gms | German Medical Science

Objective: The treatment of elderly patients with traumatic brain injury (TBI) is mainly determined by the age of the patient and the severity of the trauma. The aim of this study was to explore personal preferences regarding life-prolonging neurosurgical interventions among ambulatory, autonomous elderly people.

Methods: 100 consecutive patients aged more than 75 years frequenting the outpatient clinic oft the Department of Neurosurgery were interviewed about their personal opinion on surgical treatment, if they themselves would suffer from TBI with space-occupying acute subdural hematoma. Their position, wishes and fears were assessed by a 23 point questionnaire. Additionally, the Mini-Mental-score plus the Beck Depression score and the Barthel Index were evaluated.

Results: Fifty-one percent of autonomous elderly persons would not wish surgical measures. If treatment was expected to physical disabilities, 68% of the people wished no surgery. In case of expected cognitive impairment, 91% were against any surgical intervention. The majority of the cohort feared to be a burden to their relatives (76%) and not being able to master an independent life (75%). Four fifths of the interviewed patients were not afraid of death (82%).

Conclusion: A majority of elderly patients only consents to surgical measures if no relevant disabilities are involved and if they can return to a life comparable to before. These findings need more consideration by neurosurgeons in case of neurosurgical emergencies as well as in the surgical treatment of elderly patients in general.