Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes

Abstract

Objectives: To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI). Design: Prospective cohort study. Participants: Adults 50 years and older with moderate-to-severe TBI (n = 2134). Measures: Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale–Extended (GOS-E) at 1 year). Results: Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization. Conclusion: Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

“…Two important distinctions between our classification methods, however, warrant mention. First, our resulting clusters from K-modes clustering do not permit patients to belong to more than one cluster, whereas Treelet Transform clustering undertaken by Kumar and colleagues 27 does permit patients to have overlapping cluster membership. Second, the PTOS defines PECs as conditions present before admission to the hospital, and thereby does not code for hospitalacquired infections (nosocomial conditions); this is in contrast to the data analyzed by Kumar and colleagues, 15 which included hospital codes documenting health conditions present prior to hospital entry and those acquired during patients' hospital stays.…”

“…25 Understanding the influence of the increased disease burden introduced by the development and progression of these PECs is critical across all severities of TBI. 15,16,27 In addition, the impact of PECs does not appear limited to the acute period following TBI. Patients with moderate-to-severe TBI (msTBI) with a greater total disease burden reported reduced levels of functioning and life satisfaction up to 10 years following injury.…”

“…15,24,[35][36][37] In patients older than age 50 years with msTBI, hypertension emerged as a primary PEC and along with related medical complications, predicted hospitalization at 1 year post-injury. 27 In elderly patients with TBI, not only are PECs associated with worse outcomes, but morbidity is more highly linked to PEC complications than complications from the injury. 27,38 In a cohort of elderly patients with TBI following treatment in a neurosurgical department, patients with comorbid cardiac, pulmonary, or renal conditions and malignancy were almost three times more likely to die or enter a vegetative state post-injury.…”

“…27 In elderly patients with TBI, not only are PECs associated with worse outcomes, but morbidity is more highly linked to PEC complications than complications from the injury. 27,38 In a cohort of elderly patients with TBI following treatment in a neurosurgical department, patients with comorbid cardiac, pulmonary, or renal conditions and malignancy were almost three times more likely to die or enter a vegetative state post-injury. 39 Related work has shown that patients age 50 years or older are significantly more likely to have diabetes, elevated cholesterol, osteoarthritis, and hypertension in comparison with individuals under the age of 50 who sustain TBI.…”

Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury

“…From 2002 to 2016, among adults with TBI admitted to IRFs, the proportion who were over the age of 65 increased from 39.8% to 60.3% 14 . However, compared to younger adults, older adults have higher rates of comorbidities 6,16,17 and are disproportionately more likely to sustain TBI as a consequence of declining preinjury health and function 18 . As a result, providers may perceive older adults with TBI as less able to benefit from this intensive care 6 …”