Characteristics and Incidence of Traumatic Brain Injury in Older Adults Using Home Care in Ontario from 2003-2013.

OBJECTIVES: Describe the characteristics and determine the annual cumulative incidence of traumatic brain injury (TBI) in older adults receiving home care in Ontario from 2003 to 2013.

METHODS: A retrospective cohort study of longitudinal data from the Ontario Association of Community Care Access Centers (N = 554,313). TBI, demographic variables, depression, neurological conditions, and recent falls were measured from the Resident Assessment Instrument-Home Care. Comparisons were made between service users with and without TBI using odds ratios. Standardized incidence rates were calculated and the 10-year trend of annual cumulative incidence rates was examined.

RESULTS: Characteristics associated with TBI: male sex (OR: 1.54), aboriginal origin (OR: 1.98), increasing age (low of OR: 1.22, in 70-74 years; high of OR: 2.31, in 90 years and older; comparison 65-69 years), being widowed (OR: 1.59), having one or more falls (OR: 2.31), the use of antidepressants (OR: 1.49) and the presence of depression (OR: 1.57), dementia (OR: 1.65), hemiplegia (OR: 4.34), multiple sclerosis (OR: 3.19) or parkinsonism (OR: 1.22). TBI incidence was significantly higher than rates previously reported in the literature. There was no change in the overall annual cumulative incidence over the 10-year period (p = .13).

CONCLUSIONS: Certain demographic characteristics, neurological diseases, antidepressant use, and a recent fall are associated with TBI. Incidence of TBI is higher than previous estimates and the overall incidence is not changing over time. These results can be used to improve care of the elderly and to generate hypotheses for future research regarding TBI in the home care setting.