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 - A˚ kerlund, 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 - den Boogert, Hugo

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 - Fabricius, Martin

AU - Kondziella, Daniel

AU - CENTER-TBI Participants and Investigators

N1 - Funding Information: CENTER-TBI was supported by the European Union 7th Framework program (EC Grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA). Funding Information: CENTER-TBI was supported by the European Union 7th Framework program ( EC Grant 602150 ). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA) . Publisher Copyright: © 2022

PY - 2022

Y1 - 2022

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

U2 - 10.1016/j.injury.2022.05.009

DO - 10.1016/j.injury.2022.05.009

M3 - Journal article

C2 - 35725508

AN - SCOPUS:85132842261

VL - 53

SP - 2774

EP - 2782

JO - Injury

JF - Injury

SN - 0020-1383

IS - 8

ER -