Can Baseline Frailty Assessment Inform on Functional Outcomes and Quality of Life in Older Neurosurgical Patients Following a Traumatic Brain Injury?

: (Alternative Format Thesis)

Abstract

Background: Traumatic brain injury (TBI) in older adults (aged ≥65 years) is frequently associated with ground-level falls and leads to substantial morbidity. Frailty, reflecting reduced physiological reserve, may influence recovery following TBI, however, it’s prognostic role in geriatric neurosurgical populations remains underexplored. This study examined whether baseline frailty, as measured by the Clinical Frailty Scale (CFS), was associated with functional outcomes and health-related quality of life (HRQoL) following TBI.
Methods: A prospective longitudinal study was conducted at a single neurosurgical centre in the Southwest Peninsula, UK (July 2023 - August 2024). Seventy-one older adults with CT-confirmed TBI were enrolled. Baseline frailty was assessed within 24 hours of admission. Functional outcomes were evaluated at 3 and 6 months using the modified Rankin Scale (mRS), Glasgow Outcome Scale Extended (GOSE), and Barthel Index (BI). HRQoL was assessed using the EQ-5D-5L utility and visual analogue scale (VAS); post-concussive symptoms were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Multivariable regression analyses adjusted for age, gender, injury severity (GCS) and comorbidity burden (Charlson Comorbidity Index, CCI).
Results: Higher baseline frailty was independently associated with poorer functional outcomes at 3 months across mRS, GOSE and BI measures, and with lower EQ-5D-5L utility scores. By 6 months, frailty remained independently associated with poor functional outcome on the mRS and Barthel Index, while chronological age emerged as the dominant predictor of GOSE and HRQoL. Frailty was not associated with neurosurgical admission, length of stay, discharge destination, or post-concussion symptom burden. Functional and HRQoL improvements occurred predominantly within the first 3 months post-injury, with relative stabilisation thereafter. Patients who died within 6 months were significantly frailer at baseline.
Conclusions: Baseline frailty is independently associated with early functional recovery and quality of life following TBI in older adults. The prognostic influence of frailty appears strongest in the early post-injury period, while chronological age becomes more influential over longer-term recovery. Routine frailty assessment may support risk stratification and inform early rehabilitation planning in older neurosurgical patients. Larger multicentre studies are required to validate these findings.

Date of Award	20 May 2026
Original language	English
Awarding Institution	University of Bath
Sponsors	University Hospitals Plymouth NHS Trust
Supervisor	Max Western (Supervisor) & Ellie Edlmann (Supervisor)