Rehabilitation outcomes in elderly patients with traumatic brain injury in Singapore.

OBJECTIVE: To identify and characterize injury variables and outcomes in persons with traumatic brain injury (TBI) 55 years and older admitted to a tertiary rehabilitation unit.

DESIGN: Retrospective study of 52 individuals with TBI covering a 4-year period.

OUTCOME MEASURES: Admission and discharge Modified Barthel Index scores; total acute and rehabilitation length of stay; Glasgow Coma Scale (GCS); duration of posttraumatic amnesia (PTA); Glasgow Outcome Scale at discharge and at 6 months postinjury; Ranchos Los Amigos Scale; and discharge disposition.

RESULTS: Most common mechanism of injury was falls (61.5%), and predominant computed tomographic scan finding was lobar contusion (44%). Thirty-one percent had GCS score less than 9, but 90% had PTA duration of more than 1 week. Mean length of stay in acute and rehabilitation facilities was 26.4 (SD = 15.9) days and 29.8 (SD = 14.4) days, respectively. Difference between admission and discharge Modified Barthel Index was significant (P < .001), and 90% were discharged home. There was improvement in Glasgow Outcome Scale score at 6 months.

CONCLUSIONS: Most patients in this cohort had severe brain injury, which may be due to a higher incidence of intracerebral hematoma. The GCS score underestimates the severity of brain injury in elderly persons with TBI; PTA duration was more representative of severity. Older patients with TBI do benefit from rehabilitation with significant functional gains and a high rate of return to home and to community.