Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

Affiliations

¹ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: raj.kumar@mountsinai.org.
² Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
³ Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas.
⁴ Departments of Physical Medicine & Rehabilitation and Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Kessler Institute for Rehabilitation, Rutgers University, West Orange, New Jersey.
⁷ Departments of Ophthalmology & Visual Sciences & Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama.
⁸ Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts.
⁹ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁰ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 39374687
PMCID: PMC11968243 (available on 2026-04-01)
DOI: 10.1016/j.apmr.2024.09.012

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

Raj G Kumar et al. Arch Phys Med Rehabil. 2025 Apr.

. 2025 Apr;106(4):517-526.

doi: 10.1016/j.apmr.2024.09.012. Epub 2024 Oct 5.

Authors

Affiliations

¹ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: raj.kumar@mountsinai.org.
² Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
³ Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas.
⁴ Departments of Physical Medicine & Rehabilitation and Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Kessler Institute for Rehabilitation, Rutgers University, West Orange, New Jersey.
⁷ Departments of Ophthalmology & Visual Sciences & Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama.
⁸ Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts.
⁹ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁰ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.

PMID: 39374687
PMCID: PMC11968243 (available on 2026-04-01)
DOI: 10.1016/j.apmr.2024.09.012

Abstract

Objective: To examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry.

Design: Secondary analysis of a longitudinal prospective cohort study.

Setting: TBI Model Systems centers.

Participants: Community-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury.

Interventions: Not applicable.

Main outcome measures: Homebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry.

Results: In our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y).

Conclusions: The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

Keywords: Discharge planning; Home discharge; Homebound; Post-acute; Rehabilitation; Social isolation; Traumatic brain injury.

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Conflict of interest statement

Conflicts: The authors have no conflicts of interest to report.

References

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Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

Affiliations

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical