Functional Outcomes and Cognitive Interventions in Older People following Traumatic Brain Injury

Among older adults, traumatic brain injuries (TBIs) become a significant public health problem because the segment of the population is increasing and improvement of medical technology leads to increased survival of older TBI victims. Older people contribute more than 60% of TBIs, and those aged 65 years and older have greater risk of TBI deaths and hospitalizations than any other age group. Despite tremendous economic cost of treating TBI in older patients, information on their functional outcomes and effective cognitive interventions are very limited. In this 4-year project, we design a longitudinal cohort study, and a randomized trial to address important issues for older people with TBI. Two specific aims are targeted in this research. First, functional changes in the physical (eg, balance, mobility, falls, activities of daily living, hospital admissions, mortality, and global TBI outcome), cognitive (eg, attention, memory, speed of processing, and executive function), and psychosocial (eg, posttraumatic stress disorder, depression, employment, relocation, and health-related quality of life) over an 18-month period among 240 older TBI patients will be investigated and compared with 120 young TBI patients and 120 healthy older people. Influential factors for changes in each functional outcome will also be determined. Second, the effectiveness of computerized cognitive rehabilitation, tai chi exercise, and usual care in improving cognitive functions and secondary outcomes (ie, physical and psychosocial functions) over a 6-month intervention period among 159 older TBI adults (53 subjects for each intervention group) will be compared. The adherence rates to the three intervention programs will also be examined at 6- and 12-months after intervention.