Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study

Citation

van der Vlegel M, Mikolić A, Lee Hee Q, Kaplan ZLR, Retel Helmrich IRA, van Veen E, Andelic N, Steinbuechel Nv, Plass AM, Zeldovich M, Wilson L, Maas AIR, Haagsma JA, Polinder S & Åkerlund C (2022) Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study. Injury. https://doi.org/10.1016/j.injury.2022.05.009

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.

Keywords
Traumatic Brain Injury; Older adults; Outcomes; Health care utilization; Health-related quality of life; Mental health

Notes
Output Status: Forthcoming/Available Online Additional co-authors: 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 Andelic, 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 Brazinova, Marek Majdan, Mark Steven Taylor, Veronika Zelinkova, Vibeke Brinck, Mike Jarrett, Joanne Brooker, Emma Donoghue, Anneliese Synnot, Camilla Brorsson, Lars-Owe Koskinen, Nina Sundström, Andras Buki, Endre Czeiter, Monika Bullinger, Manuel Cabeleira, Marek Czosnyka, Abhishek Dixit, Ari Ercole, Evgenios Koraropoulos, David Menon, Virginia Newcombe, Sophie Richter, Peter Smielewski, Emmanuel 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, Inigo Pomposo, Ana M. Castaño-León, Pedro A. Gomez, Alfonso Lagares, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Alessia Vargiolu, Iris Ceyisakar, Benjamin Gravesteijn, Juanita A. Haagsma, Jilske Huijben, Hester Lingsma, Daan Nieboer, Ana Mikolic, Suzanne Polinder, Charlie Sewalt, Ewout W. Steyerberg, Kimberley Velt, Daphne Voormolen, Eveline Wiegers, Wilco Peul, Jeroen T.J.M. van Dijck, Thomas A. van Essen, Roel P.J. van Wijk, Hans Clusmann, Mark Coburn, Ana Kowark, Rolf Rossaint, Jonathan Coles, Jamie D. Cooper, Marta Correia, Amra Čovid, Nicole von Steinbüchel, Nicola Curry, Simon Stanworth, Claire Dahyot-Fizelier, Paul Dark, Faye Johnson, Helen Dawes, Patrick Esser, Caroline van Heugten, Véronique De Keyser, Andrew I.R. Maas, Tomas Menovsky, Gregory Van der Steen, Francesco Della Corte, Francesca Grossi, Bart Depreitere, Đula Đilvesi, Jagoš Golubovic, Mladen Karan, Petar Vulekovic, Jens Dreier, Peter Vajkoczy, Stefan Wolf, Guy-Loup Dulière, Hugues Maréchal, Martin Fabricius, Daniel Kondziella, Valery L. Feigin, Kelly Jones, Braden Te Ao, Alice Theadom, Kelly Foks, Iain Haitsma, Victor Volovici, Alex Furmanov, Guy Rosenthal, Pablo Gagliardo, Guoyi Gao, Ji-yao Jiang, Alexandre Ghuysen, Lelde Giga, Egils Valeinis, Agate Ziverte, Ben Glocker, Daniel Rueckert, Johannes Gratz, Russell L. Gruen, Deepak Gupta, Cecilie Roe, Eirik Helseth, Olav Roise, Lindsay Horton, Lindsay Wilson, Peter J. Hutchinson, Angelos G. Kolias, Bram Jacobs, Joukje van der Naalt, Stefan Jankowski, Erwin Kompanje, Marjolein Timmers, Steven Laureys, Didier Ledoux, Benoit Misset, Fiona Lecky, Otesile Olubukola, Rolf Lefering, Nadine Schäfer, Valerie Legrand, Aurelie Lejeune, Emmanuel Vega, Julia Mattern, Leon Levi, Roger Lightfoot, Marc Maegele, Alex Manara, Matt Thomas, Geoffrey Manley, Costanza Martino, Oliver Sakowitz, Renan Sanchez-Porras, Alexander Younsi, Catherine McMahon, Ancuta Negru, Matej Oresic, Aarno Palotie, Paul M. Parizel, Jean-François Payen, Paolo Persona, Anna Piippo-Karjalainen, Matti Pirinen, Horia Ples, Jussi P. Posti, Louis Puybasset, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Jonathan Rhodes, Sylvia Richardson, Samuli Ripatti, Saulius Rocka, Jonathan Rosand, Jeffrey V. Rosenfeld, Sandra Rossi, Martin Rusnák, Juan Sahuquillo, Janos Sandor, Silke Schmidt, Herbert Schoechl, Guus Schoonman, Toril Skandsen, Robert Stevens, William Stewart, Riikka Takala, Tomas Tamosuitis, Olli Tenovuo, Dick Tibboel, Christos Tolias, Cristina Maria Tudora, Mathieu van der Jagt, Wim Van Hecke, Dominique Van Praag, Thijs Vande Vyvere, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Kevin K.W. Wang, Zhihui Yang, Peter Ylén

Journal
Injury