Predictors of cognitive gains during inpatient rehabilitation for older adults with traumatic brain injury

Abstract

Introduction: Traumatic brain injury (TBI) among older adults is increasing and can affect cognition. To effectively meet the rehabilitation needs of older adults, a clearer picture is needed of patient-, clinical-, and facility-level characteristics that affect cognitive recovery during inpatient rehabilitation facility (IRF) stays. Objective: To identify patient, clinical, and facility factors associated with cognitive recovery among older adults with TBI who received IRF care. Design: Secondary data analysis. Setting: Uniform Data System for Medical Rehabilitation-participating IRFs in the United States. Patients: Patients were 65 to 99 years of age at IRF admission for TBI. Participants received IRF care between 2002 and 2018 (N = 137,583); 56.3% were male; 84.2% were white; mean age was 78.7 years. Main Outcome Measure: Change in Functional Independence Measure Cognitive Score (FIM-Cognitive) from IRF admission to discharge, categorized as favorable (FIM-cognitive score gains ≥3 points) or poor (FIM-cognitive score gains <3 points) cognitive outcomes. Interventions: Not applicable.Results: Patients had greater odds of favorable cognitive recovery if they were female (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.05-1.08), had higher motor functioning at IRF admission (aOR 1.03, 95% CI 1.03-1.04), longer length of stay (aOR 1.07, 95% CI 1.06-1.07), or received care at a freestanding IRF (vs. hospital rehab unit) (aOR 1.57, 95% CI 1.52-1.61). Patients who were older (aOR 0.99, 95% CI 0.98-0.99), Black (aOR 0.79, 95% CI 0.75-0.83), Hispanic or Latino (aOR 0.97, 95% CI 0.91-1.02), or were part of another racial or ethnic group (aOR 0.85, 95% CI 0.81-0.90) (vs. White), had high-cost comorbid conditions (aOR 0.71, 95% CI 0.65-0.76), or who had higher cognitive functioning at IRF admission (aOR 0.90, 95% CI 0.90-0.91) had lower odds of favorable cognitive recovery. Conclusions: Patient (age, sex, race, ethnicity), clinical (level of functioning at IRF admission, length of stay) and facility (e.g., freestanding IRF) factors contributed to the cognitive recoveries of older adults during IRF stays.Disclosure: None.

How Subjective and Objective Factors in Research and Practice May Perpetuate Health Disparities amongst Patients with Traumatic Brain Injury

“…It should be recognized that there are associations between objective factors (e.g., race/ethnicity, socioeconomic status, health insurance status) as racial/ethnic minorities make up a larger percentage of those with lower socioeconomic status and without insurance among patients with TBI 5,15,16 . Research also shows that objective factors influence hospital discharge timing and destinations, 8,10,15,17–22 mortality rates, 11,19,23 readmission rates, 10 healthcare utilization, 24–26 quality of life, 27 functional outcomes, 25,28 cognitive outcomes, 28–30 and vocational outcomes 28,31–33 …”