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Physical and Functional Impairment Among Older Adults With a History of Traumatic Brain Injury
Erica S Kornblith1, Kenneth M Langa, Kristine Yaffe
1San Francisco Veterans Affairs Medical Center, San Francisco, California (Drs Kornblith, Yaffe, and Gardner); Division of General Medicine, University of Michigan Health System, Ann Arbor (Dr Langa); Veterans Affairs Center for Practice Management and Outcomes Research, Washington, District of Columbia (Dr Langa); Institute for Social Research, University of Michigan, Ann Arbor (Dr Langa); Institute of Gerontology, University of Michigan, Ann Arbor (Dr Langa); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Langa); and Departments of Neurology (Drs Yaffe and Gardner) and Psychiatry & Epidemiology & Biostatistics (Dr Yaffe), University of California San Francisco (UCSF).
Objectives:
To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI on these relations.
Participants:
A total of 1148 respondents to the 2014 Wave of the Health and Retirement Study, a nationally representative survey of older community-dwelling adults, randomly selected to participate in a TBI exposure survey. They reported no prior TBI (n = 737) or prior TBI (n = 411).
Design:
Cross-sectional survey study.
Main Measures:
Physical impairment (self-reported difficulty with ≥1 of 8 physical activities); FI (self-reported difficulty with ≥1 of 11 activities of daily living); self-reported current neurobehavioral symptoms (pain, sleep problems, depression, subjective memory impairment); The Ohio State University TBI Identification Method (OSU-TBI-ID)-short form.
Analyses:
Stepwise logistic regression models ([1] unadjusted; [2] adjusted for demographics and medical comorbidities; [3] additionally adjusted for neurobehavioral symptoms) compared PI and FI between TBI groups.
Results:
Traumatic brain injury-exposed (mean: 33.6 years postinjury) respondents were younger, less likely to be female, and reported more comorbidities and neurobehavioral symptoms. Although TBI was significantly associated with increased odds of PI and FI in unadjusted models and models adjusted for demographics/comorbidities (adjusted odds ratio, 95% confidence interval: PI 1.62, 1.21-2.17; FI 1.60, 1.20-2.14), this association was no longer statistically significant after further adjustment for neurobehavioral symptoms.
Conclusion:
History of TBI is associated with substantial PI and FI among community-dwelling older adults. Further research is warranted to determine whether aggressive management of neurobehavioral symptoms in this population may mitigate long-term PI and FI in this population.
