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Impact of age on long-term recovery from traumatic brain injury |
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| Authors: | Marquez de la Plata Carlos D Hart Tessa Hammond Flora M Frol Alan B Hudak Anne Harper Caryn R O'Neil-Pirozzi Therese M Whyte John Carlile Mary Diaz-Arrastia Ramon |
| Institution: | a Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX b Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX c Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX d Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA e Carolinas Rehabilitation, Charlotte, NC f Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA g Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA. h Baylor Institute for Rehabilitation, Dallas, TX |
| Abstract: | Marquez de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR, O'Neil-Pirozzi TM, Whyte J, Carlile M, Diaz-Arrastia R. Impact of age on long-term recovery from traumatic brain injury.ObjectiveTo determine whether older persons are at increased risk for progressive functional decline after traumatic brain injury (TBI).DesignLongitudinal cohort study.SettingTraumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.ParticipantsSubjects enrolled in the TBIMS national dataset.InterventionsNot applicable.Main Outcome MeasuresDisability Rating Scale (DRS), FIM instrument cognitive items, and the Glasgow Outcome Scale-Extended.ResultsParticipants were separated into 3 age tertiles: youngest (16-26y), intermediate (27-39y), and oldest (≥40y). DRS scores were comparable across age groups at admission to a rehabilitation center. The oldest group was slightly more disabled at discharge from rehabilitation despite having less severe acute injury severity than the younger groups. Although DRS scores for the 2 younger groups improved significantly from year 1 to year 5, the greatest magnitude of improvement in disability was seen among the youngest group. In addition, after dividing patients into groups according to whether their DRS scores improved (13%), declined (10%), or remained stable (77%) over time, the likelihood of decline was found to be greater for the 2 older groups than for the youngest group. A multiple regression model showed that age has a significant negative influence on DRS score 5 years post-TBI after accounting for the effects of covariates.ConclusionsThis study supported our primary hypothesis that older patients show greater decline over the first 5 years after TBI than younger patients. In addition, the greatest amount of improvement in disability was observed among the youngest group of survivors. These results suggest that TBI survivors, especially older patients, may be candidates for neuroprotective therapies after TBI. |
| Keywords: | Brain injuries Disabled persons Rehabilitation |
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