San Francisco Veterans Affairs Medical Center, San Francisco, California (Drs Kornblith, Yaffe, and Gardner); Division of General Medicine, University of Michigan Health System, Ann Arbor (Dr Langa); Veterans Affairs Center for Practice Management and Outcomes Research, Washington, District of Columbia (Dr Langa); Institute for Social Research, University of Michigan, Ann Arbor (Dr Langa); Institute of Gerontology, University of Michigan, Ann Arbor (Dr Langa); Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Langa); and Departments of Neurology (Drs Yaffe and Gardner) and Psychiatry & Epidemiology & Biostatistics (Dr Yaffe), University of California San Francisco (UCSF).
J Head Trauma Rehabil. 2020 Jul/Aug;35(4):E320-E329. doi: 10.1097/HTR.0000000000000552.
To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI on these relations.
A total of 1148 respondents to the 2014 Wave of the Health and Retirement Study, a nationally representative survey of older community-dwelling adults, randomly selected to participate in a TBI exposure survey. They reported no prior TBI (n = 737) or prior TBI (n = 411).
Cross-sectional survey study.
Physical impairment (self-reported difficulty with ≥1 of 8 physical activities); FI (self-reported difficulty with ≥1 of 11 activities of daily living); self-reported current neurobehavioral symptoms (pain, sleep problems, depression, subjective memory impairment); The Ohio State University TBI Identification Method (OSU-TBI-ID)-short form.
Stepwise logistic regression models ([1] unadjusted; [2] adjusted for demographics and medical comorbidities; [3] additionally adjusted for neurobehavioral symptoms) compared PI and FI between TBI groups.
Traumatic brain injury-exposed (mean: 33.6 years postinjury) respondents were younger, less likely to be female, and reported more comorbidities and neurobehavioral symptoms. Although TBI was significantly associated with increased odds of PI and FI in unadjusted models and models adjusted for demographics/comorbidities (adjusted odds ratio, 95% confidence interval: PI 1.62, 1.21-2.17; FI 1.60, 1.20-2.14), this association was no longer statistically significant after further adjustment for neurobehavioral symptoms.
History of TBI is associated with substantial PI and FI among community-dwelling older adults. Further research is warranted to determine whether aggressive management of neurobehavioral symptoms in this population may mitigate long-term PI and FI in this population.
研究终生创伤性脑损伤（TBI）史与晚年身体损伤（PI）和功能障碍（FI）的关系，并评估经常与 TBI 同时发生的神经行为症状对这些关系的影响。
共有 1148 名 2014 年健康与退休研究波的受访者参加了这项研究，这是一项针对老年社区居住成年人的全国代表性调查，他们被随机选中参加 TBI 暴露调查。他们报告没有先前的 TBI（n=737）或先前的 TBI（n=411）。
横断面调查研究。
身体损伤（自我报告的≥8 项身体活动中有 1 项困难）；FI（自我报告的≥11 项日常生活活动中有 1 项困难）；自我报告的当前神经行为症状（疼痛、睡眠问题、抑郁、主观记忆障碍）；俄亥俄州立大学 TBI 识别方法（OSU-TBI-ID）-短式。
逐步逻辑回归模型（[1]未调整；[2]调整人口统计学和合并症；[3]进一步调整神经行为症状）比较 TBI 组之间的 PI 和 FI。
创伤性脑损伤暴露组（平均：受伤后 33.6 年）的受访者年龄较小，女性比例较低，合并症和神经行为症状较多。尽管在未调整模型和调整人口统计学/合并症的模型中，TBI 与 PI 和 FI 的几率增加显著相关（调整后的优势比，95%置信区间：PI 1.62，1.21-2.17；FI 1.60，1.20-2.14），但在进一步调整神经行为症状后，这种关联不再具有统计学意义。
TBI 史与社区居住的老年成年人的大量 PI 和 FI 相关。需要进一步研究，以确定在该人群中积极管理神经行为症状是否可以减轻该人群的长期 PI 和 FI。
