Fall Risk and Physical/Occupational Therapy Referral Patterns in Older Adults with Mild Traumatic Brain Injury

Falls are the primary cause of mild traumatic brain injury (mTBI) among older adults, yet limited research has examined patterns of clinical care, mobility, and subsequent fall risk in this population. The objective of this study was to evaluate outpatient physical or occupational therapy (PT/OT) referral patterns and assess physical function and fall risk status of older adults with mTBI. We analyzed acute care and 2-week post-mTBI assessment data from a prospective cohort study of adults aged 65 and older with mTBI treated at a level 1 trauma center and six affiliated hospitals 2023-2025 and meeting eligibility criteria. Of 625 that were confirmed eligible, 155 consented to participate in the study. Of these, five were missing the 2-week assessment and nine were missing PT/OT referral information, leaving 141 in the current study. The exposure of interest was referral to PT/OT at discharge, obtained from medical records. Two-week post-mTBI assessments included the Short Physical Performance Battery (SPPB) and the Four-Square Step Test (FSST). Statistical comparisons between exposure groups were made using Fisher's exact test, Student's t-test or the Wilcoxon rank-sum test. Participants (n = 141) were on average 76.1 (standard deviation 7.3) years old and 56.0% female. Falls were the primary cause of mTBI (89%). At the 2-week assessment, participants demonstrated poor physical performance: 53% had impaired SPPB (<10), 62% had impaired FSST (>15 sec), and 65% had slow gait speeds (<0.80 m/s), all indicative of elevated fall risk. Only 34 (24%) were referred to PT/OT at discharge. Those referred were more likely to have received an inpatient PT/OT consultation (97% vs. 22%, p < 0.001). Among participants not referred to PT/OT, 46% had impaired SPPB, 58% had impaired FSST, and 60% had slow gait speed, indicating high fall risk. Less than a quarter of older adults with primarily fall-related mTBI received any discharge PT/OT referral despite clear mobility and balance deficits. This critical gap in post-discharge rehabilitation underscores a disconnect between fall-prevention guidelines and clinical practice, leaving many older adults at high risk of recurrent falls and injuries.