**3.5. Head injury**

Traumatic brain injury (TBI) is a significant problem among the elderly. For the age of 65 years and older, falls are the primary mechanisms of TBI-related ED visits (81.8%) and TBI-related deaths (54.4%) [30]. In the review of the literature, it is recognized that older adults with moderate–severe TBI have poor outcomes with high rates of significant disability and mortality. Two major factors put geriatric trauma patients at a greater risk for increased incidence of TBI: age-related structural changes and preinjury anticoagulant-antiplatelet usage. First, with aging, parasagittal bridging veins stretch and make the elderly more susceptible to traumatic tears. Thus, the elderly have a higher incidence of subdural hematoma. Also, cerebral atrophy leads to a significant amount of blood accumulating in subdural area before clinical signs manifest. Rapid neurologic decline should be considered in these patients. Second, an increased incidence of the anticoagulant and antiplatelet therapy in the elderly may have detrimental consequences. It is suggested that taking anticoagulant therapy at the time of the injury increases the risk of intracranial hemorrhage [31] and is related with worse outcomes [32, 33]. One of the most frequently prescribed anticoagulant medications is warfarin. Also, Franko et al. concluded that warfarin use at the time of injury also makes mortality significantly higher after the age 70 [32]. Thus, immediate noncontrast head computed tomography (CT) is recommended for the elderly patients who take anticoagulant or antiplatelet therapy, even if their trauma seems minor. Additionally, rapid screening for anticoagulant use, INR value and subsequent correction with blood component therapy may improve outcomes.
