Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study

Vlegel, Marjolein van der; Mikolić, Ana; Hee, Quentin Lee; Kaplan, Z; Helmrich, Isabel R.A. Retel; Veen, Ernest van; Anđelić, Nada; Steinbüechel, Nicole von; Plass, Anne Marie; Zeldovich, Marina; Wilson, Lindsay; Maas, Andrew I.R.; Haagsma, Juanita A.; Polinder, Suzanne; Åkerlund, Cecilia; George, Pradeep; Lanyon, Linda; Muraleedharan, Visakh; Nelson, David W.; Amrein, Krisztina; Ezer, Erzsébet; Kovács, Noémi; Melegh, Béla; Nyirádi, József; Tamás, Viktória; Vámos, Zoltán; Sorinola, Abayomi; Andreassen, Lasse; Anke, Audny; Frisvold, Shirin; Antoni, Anna; Schwendenwein, Elisabeth; Audibert, Gérard; Azouvi, Philippe; Azzolini, Maria Luisa; Beretta, Luigi; Calvi, Maria Rosa; Bartels, Ronald; Boogert, Hugo den; Barzó, Pál; Beauvais, Romuald; Perera, Natascha; Beer, Ronny; Helbok, Raimund; Bellander, Bo‐Michael; Belli, Antonio; Benali, Habib; Degos, Vincent; Galanaud, Damien; Perlbarg, Vincent; Berardino, Maurizio; Cavallo, Simona; Blaabjerg, Morten; Rosenlund, Christina; Schou, Rico Frederik; Bragge, Peter; Bražinová, Alexandra; Majdán, Marek; Taylor, Mark; Zelinkova, Veronika; Brinck, Vibeke; Jarrett, Mike; Brooker, Joanne; Donoghue, Emma; Synnot, Anneliese; Brorsson, Camilla; Koskinen, Lars‐Owe D.; Sundström, Nina; Büki, András; Czeiter, Endre; Bullinger, Monika; Cabeleira, Manuel; Czosnyka, Marek; Dixit, Abhishek; Ercole, Ari; Koraropoulos, Evgenios; Menon, David; Newcombe, Virginia; Richter, Sophie; Smielewski, Peter; Stamatakis, Emmanuel; Williams, Guy; Winzeck, Stefan; Zeiler, Frederick A.; Caccioppola, Alessio; Calappi, Emiliana; Carbonara, Marco; Ortolano, Fabrizio; Zoerle, Tommaso; Stocchetti, Nino; Cameron, Peter; Gantner, Dashiell; Murray, Lynnette; Trapani, Tony; Vallance, Shirley; Lozano, Guillermo Carbayo; Pomposo, Iñigo; Castaño‐León, Ana M.; Gómez, Pedro A.; Lagares, Alfonso; Chevallard, Giorgio; Chieregato, Arturo; Citerio, Giuseppe; Vargiolu, Alessia; Ceyisakar, Iris; Gravesteijn, Benjamin; Huijben, Jilske; Lingsma, Hester F.; Nieboer, Daan; Sewalt, Charlie; Steyerberg, Ewout W.; Velt, Kimberley; Voormolen, Daphne; Wiegers, Eveline; Peul, Wilco C.; Dijck, Jeroen T.J.M. van; Essen, Thomas A. van; Wijk, Roel P. J. van; Clusmann, Hans; Coburn, Mark; Kowark, Ana; Rossaint, Rolf; Coles, Jonathan P.; Cooper, Jamie D.; Correia, Marta; Čovid, Amra; Steinbüchel, Nicole von; Curry, Nicola; Stanworth, Simon; Dahyot‐Fizelier, Claire; Dark, Paul; Johnson, Faye; Dawes, Helen; Esser, Patrick; Heugten, Caroline van; Keyser, Véronique De; Menovsky, Tomas; Steen, Gregory Van der; Corte, Francesco Della; Grossi, Francesca; Depreitere, Bart; Đilvesi, Đula; Golubović, Jagoš; Karan, Mladen; Vuleković, Petar; Dreier, Jens P.; Vajkoczy, Peter; Wolf, Stefan; Dulière, Guy‐Loup; Maréchal, Hugues; Fabricius, Martin; Kondziella, Daniel; Feigin, Valery; Jones, Kelly; Ao, Braden Te; Theadom, Alice; Foks, Kelly; Haitsma, Iain; Volovici, Victor; Furmanov, Alex; Rosenthal, Guy; Gagliardo, Pablo; Gao, Guoyi; Jiang, Jiyao; Ghuysen, Alexandre; Giga, Lelde; Valeinis, Egils; Ziverte, Agate; Glocker, Ben; Rueckert, Daniel; Gratz, Johannes; Gruen, Russell L.; Gupta, Deepak; Røe, Cecilie; Helseth, Eirik; Røise, Olav; Horton, Lindsay; Hutchinson, Peter J.; Kolias, Angelos; Jacobs, Bram; Naalt, Joukje van der; Jankowski, Stefan; Kompanje, Erwin J. O.; Timmers, Marjolein; Laureys, Steven; Ledoux, Didier; Benoît, Michel; Lecky, Fiona; Olubukola, Otesile; Lefering, Rolf; Schäfer, Nadine; Legrand, Valérie; Lejeune, Aurélie; Vega, Emmanuel; Mattern, Julia; Levi, Leon; Lightfoot, Roger; Maegele, Marc; Manara, Alex; Thomas, Matt; Manley, Geoffrey T.; Martino, Costanza; Sakowitz, Oliver; Sánchez-Porras, Renán; Younsi, Alexander; McMahon, Catherine; Negru, Ancuta; Orešič, Matej; Palotie, Aarno; Parizel, Paul M.; Payen, Jean‐François; Persona, Paolo; Piippo-Karjalainen, Anna; Pirinen, Matti; Pleș, Horia; Posti, Jussi P.; Puybasset, Louis; Rădoi, Andreea; Ragauskas, Arminas; Raj, Rahul; Rambadagalla, Malinka; Rhodes, Jonathan R.; Richardson, Sylvia; Ripatti, Samuli; Ročka, Saulius; Rosand, Jonathan; Rosenfeld, Jeffrey V.; Rossi, Sandra; Rusňák, Martin; Sahuquillo, Juan; Sándor, János; Schmidt, Silke; Schöechl, Herbert; Schoonman, Guus; Skandsen, Toril; Stevens, Robert; Stewart, William Α.; Takala, Riikka; Tamošuitis, Tomas; Tenovuo, Olli; Tibboel, Dick; Tolias, Christos M.; Tudora, Cristina Maria; Jagt, Mathieu van der; Hecke, Wim Van; Praag, Dominique Van; Vyvere, Thijs Vande; Verheyden, Jan; Vespa, Paul; Vik, Anne; Vilcinis, Rimantas; Wang, Kevin; Yang, Zhihui; Ylén, Peter

doi:10.1016/j.injury.2022.05.009

Cited by 23 publications

(6 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Older adults are at greater risk of TBI and worse outcomes (i.e., functional outcome) after injury compared with those at younger ages. [32][33][34][35] This study adds to these previous findings, indicating that older adults, particularly those not working at the time of injury, are at higher risk of long-term functional decline in the first 7 years postinjury and may require closer monitoring and community support. A number of other potential risk factors, such as history of psychiatric disorder, cardiovascular disease, headache disorder, and prior TBI had unadjusted p values of <0.05 for various outcome domains (Table 5), but did not survive correction for multiple comparisons.…”

Section: Discussionmentioning

confidence: 58%

Long-term Multidomain Patterns of Change After Traumatic Brain Injury

Brett¹,

Temkin²,

Barber³

et al. 2023

Neurology

View full text Add to dashboard Cite

Background:Traumatic brain injury (TBI) may be a chronic condition carrying risk for future sequelae; few prospective studies examine long-term post-injury outcomes. We examined prevalence of functional, cognitive, and psychiatric change outcomes from 1–7 years post-injury.Methods:TRACK-TBI LONG participants were prospectively enrolled within 24-hours of injury and followed to 1-year post-injury; a subset participated in long-term follow-up from 2-7 years post-injury. Reliable change thresholds for the Brief Test of Adult Cognition by Telephone General Composite (cognition) and Brief Symptom Inventory-18 (psychiatric) were derived from orthopedic trauma controls (OTCs). Multiple assessments were completed (post-injury baseline assessment and two or three visits 2-7 years post-injury) within a sample subset. Change was assessed for functional outcome (Glasgow Outcome Scale-Extended[GOSE]) and self/informant report of decline. Prevalence ratios for outcomes classified as stable, improved, declined were reported individually and collectively. Fisher’s-exact test and log-binomial regression models examined factors associated with decline and improvement.Results:Of the sample (N=1264; mild TBI, GCS 13-15 [mTBI] n=917, moderate-severe TBI GCS 3-12 [msTBI] n=193, or OTC n=154), ‘stable’ was the most prevalent outcome. Functional outcome showed the highest rates of decline, regardless of TBI severity (mild=29%; moderate/severe=23%). When measures were considered collectively, rates of decline included mTBI(21%), msTBI(26%), OTC(15%). Age and pre-injury employment status were associated with functional decline (per 10-years; RR=1.16[95% CI=1.07, 1.25], p<.001; higher in retired/disabled/not working vs. full-time/part-time; RR=1.81[1.33, 2.45], respectively) in the mTBI group. Improvement in functional recovery 2-7 years post-injury was associated with higher BSI scores (per 5 points; RR=1.11[1.04, 1.18], p=.002) and GOSE score of 5-7 (GOSE=8 as reference; RR=2.64[1.75, 3.97], p<.001). Higher BSI scores and identifying as Black (RR=2.28[1.59, 3.25], p<.001) was associated with greater likelihood of improved psychiatric symptoms in mTBI (RR=1.21[1.14, 1.29], p<.001). Greater likelihood of cognitive improvement was observed among those with higher educational attainment in msTBI (per 4-years; RR=2.61[1.43, 4.79], p=.002).Conclusionsand Relevance: Function across domains at 1-year post-injury, a common recovery benchmark, undergo change across the subsequent 6-years. Results support consideration of TBI as a chronic, evolving condition and suggest continued monitoring, rehabilitation, and support is required to optimize long-term independence and quality of life.

show abstract

Section: Discussionmentioning

confidence: 58%

Long-term Multidomain Patterns of Change After Traumatic Brain Injury

Brett¹,

Temkin²,

Barber³

et al. 2023

Neurology

View full text Add to dashboard Cite

show abstract

“…This last study seems to contradict our current results, which could be due to the fact that their study involved a relatively small population with 92% of the elderly patients reporting their HRQoL to be normal. Older age has also been found to be a strong independent predictor of poor HRQoL in severe TBI [36,39]. It is conceivable that older patients with severe TBI lack the resilience to combat symptoms, resulting in poor HRQoL.…”

Section: Discussionmentioning

confidence: 99%

Good Health-Related Quality of Life in Older Patients One Year after mTBI despite Incomplete Recovery: An Indication of the Disability Paradox?

Coffeng,

Abdulle,

van der Horn

et al. 2024

JCM

Self Cite

View full text Add to dashboard Cite

Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (<60 years) admitted to the emergency department were analyzed. Post-traumatic complaints, emotional distress and coping were evaluated 2 weeks post-injury using standardized questionnaires. At 12 months post-injury, HRQoL and functional recovery were determined with the abbreviated version of the World Health Organization Quality of Life scale and Glasgow Outcome Scale Extended (GOSE), respectively. Results: One year post-injury, 80% (n = 131) of the OA-mTBI rated their HRQoL as “good” or “very good”, which was comparable to younger patients (79% (n = 226), p = 0.72). Incomplete recovery (GOSE <8) was present in 43% (n = 69) of OA-mTBI, with 67% (n = 46) reporting good HRQoL. Two weeks post-injury, fewer OA-mTBI had (≥2) post-traumatic complaints compared to younger patients (68% vs. 80%, p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01–1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI.

show abstract

“…Severe head injury is a high-risk disease in the older population with a long hospital stay and high mortality, which brings great problems to clinical treatment [ 15 – 17 ]. Previous studies had shown that the older the age, the worse the prognosis and the higher the hospital mortality [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of prognosis in older patients with severe brain injury after surgical intervention

Shen,

Liu,

et al. 2023

Eur J Med Res

View full text Add to dashboard Cite

Background Older patients (aged ≥ 60 years) with severe brain injury have a high mortality and disability rate. The objective of this retrospective study was to assess the clinical risk factors of prognosis in older patients with severe brain injury after surgical intervention and to analyze the prognosis of the surviving group of patients 1 year after discharge. Methods Clinical data of older patients with severe brain injury who were admitted to two neurosurgical centers between January 2010 and December 2020 were collected. Patient age, sex, Glasgow Coma Scale (GCS) score at admission, underlying disease, mechanisms of injury, abnormal pupillary reflex, head computed tomography imaging findings (such as hematoma type),intraoperative brain swelling and other factors were reviewed. All the patients were categorized into a good prognosis (survival) group and a poor prognosis (death) group by the Glasgow Outcome Score (GOS); also, the related factors affecting the prognosis were screened and the independent risk factors were identified by the Binary logistic regression analysis. GOS was used to evaluate the prognosis of the surviving group of patients 1 year after discharge. Results Out of 269 patients, 171 (63.6%) survived, and 98 (36.4%) died during hospitalization. Univariate analysis showed that age, GCS score at admission, underlying diseases, abnormal pupillary reflex, the disappearance of ambient cistern, the midline structure shift, intraoperative brain swelling, oxygen saturation < 90%, and cerebral hernia were risk factors for the prognosis of older patients with severe brain injury after surgical intervention. Multivariate analysis showed that age, underlying diseases, disappearance of ambient cistern, Oxygen saturation < 90% and intraoperative brain swelling were independent risk factors of the prognosis in the population. The effect of surgical intervention differed among various age groups at 1-year follow-up after surgery. Conclusions The results of this retrospective study confirmed that age, underlying diseases, disappearance of ambient cistern, intraoperative brain swelling, and oxygen saturation < 90% are associated with poor prognosis in older postoperative patients with severe brain injury. Surgical intervention may improve prognosis and reduce mortality in older patients (age < 75 years). But for those patients (age ≥ 75 years), the prognosis was poor after surgical intervention.

show abstract

Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study

Cited by 23 publications

References 51 publications

Long-term Multidomain Patterns of Change After Traumatic Brain Injury

Long-term Multidomain Patterns of Change After Traumatic Brain Injury

Good Health-Related Quality of Life in Older Patients One Year after mTBI despite Incomplete Recovery: An Indication of the Disability Paradox?

Risk factors of prognosis in older patients with severe brain injury after surgical intervention

Contact Info

Product

Resources

About