Rehabilitation outcomes in elderly patients with traumatic brain injury in Singapore.

OBJECTIVE

To identify and characterize injury variables and outcomes in persons with traumatic brain injury (TBI) 55 years and older admitted to a tertiary rehabilitation unit.

DESIGN

Retrospective study of 52 individuals with TBI covering a 4-year period.

OUTCOME MEASURES

Admission and discharge Modified Barthel Index scores; total acute and rehabilitation length of stay; Glasgow Coma Scale (GCS); duration of posttraumatic amnesia (PTA); Glasgow Outcome Scale at discharge and at 6 months postinjury; Ranchos Los Amigos Scale; and discharge disposition.

RESULTS

Most common mechanism of injury was falls (61.5%), and predominant computed tomographic scan finding was lobar contusion (44%). Thirty-one percent had GCS score less than 9, but 90% had PTA duration of more than 1 week. Mean length of stay in acute and rehabilitation facilities was 26.4 (SD = 15.9) days and 29.8 (SD = 14.4) days, respectively. Difference between admission and discharge Modified Barthel Index was significant (P < .001), and 90% were discharged home. There was improvement in Glasgow Outcome Scale score at 6 months.

CONCLUSIONS

Most patients in this cohort had severe brain injury, which may be due to a higher incidence of intracerebral hematoma. The GCS score underestimates the severity of brain injury in elderly persons with TBI; PTA duration was more representative of severity. Older patients with TBI do benefit from rehabilitation with significant functional gains and a high rate of return to home and to community.