Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 896-903, May 2008

Impact of Age on Long-Term Recovery From Traumatic Brain Injury

  • Carlos D. Marquez de la Plata, PhD

      Affiliations

    • Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
    • Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Tessa Hart, PhD

      Affiliations

    • Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA
    • ,
  • Flora M. Hammond, MD

      Affiliations

    • Carolinas Rehabilitation, Charlotte, NC
    • ,
  • Alan B. Frol, PhD

      Affiliations

    • Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Anne Hudak, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Caryn R. Harper, MS

      Affiliations

    • Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Therese M. O'Neil-Pirozzi, ScD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
    • Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA.
    • ,
  • John Whyte, MD, PhD

      Affiliations

    • Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA
    • ,
  • Mary Carlile, MD

      Affiliations

    • Baylor Institute for Rehabilitation, Dallas, TX
    • ,
  • Ramon Diaz-Arrastia, MD, PhD

      Affiliations

    • Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
    • Corresponding Author InformationReprint requests to Ramon Diaz-Arrastia, MD, PhD, 5323 Harry Hines Blvd, Dallas, TX 75390-9036

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.

Key Words: Brain injuries, Disabled persons, Rehabilitation

 

 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.

PII: S0003-9993(08)00072-5

doi:10.1016/j.apmr.2007.12.030

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 896-903, May 2008

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