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Risk Factors for Institutionalization After Traumatic Brain Injury Inpatient Rehabilitation
Regina S Eum1, Allen W Brown, Thomas K Watanabe
1West Haven Medical Group, a division of PACT, LLC, West Haven, Connecticut (Dr Eum); Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Brown); Drucker Brain Injury Center, MossRehab, Albert Einstein Healthcare Network, and Temple University School of Medicine, Philadelphia, Pennsylvania (Dr Watanabe); Concussion Care Centre of Virginia, Ltd, Richmond, Tree of Life Services, Inc, Richmond, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, and International Brain Injury Association, Alexandria, Virginia (Dr Zasler); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brighton, Massachusetts (Dr Goldstein); Crawford Research Institute, Shepherd Center, Atlanta, Georgia (Dr Seel); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, and Patient Recovery Unit, Rehabilitation Institute of Chicago, Northwestern University, Chicago, Illinois (Dr Roth); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Spaulding Rehabilitation Hospital, Charlestown, and Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Department of Physical Medicine and Rehabilitation, Boston, Massachusetts (Dr Zafonte); and Harvard Medical School, Spaulding Rehabilitation Hospital Boston, Charlestown, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, and Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts (Dr Glenn).
Older individuals with traumatic brain injury (TBI) who lived alone before injury and had lower functional independence at discharge were more likely to be institutionalized after inpatient rehabilitation. This highlights needs for targeted post-discharge support.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Public Health
Background:
- Traumatic brain injury (TBI) is a significant cause of disability.
- Understanding factors influencing discharge destinations after inpatient rehabilitation is crucial for patient outcomes.
- Previous research has not fully profiled individuals with TBI discharged to institutional settings.
Purpose of the Study:
- To profile individuals with traumatic brain injury (TBI) discharged to institutional settings after inpatient rehabilitation.
- To identify sociodemographic, functional, and injury-related factors associated with institutionalization post-TBI rehabilitation.
Main Methods:
- Analysis of data from the Traumatic Brain Injury Model Systems National Database (2002-2012).
- Inclusion of participants with moderate to severe TBI who lived in a private residence before injury.
- Logistic regression analyses to identify predictors of discharge to institutional versus private settings.
Main Results:
- Older age, living alone prior to TBI, and lower functional independence at discharge were significantly associated with higher institutionalization rates.
- Key areas of lower function included locomotion, bladder management, comprehension, and social interaction.
- Decreased independence in bed-chair-wheelchair transfers and longer posttraumatic amnesia duration were also linked to institutionalization.
Conclusions:
- Individuals institutionalized after TBI rehabilitation are often older, lived alone, experienced longer posttraumatic amnesia, and had reduced functional independence.
- Findings suggest a need for research into enhanced postdischarge support and improved treatment effectiveness in functional areas critical for community living.
- Targeted interventions may reduce institutionalization rates for TBI survivors.
