TY - JOUR
T1 - Health care utilization and outcomes in older adults after Traumatic Brain Injury
T2 - A CENTER-TBI study
AU - van der Vlegel, Marjolein
AU - Mikolić, Ana
AU - Lee Hee, Quentin
AU - Kaplan, Z. L.Rana
AU - Retel Helmrich, Isabel R.A.
AU - van Veen, Ernest
AU - Andelic, Nada
AU - Steinbuechel, Nicole v.
AU - Plass, Anne Marie
AU - Zeldovich, Marina
AU - Wilson, Lindsay
AU - Maas, Andrew I.R.
AU - Haagsma, Juanita A.
AU - Polinder, Suzanne
AU - Åkerlund, Cecilia
AU - George, Pradeep
AU - Lanyon, Linda
AU - Muraleedharan, Visakh
AU - Nelson, David
AU - Amrein, Krisztina
AU - Ezer, Erzsébet
AU - Kovács, Noémi
AU - Melegh, Béla
AU - Nyirádi, József
AU - Tamás, Viktória
AU - Vámos, Zoltán
AU - Sorinola, Abayomi
AU - Andreassen, Lasse
AU - Anke, Audny
AU - Frisvold, Shirin
AU - Antoni, Anna
AU - Schwendenwein, Elisabeth
AU - Audibert, Gérard
AU - Azouvi, Philippe
AU - Azzolini, Maria Luisa
AU - Beretta, Luigi
AU - Calvi, Maria Rosa
AU - Bartels, Ronald
AU - Boogert, Hugo den
AU - Barzó, Pál
AU - Beauvais, Romuald
AU - Perera, Natascha
AU - Beer, Ronny
AU - Helbok, Raimund
AU - Bellander, Bo Michael
AU - Belli, Antonio
AU - Benali, Habib
AU - Degos, Vincent
AU - Galanaud, Damien
AU - Ylén, Peter
AU - CENTER-TBI investigators and participants
N1 - Copyright © 2022. Published by Elsevier Ltd.
PY - 2022/8
Y1 - 2022/8
N2 - Introduction: The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. Methods: We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. Results: Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. Conclusion: The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.
AB - Introduction: The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. Methods: We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. Results: Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. Conclusion: The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.
KW - Health care utilization
KW - Health-related quality of life
KW - Mental health
KW - Older adults
KW - Outcomes
KW - Traumatic Brain Injury
KW - Prospective Studies
KW - Humans
KW - Glasgow Outcome Scale
KW - Brain Injuries, Traumatic
KW - Quality of Life/psychology
KW - Patient Acceptance of Health Care
KW - Aged
UR - http://www.scopus.com/inward/record.url?scp=85132842261&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2022.05.009
DO - 10.1016/j.injury.2022.05.009
M3 - Article
C2 - 35725508
AN - SCOPUS:85132842261
SN - 0020-1383
VL - 53
SP - 2774
EP - 2782
JO - Injury
JF - Injury
IS - 8
ER -
