Original article
Influence of Sex and Age on Inpatient Rehabilitation Outcomes Among Older Adults With Traumatic Brain Injury

https://doi.org/10.1016/j.apmr.2009.09.017Get rights and content

Abstract

Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury.

Objective

To assess the influence of sex and age on inpatient rehabilitation outcomes in a large national sample of older adults with traumatic brain injury (TBI).

Design

Prospective case series.

Setting

Eight hundred forty-eight inpatient rehabilitation facilities that subscribe to the Uniform Data System for Medical Rehabilitation.

Participants

Patients (n=18,413) age 65 years and older admitted for inpatient rehabilitation after TBI from 2005 through 2007.

Interventions

None.

Main Outcome Measures

Rehabilitation length of stay, discharge FIM motor and cognitive ratings, discharge setting, and scheduled home health services at discharge.

Results

Mean age ± SD of the sample was 79±7 years, and 47% were women. In multivariable models, higher age was associated with shorter lengths of stay (P<.001), lower discharge FIM motor and cognitive ratings (P<.001), and greater odds of home health services at discharge (P<.001). Women demonstrated shorter lengths of stay (P=.006) and greater odds of being scheduled for home health services at discharge (P<.001) than men. The sex-by-age interaction term was not significant in any outcome model. Sex differences and trends were consistent across the entire age range of the sample.

Conclusions

Sex and age patterns in rehabilitation outcomes among older adults with TBI varied by outcome. The current findings related to rehabilitation length of stay may be helpful for facility-level resource planning. Additional studies are warranted to identify the factors associated with returning to home and to assess the long-term benefits of combined inpatient rehabilitation and home health services for older adults with TBI.

Section snippets

Data Source

Data were obtained from the Uniform Data System for Medical Rehabilitation.20 Admission and discharge information were collected from patient medical records contained within the inpatient rehabilitation facility–patient assessment instrument.21

Study Sample

The inclusion criteria for this study included patients who were (1) being admitted for initial inpatient rehabilitation services after TBI, (2) age 65 years or older at the time of admission, (3) living at home prior to injury, and (4) discharged from

Sample Characteristics

Women represented 47% of the 18,413 older adults (mean age ± SD, 79±7y) in our sample who received inpatient rehabilitation after TBI from 2005 through 2007. The sample was predominantly white, slightly more than half were married, and approximately one third was living alone at the time of the injury. More than 97% of patients experienced closed head injuries, and the mean rehabilitation admission delay was 13 days. On average, patients had 8 comorbid conditions and admission FIM total scores

Discussion

Few studies have examined older adults with TBI exclusively,19 and relatively little is known regarding the differences within and between groups of older women and men.24 This study provides a broad snapshot of admission characteristics and outcomes for adults age 65 years and older admitted to inpatient rehabilitation after TBI, and it highlights the influence of sex and age on rehabilitation outcomes. We hypothesized that women would generally fare better than men and that the sex advantage

Conclusions

We identified certain differences in inpatient rehabilitation outcomes between older women and men with TBI. Age was significantly related to 4 of the 5 outcomes included in this study. Home discharge was the only outcome not significantly associated with age. The sex-by-age interaction term did not reach significance in any models, suggesting that the main effects for sex are consistent across the entire age range of older adults in our sample. Multivariable analyses showed that motor and

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  • Cited by (0)

    Supported in part by the National Institute on Disability and Rehabilitation Research (grant no. H133G080163) and the National Institutes of Health, National Institute for Child Health and Human Development and National Institute for Neurological Disorders and Stroke (grant no. K12-H0055929).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Granger is employed by the State University of New York at Buffalo, which is affiliated with the Uniform Data System for Medical Rehabilitation. The Uniform Data System for Medical Rehabilitation owns the copyright and trademark for the FIM instrument.

    Reprints are not available from the author.

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