Abstract
Testa JA, Malec JF, Moessner AM, Brown AW. Outcome after traumatic brain injury: effects
of aging on recovery.
Objective
To identify differences in outcome after traumatic brain injury (TBI) compared with
orthopedic injuries as a function of age.
Design
Longitudinal data analyses from an inception cohort.
Setting
Outpatient rehabilitation program.
Participants
Eighty-two orthopedic injury patients and 195 TBI patients.
Interventions
Not applicable.
Main Outcome Measures
Independent living, employment, and level of functioning 1 to 2 years after injury.
Results
Older patients and those with TBI were more likely to have increased dependence postinjury.
Older TBI patients were more likely to have changes in employment status compared
with orthopedic injury patients younger or TBI. The Mayo-Portland Adaptability Inventory
and Disability Rating Scale were moderately predictive of level of functioning, return
to employment, and independent living status 1 to 2 years postinjury. Injury severity
was only mildly predictive of outcome.
Conclusions
The effect of age on outcome affects recovery from neurologic injuries and, to a lesser
extent, orthopedic injuries. Outcome after TBI is best predicted by patients’ age
and estimates of level of function at discharge. Findings suggest that older patients
and those with TBI have a greater likelihood of becoming physically and financially
dependent on others. Rehabilitation efforts should focus on maximizing levels of independence
to limit financial and emotional costs to patients and their families.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Centers for Disease Control and Prevention.Traumatic brain injury in the United States. CDC, Atlanta1999
- Incidence of mild and moderate brain injury in the United States, 1991.Brain Inj. 1996; 10: 47-54
- The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974.Neurology. 1980; 30: 912-919
- Head injuries costs and consequences.J Head Trauma Rehabil. 1991; 6: 76-91
- The lifetime cost of injury.Inquiry. 1990; 27: 332-343
- Long-term survival after traumatic brain injury.NeuroRehabilitation. 2004; 19: 37-43
- Traumatic brain injury in the United States.J Head Trauma Rehabil. 1999; 14: 602-615
- Senile dementia of the Alzheimer’s type.J Gerontol. 1987; 42: 412-417
- Falls in the elderly.Am J Epidemiol. 1996; 143: 1129-1136
- Falls in cognitive impairment and dementia.Clin Geriatr Med. 2002; 18: 159-173
- Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department.BMJ. 2003; 326: 73-79
- Risk factors for falls among elderly persons living in the community.N Engl J Med. 1988; 319: 1701-1707
- Traumatic brain injury in elderly individuals.Phys Med Rehabil Clin North Am. 1992; 3: 441-449
- Rehabilitation of the elderly crash victim.Clin Geriatr Med. 1993; 9: 473-483
- Geriatric rehabilitation.Arch Phys Med Rehabil. 1993; 74: S406-S412
- Mortality risk after head injury increases at 30 years.J Am Coll Surg. 2003; 197: 711-716
- Patient age and outcome following severe traumatic brain injury.J Neurosurg. 2003; 99: 666-673
- Functional outcomes of older adults with traumatic brain injury.Arch Phys Med Rehabil. 1996; 77: 883-888
- Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults.J Int Neuropsychol Soc. 2001; 7: 373-383
- Cognitive and behavioral sequelae of closed head injury in older adults according to their significant others.J Neuropsychiatry Clin Neurosci. 1999; 11: 38-44
- Head injuries and cognitive decline among older adults.Neurology. 1999; 52: 557-562
- Aging effect on psychosocial outcome in traumatic brain injury.Arch Phys Med Rehabil. 1998; 79: 881-887
- Survival after severe brain injury in the aged.Arch Surg. 1993; 128 (discussion 93-4): 787-793
- Traumatic brain injury in the elderly.J Trauma. 2002; 53 (discussion 223-4): 219-223
- Traumatic brain injury outcome in older adults.J Clin Geropsychol. 2001; 7: 161-187
- Age and outcome of severe head injury.Acta Neurochir. 1979; 75: S37-S49
- Neurobehavioural consequences of closed head injury in the elderly.Brain Inj. 1997; 11: 871-875
- Age and functioning after mild traumatic brain injury.Brain Inj. 2001; 15: 857-864
- The effects of normal ageing on neuropsychological functioning following traumatic brain injury.Brain Inj. 1998; 12: 569-576
- The functional effects of head injury in the elderly.Brain Inj. 1987; 1: 183-188
- Neurobehavioral consequences of closed head injury in older adults.J Neurol Neurosurg Psychiatry. 1994; 57: 961-966
- Severe head injury hastens age of onset of Alzheimer’s disease.J Am Geriatr Soc. 1989; 37: 970-973
- Traumatic brain injury and time to onset of Alzheimer’s disease.Am J Epidemiol. 1999; 149: 32-40
- Alzheimer’s disease after remote head injury.J Neurol Neurosurg Psychiatry. 1997; 62: 119-124
- Head trauma and age of onset of dementia of the Alzheimer type.JAMA. 1987; 257: 2289-2290
- The association between head trauma and Alzheimer’s disease.Am J Epidemiol. 1990; 131: 491-501
- Head trauma as a risk factor for Alzheimer’s disease.Int J Epidemiol. 1991; 20: S28-S35
- Traumatic brain injury as a risk factor for Alzheimer’s disease.Neuropsychol Rev. 2000; 10: 115-129
- Cognitive outcome after mild and moderate traumatic brain injury in older adults.J Clin Exp Neuropsychol. 2001; 23: 739-752
- Age-dependent synuclein pathology following traumatic brain injury in mice.Exp Neurol. 2003; 184: 214-224
- Laser capture microdissection and analysis of amplified antisense RNA from distinct cell populations of the young and aged rat brain.Brain Res Mol Brain Res. 2004; 122: 47-61
- Disability rating scale for severe head trauma.Arch Phys Med Rehabil. 1982; 63: 118-123
- Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome.J Head Trauma Rehabil. 2000; 15: 670-682
- Functional measures after traumatic brain injury.J Head Trauma Rehabil. 1996; 11: 27-39
- Factor analysis of the Mayo-Portland Adaptability Inventory.Brain Inj. 1997; 11: 469-482
- Differing problem perceptions of staff, survivors, and significant others after brain injury.J Head Trauma Rehabil. 1997; 12: 1-13
- Relationship of the Mayo-Portland Adaptability Inventory to functional outcome and cognitive performance measures.J Head Trauma Rehabil. 1994; 9: 1-15
- Comparability of Mayo-Portland Adaptability Inventory ratings by staff, significant others and people with acquired brain injury.Brain Inj. 2004; 18: 563-575
Malec JF, Lezak MD. Manual for the Mayo-Portland Adaptability Inventory. 2003. Available at: http://tbims.org/combi/mpai/manual.pdf. Accessed March 8, 2005.
- Facets for Windows. 3.41.2 ed.Winsteps, Chicago2003
- Outcomes of community re-entry programmes for brain injury survivors. Part 2.Brain Inj. 1991; 5: 155-168
- Maximizing vocational outcome after brain injury.Mayo Clin Proc. 1995; 70: 1165-1171
- A medical/vocational case coordination system for persons with brain injury.Arch Phys Med Rehabil. 2000; 81: 1007-1015
- Impact of comprehensive day treatment on societal participation for persons with acquired brain injury.Arch Phys Med Rehabil. 2001; 82: 885-894
- Acute predictors of return to employment after traumatic brain injury.Arch Phys Med Rehabil. 2002; 85: 635-641
- A comparison of acute and postdischarge predictors of employment 2 years after traumatic brain injury.Arch Phys Med Rehabil. 2001; 82: 435-439
- Comparison of the predictive power of socio-economic variables, severity of injury and age on long-term outcome of traumatic brain injury.Brain Inj. 2002; 16: 9-27
- Prediction of employment outcome one to three years following traumatic brain injury (TBI).Brain Inj. 1998; 12: 255-263
- Glasgow Outcome Scale and Disability Rating Scale.Arch Phys Med Rehabil. 1985; 66: 35-37
- Measuring psychosocial recovery after brain injury.Arch Phys Med Rehabil. 2004; 85: 538-545
- Assessing traumatic brain injury outcome measure for long-term follow-up of community-based individuals.Arch Phys Med Rehabil. 2001; 82: 367-374
- The need for multiple time points in aging studies.Neurobiol Aging. 2004; 25: 3-4
- The impact of aging on head injuries.J Trauma. 2002; 53: 391
Article info
Footnotes
Supported by the Traumatic Brain Injury Model Systems, National Institute for Disability and Rehabilitation Research (grant no. H133A020507).
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 author(s) or upon any organization with which the author(s) is/are associated.
Identification
Copyright
© 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
