A new study, published on October 6, 2025, in the Canadian Medical Association Journal (CMAJ) (DOI: 10.1503/cmaj.250361), shows that traumatic brain injuries (TBIs) in older adults are associated with a significantly increased risk of dementia, increased need for home care, and admission to long-term care facilities. The findings underscore the need for targeted prevention measures, particularly to reduce fall-related injuries, which are common in this age group.
Falls as the main cause of TBI
Traumatic brain injuries result from direct or indirect forces applied to the head, such as falls or whiplash injuries, and can cause symptoms like loss of consciousness, amnesia, disorientation, or neurological impairments such as slurred speech or muscle weakness. In Canada, approximately 1 million people over 65 years of age sustain a TBI in their lifetime, with over 50% of cases attributed to falls.
“Falls are one of the most common causes of traumatic brain injuries in older adults and are often preventable,” explain Dr. Yu Qing Huang, a PhD student at ICES, and Dr. Jennifer Watt, a geriatrician at St. Michael’s Hospital and the University of Toronto. “By implementing targeted fall prevention strategies, we could reduce TBI-related dementia in this population.”
Increased dementia risk and care needs
The population-based cohort study analyzed data from over 260,000 adults aged 65 and older in Ontario, Canada, between April 2004 and March 2020. Participants were followed until diagnosis of dementia, until March 2021, or until death. The results show that a new TBI is associated with a 69% higher risk of dementia in the first five years and a 56% higher risk after five years. Additionally, individuals with TBI required more days of publicly funded home care on average (87 days compared to 84 days for individuals without TBI).
Risk factors: age, sex, and socioeconomic status
The study identified several factors influencing dementia risk after a TBI. Older individuals, particularly those aged 85 and older, had a particularly high risk—about one-third of this group developed dementia after a TBI. Women were more affected than men. Socioeconomic status also played a role: people in low-income neighborhoods had a higher risk of dementia than those in more affluent areas. Furthermore, individuals from smaller communities, low-income regions, and areas with low ethnic diversity were more frequently admitted to long-term care facilities.
Implications for healthcare
The results underscore the need for specialized programs, particularly for older women aged 75 and over in low-income or less diverse communities. "Community-based dementia prevention programs and support services could help target limited health resources," the authors emphasize. Doctors can use the findings to educate patients and families about the long-term risks of TBI and promote preventive measures such as fall prevention.
"Our study shows that TBI remains a significant risk factor for dementia even later in life," the authors explain. "These findings can help doctors better advise older patients and manage the long-term consequences of brain injuries."
Call for fall prevention
The study calls for increased efforts to reduce falls, for example, through improved home modifications, mobility aids, and awareness campaigns. Such measures could not only lower the risk of dementia but also reduce the burden on the healthcare system through decreased care needs.
Source:
CMAJ
DOI: 10.1503/cmaj.250361
Original publication: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250361
Keywords:
Traumatic brain injury, dementia, fall prevention, geriatrics, care needs
