Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study
Marjolein van der Vlegel, Ana Mikolić, Quentin Lee Hee, Z Kaplan, Isabel R. A. Retel Helmrich, Ernest van Veen, Nada Anđelić, Nicole von Steinbüechel, Anne Marie Plass, Marina Zeldovich, Lindsay Wilson, Andrew I.R. Maas, Juanita A. Haagsma, Suzanne Polinder, Cecilia A ̊ kerlund, Pradeep George, Linda Lanyon, Visakh Muraleedharan, David Nelson, Krisztina Amrein, Erzsébet Ezer, Noémi Kovács, Béla Melegh, József Nyirádi, Viktória Tamás, Zoltán Vámos, Abayomi Sorinola, Nada Anđelić, Lasse Andreassen, Audny Anke, Shirin Frisvold, Anna Antoni, Elisabeth Schwendenwein, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Luigi Beretta, Maria Rosa Calvi, Ronald Bartels, Hugo den Boogert, Pál Barzó, Romuald Beauvais, Natascha Perera, Ronny Beer, Raimund Helbok, Bo‐Michael Bellander, Antonio Belli, Habib Benali, Vincent Degos, Damien Galanaud, Vincent Perlbarg, Maurizio Berardino, Simona Cavallo, Morten Blaabjerg, Christina Rosenlund, Rico Frederik Schou, Peter Bragge, Alexandra Bražinová, Marek Majdán, Mark Taylor, Veronika Zelinkova, Vibeke Brinck, Mike Jarrett, Joanne Brooker, Emma Donoghue, Anneliese Synnot, Camilla Brorsson, Lars‐Owe Koskinen, Nina Sundström, András Büki, Endre Czeiter, Monika Bullinger, Manuel Cabeleira, Marek Czosnyka, Abhishek Dixit, Ari Ercole, Evgenios Koraropoulos, David K. Menon, Virginia Newcombe, Sophie Richter, Peter Smielewski, Emmanuel A. Stamatakis, Guy Williams, Stefan Winzeck, Frederick A. Zeiler, Alessio Caccioppola, Emiliana Calappi, Marco Carbonara, Fabrizio Ortolano, Tommaso Zoerle, Nino Stocchetti, Peter Cameron, Dashiell Gantner, Lynnette Murray, Tony Trapani, Shirley Vallance, Guillermo Carbayo Lozano, Iñigo Pomposo, Ana M. Castaño‐León, Pedro A. Gómez
Abstract
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.