Traumatic Brain Injury in Older Adults: A Descriptive & Etiologic Analysis

A two-part study was undertaken to determine the characteristics and incidence of older adults
\nwho sustained a traumatic brain injury (TBI) while in Ontario home care from 2003 to 2013, and
\nto determine the association between depression and sustaining a TBI. Both parts used data from
\nthe Ontario Association of Community Care Access Center?s database. Data were retrieved for
\nall service users 65 years or older who had home care between 2003 and 2013; these data are
\nbased on the Resident Assessment Instrument-Home Care. The variables used in the analyses
\nincluded: TBI, depression, demographics, neurological conditions and history of falling. For the
\ndescriptive component, comparisons of characteristics were made between service users who did
\nand did not sustain a TBI using odds ratios (OR). The ten-year trend of annual cumulative
\nincidence and standardized incidence rates were assessed using regression. For the etiologic
\ncomponent, incident TBI cases were matched to four controls by age, sex and date of assessment.
\nCrude OR?s were determined for the association between depression and TBI. Multivariable
\nconditional logistic regression was used to adjust for potential confounders and identify effect
\nmodifiers. Multivariable estimates were stratified by history of falling. A total of 554,313 service
\nusers were included, of which 5215 (0.9%) had a TBI and 39,048 (7.0%) had depression.
\nCharacteristics associated with TBI were: male sex (OR: 1.54, 95% CI: 1.45, 1.62), aboriginal
\norigin (OR: 1.98; 95% CI: 1.57, 2.50), increasing age (OR: 1.22, 95% CI: 1.09, 1.35 for 70-74;
\nup to OR: 2.31, 95% CI: 2.05, 2.59 for >90; referent group 65-69), being widowed (OR: 1.59,
\n95% CI: 1.41, 1.80), having a history of one or more falls (OR: 2.31, 95% CI: 2.19, 2.44), the
\nuse of antidepressants (OR: 1.49, 95% CI: 1.40, 1.59) and the presence of depression (OR: 1.57,
\n95% CI: 1.43, 1.71), dementia (OR: 1.65, 95% CI: 1.54, 1.76), hemiplegia (OR: 4.34, 95% CI:
\n3.88, 4.85), multiple sclerosis (OR: 3.19, 95% CI: 2.49, 4.08) and parkinsonism (OR: 1.22, 95% CI: 1.07, 1.38). Incidence was significantly higher than previously reported figures in the general
\npopulation. There was a decrease in the annual cumulative incidence over the ten-year period.
\nFemale standardized rates decreased significantly (p<0.05) in a linear fashion while male and
\noverall decreased in a non-linear fashion. The crude OR for the association between depression
\nand TBI was 1.54 (95% CI: 1.43, 1.64). Stratified analyses indicated that the association was
\nsignificantly different for those with a history of falling (OR: 1.45, 95% CI: 1.22, 1.73) and those
\nwithout a history of falling (OR: 1.19, 95% CI: 0.99, 1.42). Multivariable analysis suggested that
\nthere were three significant effect modifiers for the exposure: history of falling, level of
\neducation and Alzheimer?s. As the level of education increased, the association between
\ndepression and TBI became smaller (OR: 1.88, 95% CI: 1.30, 2.70 for 8th grade or less compared
\nto OR: 1.11, 95% CI: 0.78, 1.65 for graduate degree). Service users with a TBI had greater odds
\nof having a history of falling (OR: 1.45, 95% CI: 1.22, 1.73) and being diagnosed with
\nAlzheimer?s Disease (OR: 1.18, 95% CI: 1.05, 1.32). Longitudinal studies are needed to confirm
\nthis finding, as our study was cross-sectional in nature, and to investigate the association between
\nother chronic conditions and TBI.

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