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. 2021 Dec;102(12):2316-2324.e1.
doi: 10.1016/j.apmr.2021.06.018. Epub 2021 Jul 18.

Association of Lifetime TBI and Military Employment with Late Life ADL Functioning: A Population-Based Prospective Cohort Study

Laura Tabio  1 , Rod L Walker  2 , Paul K Crane  3 , Laura E Gibbons  3 , Raj G Kumar  4 , Melinda C Power  5 , Amy S Kelley  6 , Eric B Larson  2 , Kristen Dams-O'Connor  7
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Association of Lifetime TBI and Military Employment with Late Life ADL Functioning: A Population-Based Prospective Cohort Study

Laura Tabio et al. Arch Phys Med Rehabil. 2021 Dec.

Abstract

Objective: To determine associations of traumatic brain injury (TBI) and military employment with activities of daily living (ADL) in late life.

Design: Population-based prospective cohort study with biennial follow-up and censoring at the time of dementia diagnosis.

Setting: Community-based integrated health care delivery system.

Participants: Participants (N=4953) were men (n=2066) and women (n=2887) aged ≥65 years who were dementia free.

Interventions: Not applicable.

Main outcome measures: ADL difficulties at baseline and accumulation during follow-up.

Results: TBI with loss of consciousness (LOC) before the age of 40 years was associated with slightly higher ADL difficulty at baseline for women (rate ratio [RR], 1.44; 95% confidence interval [CI], 1.08-1.93; P=.01). For men, TBI with LOC at any age was associated with greater ADL difficulty at baseline (age <40y: RR, 1.58; 95% CI, 1.20-2.08; P=.001; age ≥40y: RR, 2.14; 95% CI, 1.24-3.68; P=.006). TBI with LOC was not associated with the rate of accumulation of ADL difficulties over time in men or women. There was no evidence of an association between military employment and either outcome, nor of an interaction between military employment and TBI with LOC. Findings were consistent across a variety of sensitivity analyses.

Conclusions: Further investigation into factors underlying greater late life functional impairment among survivors of TBI is warranted.

Keywords: Activities of daily living; Brain injuries, traumatic; Military personnel; Prospective cohort studies; Rehabilitation.

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Figures

Figure 1.
Figure 1.
Distribution of difficulties with activities of daily living reported at study baseline and during follow-up, stratified by history of traumatic brain injury with loss of consciousness. Solid line provides the average number of reported ADL difficulties at each time point.
Figure 2.
Figure 2.
Distribution of difficulties with activities of daily living reported at study baseline and during follow-up, stratified by history of military employment. Solid line provides the average number of reported ADL difficulties at each time point.
See this image and copyright information in PMC

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