TBI and Health in Older Adults: An Exploratory Study
Principal Investigator: Marcel Dijkers, PhD; Co-Principal Investigator: Kristen Dams-O’Connor, PhD; Project period: 2012-2015
Despite growing rates of TBI in the elderly, our understanding of the consequences of TBI in older people is limited. The long-term clinical course of TBI appears to unfold heterogeneously, as some people experience accelerated decline, earlier onset of age-related diseases, or even death, while in others the course of aging is similar to the norm. It is well known that falls are the most common cause of TBI in this age group, that older adults tend to have poorer post-injury outcomes than younger adults and that TBI is associated with premature death. It is not known whether the decline seen in many elderly individuals with TBI represents a continuation of a pre-existing disease process, possibly interacting with the effects of the TBI, or if TBI is the causal trigger in stimulating subsequent decline in a previously healthy person. The mechanisms leading to accelerated decline have not been adequately investigated, and despite well-documented reductions in life expectancy among elderly survivors of TBI, little is known about the true causes of disease and death in these individuals. Better understanding of the factors that lead to TBI and that influence health outcomes after TBI in the elderly can elucidate opportunities for prevention of TBI and secondary/tertiary prevention of its consequences in this at-risk group.
The goals of this project are: (a) to begin to address critical gaps in our current knowledge regarding TBI and aging and (b) to demonstrate the feasibility and utility of methodologies that will allow collection of these data in future large-scale longitudinal studies of TBI in the aged and of aging post TBI.
- Aim 1: To examine whether there is evidence of poorer health status in the year preceding the index injury among older adults who sustain a TBI, compared to matched controls without TBI.
- We are collecting retrospective data on health status in the year prior to injury in a sample (n=170) of individuals with TBI over the age of 45 who are admitted to the Mount Sinai Brain Injury Rehabilitation Unit (MSBIRU). Data will be collected both from individuals with TBI and their informants or next of kin (NOK) through interviews. This data will be compared with that of matched controls who provided comprehensive information about their health status in the past year as part of an ongoing nationally representative study of health status in mid-life and older adults, MIDUS II.
- The utility, accuracy and completeness of a standardized structured interview to obtain pre-injury health status of individuals with TBI will be examined through comparison of self-reported health status to entries in the medical record.
- Aim 2: To compare the health status of older adults with and without TBI, and investigate the extent to which injury factors (e.g., severity, etiology, time since injury), cognitive functioning, demographics and lifestyle factors (e.g., exercise, community participation) account for differences in overall health.
- We will administer a brief neurocognitive assessment and a comprehensive health interview via telephone to a sample of individuals who sustained a TBI over the age of 45 and received inpatient care at the MSBIRU since 2002 (n=280). Data will be compared to that of a sample of matched controls drawn from the MIDUS II study.
- The feasibility of collecting data using a telephone-administered cognitive assessment will be demonstrated in a sample of community-dwelling individuals with TBI.
- Aim 3: To characterize the cause(s) leading to or potentially contributing to death among older adults who survive at least one year post TBI.
- We will modify an existing standardized postmortem interview (verbal autopsy) and conduct interviews with the NOK of individuals who have received inpatient TBI care at the MSBIRU since 2002 and who die during the project period (projected n=30). These data will be supplemented with those available from decedents’ medical records.
- The incremental value of postmortem interview data in understanding factors leading to death after TBI will be determined by comparison with data available from decedents’ death certificates and recent medical records.