Impact of Age on Long-Term Recovery From Traumatic Brain Injury
Abstract
Marquez de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR, O'Neil-Pirozzi TM, Whyte J, Carlile M, Diaz-Arrastia R. Impact of age on long-term recovery from traumatic brain injury.
Objective
To determine whether older persons are at increased risk for progressive functional decline after traumatic brain injury (TBI).
Design
Longitudinal cohort study.
Setting
Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.
Participants
Subjects enrolled in the TBIMS national dataset.
Interventions
Not applicable.
Main Outcome Measures
Disability Rating Scale (DRS), FIM instrument cognitive items, and the Glasgow Outcome Scale–Extended.
Results
Participants were separated into 3 age tertiles: youngest (16–26y), intermediate (27–39y), and oldest (≥40y). DRS scores were comparable across age groups at admission to a rehabilitation center. The oldest group was slightly more disabled at discharge from rehabilitation despite having less severe acute injury severity than the younger groups. Although DRS scores for the 2 younger groups improved significantly from year 1 to year 5, the greatest magnitude of improvement in disability was seen among the youngest group. In addition, after dividing patients into groups according to whether their DRS scores improved (13%), declined (10%), or remained stable (77%) over time, the likelihood of decline was found to be greater for the 2 older groups than for the youngest group. A multiple regression model showed that age has a significant negative influence on DRS score 5 years post-TBI after accounting for the effects of covariates.
Conclusions
This study supported our primary hypothesis that older patients show greater decline over the first 5 years after TBI than younger patients. In addition, the greatest amount of improvement in disability was observed among the youngest group of survivors. These results suggest that TBI survivors, especially older patients, may be candidates for neuroprotective therapies after TBI.
Reprint requests to Ramon Diaz-Arrastia, MD, PhD, 5323 Harry Hines Blvd, Dallas, TX 75390-9036
Supported by the National Institutes of Health, U.S. Department of Education (grant nos. H133 A020526, R01 HD48179, U01 HD42652).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT