Aging unnoticed: a snapshot review of recent neurocritical care research and guidelines highlighting geriatric underrepresentation.

Abstract

Background: Geriatric patients are disproportionately affected by neurocritical conditions including traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), yet remain underrepresented in clinical research and guidelines.

Objective: To assess the current state of geriatric-specific research and guideline development in neurocritical care (NCC), and to identify gaps in evidence and recommendations.

Methods: We conducted a structured literature review of original research articles published between 2018 and 2023 that focused on geriatric SAH, ICH, and TBI. Search strategies included key terms applied to Medline with specific inclusion/exclusion criteria. Additionally, we reviewed existing guidelines from major stakeholders including the Neurocritical Care Society and American Geriatrics Society for geriatric relevance.

Results: Of 70 featured NCC articles, 38 addressed SAH, ICH, or TBI. After filtering, 59 geriatric SAH, 218 geriatric TBI, and 63 geriatric ICH studies were identified. Results highlight a growing but insufficient body of geriatric neurotrauma research. Key gaps include the lack of validated risk stratification tools for older patients and a paucity of guideline recommendations specific to geriatric populations.

Conclusions: Despite increased incidence and complexity of neurotrauma in the elderly, current research and guidelines inadequately address geriatric needs. There is a pressing need for multidisciplinary guideline development, frailty-informed protocols, and targeted clinical research.