Discussion
This study shows that accident and emergency consultations due to head injuries increased substantially in the age groups > 80 years in the period 2006–2023. The number of consultations in this age group was more than six times higher in 2023 than 2006. The consultation rate was more than five times higher, suggesting that the increase is due not only to the ageing population, but to a growing incidence of head injuries. The number of older adults living at home is rising sharply, and this population group is more prone to falls (3).
The threshold for contacting the accident and emergency department after a head injury may have changed during the period, which could have a bearing on the findings of the study. Most patients call the accident and emergency department beforehand and are either advised to wait or to attend for an examination (12). Both the Emergency Primary Health Care Manual and the Scandinavian guidelines for head injuries from 2013 recommend a low threshold for hospitalisation (2, 13), and according to the decision support tool for telephone triage (Legevaktindeks), advanced age or frailty is a factor that warrants prompt clinical assessment (14). This may help explain the higher incidence of accident and emergency consultations among the older population, but it is uncertain whether the new threshold for contacting the accident and emergency department after a head injury can fully explain the sharp rise in consultations in recent years, as found in this study.
The Norwegian Patient Registry also shows a rise in hospital admissions due to head injuries, but the data are not broken down into age groups (15). The admission rate for head injuries was 948 per 100 000 inhabitants in 2016, which is the first year we have statistics for. The corresponding figure for 2023 was 1116 per 100 000 inhabitants. The Cause of Death Registry publishes the number of deaths due to falls, but not specifically for head injuries (16). It shows that the death rate due to falls among those aged ≥ 80 has increased from 106 per 100 000 inhabitants in 2006 to 250 in 2023.
This study found a significant increase in accident and emergency consultations for head injuries among the older population. When considered alongside registry data showing both an increase in hospital admissions for head injuries and a rising mortality rate from fall-related injuries among the older population, this study suggests that the findings reflect a genuine increase in the risk of head injuries for older adults living at home. The Norwegian Directorate of Health recently published national clinical guidelines on fall prevention in older adults (17). Fall prevention measures should be implemented for older adults with head injuries in the accident and emergency department. Such measures could include home visits by a nurse, physiotherapist and/or occupational therapist.