Citation

Bailey MD, Gambert S, Gruber-Baldini A, Guralnik J, Kozar RA, Qato D, Shardell M, Albrecht JS. J. Neurotrauma 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2022.0003

PMID

unavailable

Abstract

Traumatic brain injury (TBI) is a leading cause of injury-related disability among older adults and there is increasing interest in post-discharge management as this population grows. We evaluated the association between TBI and long-term nursing home (NH) entry among a nationally representative sample of older adults. We identified 207,355 adults aged ≥ 65 years who were diagnosed with either a TBI, non-TBI trauma, or were uninjured between January 2008 and June 2015 from a 5% sample of Medicare beneficiaries. NH entry was operationalized as the first NH admission that resulted in a stay ≥100 days. Time to NH entry was calculated as the difference between the NH entry date and the index date (the date of TBI, non-TBI trauma, or inpatient/outpatient visit in the uninjured group). We used cause specific Cox proportional hazards models with stabilized inverse probability of exposure weights to model time to NH entry as a function of injury in the presence of death as a competing risk and generated hazard ratios (HR) and 95% confidence intervals (CI). After excluding beneficiaries living in a NH at index, there were 60,600 TBI, 63,762 non-TBI trauma, and 69,893 uninjured beneficiaries in the sample. In weighted models, beneficiaries with TBI entered NHs at higher rates relative to the non-TBI trauma (HR 1.15; 95% CI 1.10, 1.20) and uninjured (HR 1.67; 95% CI 1.60, 1.74) groups. Future research should focus on interventions to retain older adult TBI survivors within the community.

Language: en

Keywords

EPIDEMIOLOGY; GERIATRIC BRAIN INJURY; TRAUMATIC BRAIN INJURY