Predictors of 10-year functional independence trajectories in older adults with traumatic brain injury: A Model Systems study

Article type: Research Article

Authors: Tyler, Carmen M.^a | Perrin, Paul B.^{b; c} | Klyce, Daniel W.^{c; d; e} | Arango-Lasprilla, Juan Carlos^{a; *} | Dautovich, Natalie D.^a | Rybarczyk, Bruce D.^a

Affiliations: [a] Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA | [b] School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA, USA | [c] Polytrauma Rehabilitation Center TBI Model Systems, Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA | [d] Department of Physical Medicine and Rehabilitation, Virginia Common wealth University, Richmond, VA, USA | [e] Sheltering Arms Institute, Richmond, VA, USA

Correspondence: [*] Address for correspondence: Juan Carlos Arango Lasprilla, Ph.D, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA. E-mail: [email protected].

Abstract: BACKGROUND:Older adults have the highest traumatic brain injury (TBI)-related morbidity and mortality, and rates in older adults are increasing, chiefly due to falls. OBJECTIVE:This study used hierarchical linear modeling (HLM) to examine baseline predictors of functional independence trajectories across 1, 2, 5, and 10 years after TBI in older adults. METHODS:Participants comprised 2,459 individuals aged 60 or older at the time of TBI, enrolled in the longitudinal TBI Model Systems database, and had Functional Independence Measure Motor and Cognitive subscale scores and Glasgow Outcome Scale-Extended scores during at least 1 time point. RESULTS:Functional independence trajectories generally declined over the 10 years after TBI. Individuals who were older, male, underrepresented minorities, had lower education, were unemployed at time of injury, had no history of substance use disorder, or had difficulties with learning, dressing, and going out of the home prior to the TBI, or longer time in posttraumatic amnesia had lower functional independence trajectories across at least one of the functional independence outcomes. CONCLUSION:These predictors of functional independence in older adults with TBI may heighten awareness of these factors in treatment planning and long-term health monitoring and ultimately as a way to decrease morbidity and mortality.

Keywords: Older adults, traumatic brain injury, functional independence, trajectories, outcomes

DOI: 10.3233/NRE-220165

Journal: NeuroRehabilitation, vol. 52, no. 2, pp. 235-247, 2023