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Published Online:https://doi.org/10.3928/19404921-20190610-01

Abstract

The purpose of the current study is to describe the experience and perceptions of older adults and their caregivers following hospitalization for mild or moderate traumatic brain injury (TBI). Qualitative analysis of data obtained in individual semi-structured interviews with older adults and their caregivers (N = 11, five dyads and one individual) was performed to capture the perceptions and experiences of the survivor and their caregivers about the acute injury, hospitalization, and recovery. Data were collected over a 2-month period following discharge from the hospital. Open coding and constant comparative analysis generated codes that were revised throughout the analysis and reformulated into thematic descriptions. As a result, seven interrelated themes were identified. These findings can be used to implement interventions focused on recovery, communication, teaching, patient outcomes, and satisfaction.

[Res Gerontol Nurs. 2019; 12(5):227–238]

  • Administration on Aging. (2018). A profile of older Americans: 2018. Retrieved from https://acl.gov/aging-and-disability-in-america/data-and-research/profile-older-americans

    Google Scholar
  • Aitken M.E., McCarthy M.L., Slomine B.S., Ding R., Durbin D.R., Jaffe K.M., Mackenzie E.J. (2009). Family burden after traumatic brain injury in children. Pediatrics, 123, 199–206.10.1542/peds.2008-0607

    CrossrefGoogle Scholar
  • Bakas T., Austin J.K., Okonkwo K.F., Lewis R.R., Chadwick L.C. (2002). Needs, concerns, strategies, and advice of stroke caregivers the first 6 months after discharge. Journal of Neuroscience Nursing, 34, 242–251.10.1097/01376517-200210000-00004

    CrossrefGoogle Scholar
  • Bakas T., Farran C.J., Austin J.K., Given B.A., Johnson E.A., Williams L.S. (2009). Stroke caregiver outcomes from the telephone assessment and skill-building kit (TASK). Topics in Stroke Rehabilitation, 16, 105–121.10.1310/tsr1602-105

    CrossrefGoogle Scholar
  • Boeije H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36, 391–409.10.1023/A:1020909529486

    CrossrefGoogle Scholar
  • Boltz M.P., Capezuti E., Shuluk J., Brouwer J., Carolan D., Conway S., Galvin J.E. (2013). Implementation of geriatric acute care best practices: Initial results of the NICHE SITE self-evaluation. Nursing Health Sciences, 15, 518–524.10.1111/nhs.12067

    CrossrefGoogle Scholar
  • Boltz M.P., Capezuti E., Wagner L., Rosenberg M.C., Secic M. (2013). Patient safety in medical-surgical units: Can nurse certification make a difference?Medsurg Nursing, 22, 26–37.

    Google Scholar
  • Bower J.H., Maraganore D.M., Peterson B.J., McDonnell S.K., Ahlskog J.E., Rocca W.A. (2003). Head trauma preceding PD: A case-control study. Neurology, 60, 1610–1615.10.1212/01.WNL.0000068008.78394.2C

    CrossrefGoogle Scholar
  • Carlozzi N.E., Kratz A.L., Sander A.M., Chiaravalloti N.D., Brickell T.A., Lange R.T., Tulsky D.S. (2015). Health-related quality of life in caregivers of individuals with traumatic brain injury: Development of a conceptual model. Archives of Physical Medicine and Rehabilitation, 96, 105–113.10.1016/j.apmr.2014.08.021

    CrossrefGoogle Scholar
  • Cifu D.X., Kreutzer J.S., Kolakowsky-Hayner S.A., Marwitz J.H., Englander J. (2003). The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: A multicenter analysis. Archives of Physical Medicine and Rehabilitation, 84, 1441–1448.10.1016/S0003-9993(03)00272-7

    CrossrefGoogle Scholar
  • Coronado V.G., Thomas K.E., Sattin R.W., Johnson R.L. (2005). The CDC traumatic brain injury surveillance system: Characteristics of persons aged 65 years and older hospitalized with a TBI. Journal of Head Trauma Rehabilitation, 20, 215–228.10.1097/00001199-200505000-00005

    CrossrefGoogle Scholar
  • Dobrez D.G., Lo Sasso A.T., Heinemann A.W. (2004). The effect of prospective payment on rehabilitative care. Archives of Physical Medicine and Rehabilitation, 85, 1909–1914.10.1016/j.apmr.2004.06.064

    CrossrefGoogle Scholar
  • Donohue J.T., Clark D.E., DeLorenzo M.A. (2007). Long-term survival of Medicare patients with head injury. Journal of Trauma, 62, 419–423.10.1097/01.ta.0000219286.88179.18

    CrossrefGoogle Scholar
  • Draper K., Ponsford J., Schonberger M. (2007). Psychosocial and emotional outcomes 10 years following traumatic brain injury. Retrieved from https://psycnet.apa.org/doi/10.1097/01.HTR.0000290972.63753.a7

    Google Scholar
  • Faul M., Xu L., Wald M.M., Coronado V.G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

    Google Scholar
  • Flaada J.T., Leibson C.L., Mandrekar J.N., Diehl N., Perkins P.K., Brown A.W., Malec J. (2007). Relative risk of mortality after traumatic brain injury: A population-based study of the role of age and injury severity. Journal of Neurotrauma, 24, 435–445.10.1089/neu.2006.0119

    CrossrefGoogle Scholar
  • Frankel J.E., Marwitz J.H., Cifu D.X., Kreutzer J.S., Englander J., Rosenthal M. (2006). A follow-up study of older adults with traumatic brain injury: Taking into account decreasing length of stay. Archives of Physical Medicine and Rehabilitation, 87, 57–62.10.1016/j.apmr.2005.07.309

    CrossrefGoogle Scholar
  • Gan C., Campbell K.A., Gemeinhardt M., McFadden G.T. (2006). Predictors of family system functioning after brain injury. Brain Injury, 20, 587–600.10.1080/02699050600743725

    CrossrefGoogle Scholar
  • Gomez-Hernandez R., Max J.E., Kosier T., Paradiso S., Robinson R.G. (1997). Social impairment and depression after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 78, 1321–1326.10.1016/S0003-9993(97)90304-X

    CrossrefGoogle Scholar
  • Granger C.V., Cotter A.C., Hamilton B.B., Fiedler R.C. (1993). Functional assessment scales: A study of persons after stroke. Archives of Physical Medicine and Rehabilitation, 74, 133–138.

    Google Scholar
  • Jones A.L., Charlesworth J.F., Hendra T.J. (2000). Patient mood and carer strain during stroke rehabilitation in the community following early hospital discharge. Disability and Rehabilitation, 22, 490–494.10.1080/096382800413970

    CrossrefGoogle Scholar
  • Itshayek E., Rosenthal G., Fraifeld S., Perez-Sanchez X., Cohen J.E., Spektor S. (2006). Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation. Neurosurgery, 58, 851–856.10.1227/01.NEU.0000209653.82936.96

    CrossrefGoogle Scholar
  • Kiraly M., Kiraly S.J. (2007). Traumatic brain injury and delayed sequelae: A review–traumatic brain injury and mild traumatic brain injury (concussion) are precursors to later-onset brain disorders, including early-onset dementia. Scientific World Journal, 7, 1768–1776.10.1100/tsw.2007.269

    CrossrefGoogle Scholar
  • Kratz A.L, Sander A.M., Brickell T.A., Lange R.T., Carlozzi N.E. (2017). Traumatic brain injury caregivers: A qualitative analysis of spouse and parent perspectives on quality of life. Neuropsychological Rehabilitation, 27, 16–37.10.1080/09602011.2015.1051056

    CrossrefGoogle Scholar
  • Langhorne P., Bernhardt J., Kwakkel G. (2011) Stroke rehabilitation. Lancet, 14, 1693–1702.10.1016/S0140-6736(11)60325-5

    CrossrefGoogle Scholar
  • LeBlanc J., de Guise E., Gosselin N., Feyz M. (2006). Comparison of functional outcome following acute care in young, middle-aged, and elderly patients with traumatic brain injury. Brain Injury, 20, 779–790.10.1080/02699050600831835

    CrossrefGoogle Scholar
  • Li C.Y., Karmarkar A., Adhikari D., Ottenbacher K., Kuo Y.F. (2018). Effects of age and sex on hospital readmission in traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 99, 1279–1288.10.1016/j.apmr.2017.12.006

    CrossrefGoogle Scholar
  • Liang P., Tsai Y., Liang C., Lee T., Chen H. (2002). Chronic subdural haematoma in young and extremely aged adults: A comparative study of two age groups. Injury, 33, 345–348.10.1016/S0020-1383(02)00020-7

    CrossrefGoogle Scholar
  • Lin W.C., Kane R.L., Mehr D.R., Madsen R.W., Petroski G.F. (2006). Changes in the use of postacute care during the initial Medicare payment reforms. Health Services Research, 41, 1338–1356.10.1111/j.1475-6773.2006.00546.x

    CrossrefGoogle Scholar
  • McCall N., Korb J., Petersons A., Moore S. (2003). Reforming Medicare payment: Early effects of the 1997 Balanced Budget Act on postacute care. Millbank Quarterly, 81, 277–303.10.1111/1468-0009.t01-1-00054

    CrossrefGoogle Scholar
  • McCullagh E., Brigstocke G., Donaldson N., Kalra L. (2005). Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke, 36, 2181–2186.10.1161/01.STR.0000181755.23914.53

    CrossrefGoogle Scholar
  • Mishel M.H. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258–263.10.1097/00006199-198109000-00002

    CrossrefGoogle Scholar
  • Mishel M.H. (1997). Uncertainty in acute illness. Annual Review of Nursing Research, 15, 57–80.10.1891/0739-6686.15.1.57

    CrossrefGoogle Scholar
  • Mishel M.H., Braden C.J. (1988). Finding meaning: Antecedents of uncertainty in illness. Nursing Research, 37, 98–103.10.1097/00006199-198803000-00009

    CrossrefGoogle Scholar
  • Mishel M.H., Sorenson D.S. (1991). Uncertainty in gynecological cancer: A test of the mediation functions of mastery and coping. Nursing Research, 40, 167–171.10.1097/00006199-199105000-00010

    CrossrefGoogle Scholar
  • Mosenthal A.C., Lavery R.F., Addis M., Kaul S., Ross S., Marburger R., Livingston D.H. (2002). Isolated traumatic brain injury: Age is an independent predictor of mortality and early outcome. Journal of Trauma, 52, 907–911.

    Google Scholar
  • Mosenthal A.C., Livingston D.H., Lavery R.F., Knudson M.M., Lee S., Morabito D., Coimbra R. (2004). The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. Journal of Trauma, 56, 1042–1048.10.1097/01.TA.0000127767.83267.33

    CrossrefGoogle Scholar
  • Murray P.K., Love T.E., Dawson N.V., Thomas C.L., Cebul R.D. (2005). Rehabilitation services after the implementation of the nursing home prospective payment system: Differences related to patient and nursing home characteristics. Medical Care, 43, 1109–1115.10.1097/01.mlr.0000182490.09539.1e

    CrossrefGoogle Scholar
  • Naylor M.D., Brooten D.A., Campbell R.L., Maislin G., McCauley K.M., Schwartz J.S. (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial. Journal of the American Geriatrics Society, 52, 675–684.10.1111/j.1532-5415.2004.52202.x

    CrossrefGoogle Scholar
  • Paddock S.M., Escarce J.J., Hayden O., Buntin M.B. (2007). Did the Medicare inpatient rehabilitation facility prospective payment system result in changes in relative patient severity and relative resource use?Medical Care, 45, 123–130.10.1097/01.mlr.0000250863.65686.bc

    CrossrefGoogle Scholar
  • Papa L., Mendes M.E., Braga C.F. (2012). Mild traumatic brain injury among the geriatric population. Current Translational Geriatrics and Experimental Gerontology Reports, 1, 135–142.10.1007/s13670-012-0019-0

    CrossrefGoogle Scholar
  • Phillips S., Montague J., Archer S. (2017). “A peculiar time in my life”: Making sense of illness and recovery with gynaecological cancer. International Journal of Qualitative Studies on Health and Well-Being, 12, 1–9.10.1080/17482631.2017.1364603

    CrossrefGoogle Scholar
  • Qadeer A., Khalid U., Amin M., Murtaza S., Khaliq M.F., Shoaib M. (2017). Caregiver's burden of the patients with traumatic brain injury. Cureus, 9, e1590.10.7759/cureus.1590

    CrossrefGoogle Scholar
  • Rapoport M.J., Feinstein A. (2001). Age and functioning after mild traumatic brain injury: The acute picture. Brain Injury, 15, 857–864.10.1080/02699050110065303

    CrossrefGoogle Scholar
  • Rapoport M.J., Herrmann N., Shammi P., Kiss A., Phillips A., Feinstein A. (2006). Outcome after traumatic brain injury sustained in older adulthood: A one-year longitudinal study. American Journal of Geriatric Psychiatry, 14, 456–465.10.1097/01.JGP.0000199339.79689.8a

    CrossrefGoogle Scholar
  • Rapoport M.J., Kiss A., Feinstein A. (2006). The impact of major depression on outcome following mild-to-moderate traumatic brain injury. Journal of Affective Disorders, 92, 273–276.10.1016/j.jad.2005.05.022

    CrossrefGoogle Scholar
  • Rapoport M.J., McCullagh S., Streiner D., Feinstein A. (2003). The clinical significance of major depression following mild traumatic brain injury. Psychosomatics, 44, 31–37.10.1176/appi.psy.44.1.31

    CrossrefGoogle Scholar
  • Rasmusson D.X., Brandt J., Martin D.B., Folstein M.F. (1995). Head injury as a risk factor in Alzheimer's disease. Brain Injury, 9, 213–219.10.3109/02699059509008194

    CrossrefGoogle Scholar
  • Richmond T.S., Thompson H.J., Deatrick J.A., Kauder D.R. (2000). Journey towards recovery following physical trauma. Journal of Advanced Nursing, 32, 1341–1347.10.1046/j.1365-2648.2000.01629.x

    CrossrefGoogle Scholar
  • Rigby H., Gibitz G., Phillips S. (2009). A systematic review of caregiver burden following stroke. International Journal of Stroke, 4, 85–92.10.1111/j.1747-4949.2009.00289.x

    CrossrefGoogle Scholar
  • Ritchie P.D., Cameron P.A., Ugoni A.M., Kaye A.H. (2000). A study of the functional outcome and mortality in elderly patients with head injuries. Journal of Clinical Neuroscience, 7, 301–304.10.1054/jocn.1999.0198

    CrossrefGoogle Scholar
  • Rothweiler B., Temkin N.R., Dikmen S.S. (1998). Aging effect on psychosocial outcome in traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 79, 881–887.10.1016/S0003-9993(98)90082-X

    CrossrefGoogle Scholar
  • Sandelowski M. (1995). Sample size in qualitative research. Research in Nursing and Health, 18, 179–183.10.1002/nur.4770180211

    CrossrefGoogle Scholar
  • Sandelowski M. (2000). Whatever happened to qualitative description?Research in Nursing Health, 23, 334–340.10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G

    CrossrefGoogle Scholar
  • Shiel A., Burn J.P., Henry D., Clark J., Wilson B.A., Burnett M.E., McLellan D.L. (2001). The effects of increased rehabilitation therapy after brain injury: Results of a prospective controlled trial. Clinical Rehabilitation, 15, 501–514.10.1191/026921501680425225

    CrossrefGoogle Scholar
  • Starkstein S.E., Jorge R. (2005). Dementia after traumatic brain injury. International Journal of Psychogeriatrics, 17, 93–107.10.1017/S1041610205001973

    CrossrefGoogle Scholar
  • Taylor C.A., Bell J.M., Breiding M.J., Xu L. (2017). Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. Morbidity and Mortality Weekly Report Surveillance Summary, 66, 1–16.10.15585/mmwr.ss6609a1

    CrossrefGoogle Scholar
  • Thompson H.J., Weir S., Rivara F.P., Wang J., Sullivan S.D., Salkever D., MacKenzie E.J. (2012). Utilization and costs of health care after geriatric traumatic brain injury. Journal of Neurotrauma, 29, 1864–1871.10.1089/neu.2011.2284

    CrossrefGoogle Scholar
  • van den Heuvel E.T., de Witte L.P., Schuve L.M., Sandevman R., Meyboom-de-Jong B. (2001). Risk factors for burnout in caregivers of stroke patients, and possibilities for intervention. Clinical Rehabilitation, 15, 669–677.10.1191/0269215501cr446oa

    CrossrefGoogle Scholar
  • Whittemore R., Chase S., Mandle C. (2001). Validity in qualitative research. Qualitative Health Research, 11, 522–537.10.1177/104973201129119299

    CrossrefGoogle Scholar
  • Wood R.L., Rutterford N.A. (2006). Demographic and cognitive predictors of long-term psychosocial outcome following traumatic brain injury. Journal of International Neuropsychological Society, 12, 350–358.10.1017/S1355617706060498

    CrossrefGoogle Scholar
  • Wu Y.P., Thompson D., Aroian K.J., McQuaid E.L., Deatrick J.A. (2016). Commentary: Writing and evaluating qualitative research reports. Journal of Pediatric Psychology, 41, 493–505.10.1093/jpepsy/jsw032

    CrossrefGoogle Scholar
  • Zhu X.L., Poon W.S., Chan C.C., Chan S.S. (2007). Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial. Brain Injury, 21, 681–690.10.1080/02699050701468941

    CrossrefGoogle Scholar

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  • Received12/28/18 12:00 AM
  • Accepted4/22/19 12:00 AM
  • Published online6/10/19 12:00 AM
  • __article__history--ppub9/1/19 12:00 AM