Long-term health outcomes in survivors after chronic subdural haematoma
Claire E Moffatt1, Maria J Hennessy2, Laurence A G Marshman3
1Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia.
Insights
Chronic subdural haematoma (CSDH) survivors experience poorer long-term functional, cognitive, and mental health. This common elderly neurosurgical condition indicates a need for comprehensive, long-term patient care.
Area of Science:
- Neurosurgery
- Geriatrics
- Public Health
Background:
- Chronic subdural haematoma (CSDH) is a frequent neurosurgical condition in the elderly.
- While survival rates are known to be reduced, long-term health outcomes for CSDH survivors are poorly understood.
- CSDH may represent a sentinel health event requiring further investigation into survivor health.
Purpose of the Study:
- To assess the long-term functional, cognitive, and mental health outcomes in patients following CSDH intervention.
- To compare the health status of CSDH survivors with age- and gender-matched controls.
- To identify potential risk factors and long-term care needs for CSDH survivors.
Main Methods:
- A telephone-based assessment was conducted with 51 CSDH patients.
- Standardized questionnaires were used, including the Functional Activities Questionnaire (FAQ), Cognitive Telephone Screening Instrument (COGTEL), Mental Health Continuum-Short Form (MHC-SF), and Geriatric Depression Scale (GDS).
- Results were compared to 52 age- and gender-matched controls, assessed 5.5 ± 2.1 years post-CSDH.
Main Results:
- CSDH patients exhibited significantly reduced functional independence (FAQ) and verbal short-term memory (COGTEL).
- Poorer emotional, psychological, and social well-being (MHC-SF) and increased depressive symptoms (GDS) were observed in CSDH survivors.
- CSDH survivors had a higher prevalence of comorbidities compared to controls.
Conclusions:
- CSDH survivors face significant long-term deficits in function, cognition, and mental health compared to controls.
- CSDH should be recognized as a sentinel health event, highlighting the vulnerability of survivors.
- These findings underscore the necessity for comprehensive, person-centered, long-term care strategies for CSDH survivors.
Abstract:
Chronic subdural haematoma (CSDH) is the most common neurosurgical presentation among the elderly. Although initially considered a non-threatening event, recent studies have highlighted poor long-term survival post-CSDH. Currently, there is a paucity of information regarding long-term health outcome in survivors after CSDH post-intervention. The objective of this research was to assess long-term functional, cognitive, and mental health outcome after CSDH. CSDH patients were administered a telephone-based assessment including a Demographic Questionnaire, Functional Activities Questionnaire (FAQ), Cognitive Telephone Screening Instrument (COGTEL), Mental Health Continuum-Short Form (MHC-SF), and the Geriatric Depression Scale (GDS). Results were obtained in n = 51 patients. CSDH patients were assessed at 5.5 + 2.1 years after CSDH and results were compared to age/gender matched controls (n = 52). Comorbidities were significantly greater in CSDH patients at the time of assessment (χ2 = 35.47, P < .01). CSDH patients demonstrated a significant reduction in functional independence (FAQ, P < .001) and Verbal Short-Term Memory (COGTEL, P = .048). Potential negative trends were observed for Verbal Long-Term Memory (P = .06) and Inductive Reasoning (P = .07). CSDH patients also demonstrated significantly poorer emotional, psychological and social well-being (MHC-SF: Emotional, P = .003; Psychological, P = .001; and Social, P < .001), with increased depressive symptomatology (GDS, P < .001). In addition to known decreased long-term survival, CSDH survivors demonstrated poorer long-term functional, cognitive and mental health outcomes than controls. Pre-existent comorbidities were also more prevalent. CSDH is therefore a sentinel health event: survivors represent a vulnerable group who require long-term, comprehensive, person-centred care. This is the first study of long term CSDH health outcomes.
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