Research Reports - Health problems precede traumatic brain injury in older adults

J Am Geriatr Soc. 2016 Apr;64(4):844-8. doi: 10.1111/jgs.14014. Epub 2016 Mar 1.

Dams-O'Connor K(1), Gibbons LE(2), Landau A(1), Larson EB(3), Crane PK(2).

OBJECTIVES: To evaluate whether indices of preinjury health and functioning are
associated with risk of incident traumatic brain injury (TBI) with loss of
consciousness (LOC) and to evaluate health-related factors associated with
mortality in individuals with incident TBI.
DESIGN: Prospective community cohort study.
SETTING: Group Health, Seattle, Washington.
PARTICIPANTS: Individuals aged 65 and older with no self-reported prior TBI with
LOC (N = 3,363) were enrolled and followed every 2 years for an average of 7.5
years (range 0-18 years).
MEASUREMENTS: Weibull survival models were used to evaluate baseline and
time-varying predictors of incident TBI with LOC, including measures of
depression, activities of daily living (ADLs), cerebrovascular disease, and
disease comorbidity.
RESULTS: In an adjusted multivariate model, baseline depression symptoms as
measured according to Center for Epidemiologic Studies Depression Scale (CES-D)
score (hazard ratio (HR) for 4 points = 1.23, 95% confidence interval (CI) =
1.02-1.49, P = .03) and baseline activity of daily living (ADL) impairment (HR =
2.37, 95% CI = 1.24-4.53, P = .009) were associated with incident TBI. In a model
that included time-dependent covariates, cerebrovascular disease at the previous
visit (HR = 2.28, 95% CI = 1.37-3.78, P < .001), CES-D score the previous visit
(HR for 4 points = 1.23, 95% CI = 1.02-1.49, P < .04) and baseline ADL impairment
(HR 2.14, 95% CI = 1.11-4.13, P = .02) predicted incident TBI. Of factors
considered, cerebrovascular disease and ADL impairment were associated with
earlier mortality in participants with incident TBI with LOC.
CONCLUSION: Indices of health, mood, and functional status predict incident TBI
with LOC in older adults. These findings may have implications for injury
prevention and postinjury clinical management. 

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