELL, Finance Business Partner

CLARE STROUD, Senior Director, Board on Health Sciences Policy

James C. Puffer, M.D./American Board of Family Medicine Fellowship

ANITA RAVI, PurpLE Health Foundation

ALYSSA TILHOU, Boston University

FORUM ON AGING, DISABILITY, AND INDEPENDENCE

STEVE EWELL (Cochair), Consumer Technology Association Foundation

REBECCA STOECKLE (Cochair), Education Development Center

JAMES C. APPLEBY, The Gerontological Society of America

TAMALA DAVID, The College at Brockport SUNY

GEORGE DEMIRIS, University of Pennsylvania

AMY KELLEY, National Institute on Aging, National Institutes of Health

FRANK R. LIN, Johns Hopkins School of Medicine and Bloomberg School of Public Health

SARITA A. MOHANTY, The SCAN Foundation

JON A. SANFORD, Georgia State University

KATIE SMITH SLOAN, LeadingAge

RANI SNYDER, John A. Hartford Foundation

BONNIELIN K. SWENOR, Johns Hopkins Bloomberg School of Public Health

ERWIN TAN, AARP

FERNANDO TORRES-GIL, University of California, Los Angeles

Forum Staff

TRACY LUSTIG, Forum Director

AUSTEN APPLEGATE, Research Associate

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FORUM ON NEUROSCIENCE AND NERVOUS SYSTEM DISORDERS

DEANNA BARCH (Co-chair), Washington University in St. Louis

FRANCES JENSEN (Co-chair), University of Pennsylvania

SHELLI AVENEVOLI, National Institute of Mental Health

BRUCE BEBO, National Multiple Sclerosis Society

DIANE BOVENKAMP, BrightFocus Foundation

KATJA BROSE, Chan Zuckerberg Initiative

TERESA BURACCHIO, Food and Drug Administration

SARAH CADDICK, Gatsby Charitable Foundation

ROSA CANET-AVILÉS, California Institute for Regenerative Medicine

MICHAEL CHIANG, National Eye Institute

MERIT CUDKOWICZ, Massachusetts General Hospital; Harvard Medical School (starting March 2025)

BEVERLY DAVIDSON, University of Pennsylvania

M. DENISE DEARING, National Science Foundation

NITA FARAHANY, Duke University

EVA FELDMAN, University of Michigan

BRIAN FISKE, Michael J. Fox Foundation for Parkinson’s Research

DANIELLE GRAHAM, American College of Neuropsychopharmacology

MORTEN GRUNNET, Lundbeck

MAGALI HAAS, Cohen Veterans Bioscience

RICHARD J. HODES, National Institute of Aging

STUART W. HOFFMAN, Department of Veterans Affairs

YASMIN HURD, Icahn School of Medicine at Mount Sinai

STEVEN E. HYMAN, The Broad Institute of MIT and Harvard University

MICHAEL IRIZARRY, Eisai Inc.

GEORGE KOOB, National Institute on Alcohol Abuse and Alcoholism

WALTER KOROSHETZ, National Institute of Neurological Disorders and Stroke

JOHN KRYSTAL, Yale University

ROBERT MALENKA, Stanford University

HUSSEINI MANJI, Oxford University; Duke University; UK Government Mental Health

HUGH MARSTON, Boehringer Ingelheim

BILL MARTIN, The Janssen Pharmaceutical Companies of Johnson & Johnson

DAVID MCMULLEN, Food and Drug Administration

CAROLINE MONTOJO, Dana Foundation

JOHN NGAI, BRAIN Initiative

GENTRY PATRICK, University of California, San Diego

KATHRYN RICHMOND, Allen Institute

MARSIE ROSS, Harmony Biosciences

M. ELIZABETH ROSS, American Neurological Association

NATALIA S. ROST, American Academy of Neurology

KATIE SALE, American Brain Coalition

RAYMOND SANCHEZ, Bain Capital Life Sciences

TERRENCE SEJNOWSKI, Salk Institute for Biological Studies

JOAN SERENO, National Science Foundation

SARA SHNIDER, One Mind

DAVID SHURTLEFF, National Center for Complementary and Integrative Health

JOHN SPIRO, Simons Foundation

ALESSIO TRAVAGLIA, Foundation for the National Institutes of Health

NORA VOLKOW, National Institute on Drug Abuse

CHRISTOPHER WEBER, Alzheimer’s Association

GARY WILSON, Huo Family Foundation

RICHARD WOYCHIK, National Institute of Environmental Health Sciences

STEVIN ZORN, MindImmune Therapeutics, Inc.

Health and Medicine Division Staff

SHEENA M. POSEY NORRIS, Director, Forum on Neuroscience and Nervous System Disorders

EVA CHILDERS, Program Officer

KIMBERLY OGUN, Senior Program Assistant

CHRISTIE BELL, Senior Finance Business Partner

CLARE STROUD, Senior Director, Board on Health Sciences Policy

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

STUART HOFFMAN, U.S. Department of Veterans Affairs

LISA OPANASHUK, National Institutes of Health

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by JESSICA GILL, Johns Hopkins University. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. We also thank staff member Stephen Maher for reading and providing helpful comments on this manuscript.

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Contents

1 LANDSCAPE OF TRAUMATIC BRAIN INJURY IN OLDER ADULTS

Unique Considerations for Traumatic Brain Injury in Older Adults

TBI, Recovery, and Advocacy: Perspectives on Unmet Research Needs from Lived Experiences

Addressing Knowledge Gaps in the Neuroepidemiology of Geriatric TBI

2 PERSPECTIVES ON ADDRESSING UNMET RESEARCH NEEDS IN ACUTE TBI CARE FOR OLDER ADULTS

Emergency Medicine in Geriatric TBI: Gaps in Prognostication and Potential for Improved Implementation of Value-Based and Patient-Centered Care

Neurocritical Care Systems in Geriatric TBI: Multidisciplinary Teaming in Coordinated Systems of Patient-Centered Care from Triage to Recovery

Trajectories of Function in the First Year Postinjury

Discussion

3 PERSPECTIVES ON ADDRESSING UNMET RESEARCH NEEDS IN POSTACUTE TBI CARE FOR OLDER ADULTS

Qualitative Research on Caregiver Perspectives in Geriatric TBI

Care Models for Integrating Patient-Centered and Personalized Goals in Recovery

TBI Among Older Adults and the Social Determinants of Health

Optimizing Care Transitions and Improving Rehabilitative Outcomes

Promoting Brain Health After TBI in Older Adults: Lessons Learned from the Epidemiology of Neurologic and Vascular Outcomes

Discussion

4 CONSIDERING APPROACHES TO REMEDY RESEARCH GAPS AND EXAMPLES OF PROMISING FUTURE DIRECTIONS

TBI Prevention Strategies for Older Adults

Using Digital Technologies to Improve Geriatric TBI Prevention, Research, and Care

Inclusion of Older Adults in Clinical Trials and Datasets

Effect of Age and Time Since Injury on TBI Biomarkers in Older Adults

Models of TBI in Aged Animals

Selected Research Needs and Opportunities for Therapeutic Development

Discussion

REFERENCES

APPENDIXES

A Statement of Task

B Workshop Agenda

C Planning Committee and Speaker Biographies