TY - JOUR
T1 - Association of Lifetime TBI and Military Employment with Late Life ADL Functioning
T2 - A Population-Based Prospective Cohort Study
AU - Tabio, Laura
AU - Walker, Rod L.
AU - Crane, Paul K.
AU - Gibbons, Laura E.
AU - Kumar, Raj G.
AU - Power, Melinda C.
AU - Kelley, Amy S.
AU - Larson, Eric B.
AU - Dams-O'Connor, Kristen
N1 - Funding Information:
Supported by the US Department of Defense Peer Reviewed Alzheimer's Research Program ( PRARP; grant no. W81XWH-17-1-0330 ) and the US National Institute on Aging (grant nos. U01 AG006781 , U19 AG066567, P50 AG05136 , K24AG062785 ).
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Activities of daily living
KW - Brain injuries, traumatic
KW - Military personnel
KW - Prospective cohort studies
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85116719570&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2021.06.018
DO - 10.1016/j.apmr.2021.06.018
M3 - Article
C2 - 34283993
AN - SCOPUS:85116719570
SN - 0003-9993
VL - 102
SP - 2316-2324.e1
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 12
ER -