Kristen Dams‐O'Connor PhD Laura E. Gibbons PhD Alexandra Landau BA Eric B. Larson MD, MPH Paul K. Crane MD, MPH (2016). Health Problems Precede Traumatic Brain Injury in Older Adults Journal of the American Geriatrics Society, 64(4), 844–848. https://doi.org/10.1111/jgs.14014
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.