Supervision Needs Following Veteran and Service Member Moderate to Severe Traumatic Brain Injury: A VA TBI Model Systems Study

Bailey, Erin K.; Nakase‐Richardson, Risa; Patel, Nitin; Dillahunt-Aspillaga, Christina; Ropacki, Susan; Sander, Angelle M.; Stevens, Lillian Flores; Tang, Xinyu

doi:10.1097/htr.0000000000000317

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…Loneliness in the general population tends to increase with age, and for older adults with TBI, the effects of age on loneliness may be compounded by TBI‐related deficits that impact social connectedness. It is worth noting that loneliness does not require or imply being alone, and in fact, individuals with TBI may rarely be alone due to care and supervision needs . In our present study, individuals with and without TBI did not significantly differ in the objective size of their social networks, suggesting that the observed findings cannot solely be explained by greater social isolation among persons with TBI.…”

Section: Discussioncontrasting

confidence: 39%

“…It is worth noting that loneliness does not require or imply being alone, 50 and in fact, individuals with TBI may rarely be alone due to care and supervision needs. 51 In our present study, individuals with and without TBI did not significantly differ in the objective size of their social networks, suggesting that the observed findings cannot solely be explained by greater social isolation among persons with TBI. If the nature of relationships shift after TBI 6 (eg, when a romantic partner becomes a caregiver) and the quality of social connections is impacted by TBI-related impairments (eg, slowed processing speed and word-finding difficulties prevent quick-witted banter, or poor emotional self-regulation results in outbursts of aggression), a person can be rarely alone and yet profoundly lonely.…”

Section: Discussionsupporting

confidence: 39%

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Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

Kumar

Ornstein

Bollens‐Lund

et al. 2020

Int J Geriat Psychiatry

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Background/Objectives An estimated 55 million individuals worldwide live with chronic disability associated with traumatic brain injury (TBI), which may include cognitive, behavioral, and social impairments. Reduced participation in social activities is common after TBI; however, few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness and to identify mediators of this association. Methods/Design Retrospective cohort study. Nationally representative sample of N = 724 adults over age 50 years (Health and Retirement Study). Loneliness was evaluated using the 11‐item Revised University of California Los Angeles (R‐UCLA) Loneliness Scale (range 11‐33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, and education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. Results History of TBI was associated with a 1.28‐point (95% CI, 0.46‐2.11; P < .05; Cohen's D = 0.284) increase in R‐UCLA Loneliness Scale scores after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms partially mediated the relationship between TBI and loneliness. All models were adjusted for US population sampling weights. Conclusions History of TBI was associated with greater loneliness compared with individuals without TBI in a representative sample of US adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population.

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Section: Discussioncontrasting

confidence: 39%

Section: Discussionsupporting

confidence: 39%

Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

Kumar

Ornstein

Bollens‐Lund

et al. 2020

Int J Geriat Psychiatry

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“…7,8 Emotional distress leads to suicidal ideation for many people with TBI, 9,10 increasing the need for supervision. Given these difficulties, it is not surprising that about one-third of persons with moderate to severe TBI require supervision one year following injury, 11,12 and over one-fourth receive some form of supervision 2-9 years post-injury. 13 Cognitive and behavioral impairments can also result in social isolation, rendering caregivers the primary source of social support for persons with an injury.…”

mentioning

confidence: 99%

The Development of a New Computer Adaptive Test to Evaluate Feelings of Being Trapped in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Feeling Trapped Item Bank

Carlozzi

Kallen

Hanks

et al. 2019

Archives of Physical Medicine and Rehabilitation

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The new TBI-CareQOL Feeling Trapped item bank was developed to provide a sensitive and efficient examination of the effect that feelings of being trapped, due to the caregiver role, have on health-related quality of life for caregivers of individuals with TBI. Both the CAT and corresponding 6-item SF demonstrate excellent psychometric properties. Future work is needed to establish the responsiveness of this measure to clinical interventions for these caregivers.

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“…Prescribing appropriate strategies to help Veterans and caregivers adapt and cope once leaving an acute health care setting is difficult. Symptoms associated with TBI may manifest and be different at home than in a protective acute care or subsequent rehabilitation setting [ 21 ]. Additionally, these symptoms may change over time.…”

Section: Introductionmentioning

confidence: 99%

Health status, difficulties, and desired health information and services for veterans with traumatic brain injuries and their caregivers: A qualitative investigation

et al. 2018

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Traumatic brain injury (TBI) is considered the signature injury among military service member and Veterans who served in Operation Iraqi Freedom and Operation Enduring Freedom with over 360,000 individuals sustaining a first-time TBI in the military. These service members and Veterans, and their caregiver(s), must navigate multiple health systems and find experts across many fields of expertise to recover and optimize functionality. Twenty-two individuals, 10 caregivers of Veterans with TBI, 12 Veterans with TBI, participated in semi-structured interviews. Responses were coded using NVivo. Participants from both groups reported difficulties finding community supportive services (support groups) in local communities. Most participants identified the need for an advocate or point-person to help guide them to needed services and provide ongoing support in the post-acute health care recovery phase. Caregivers and Veterans desired a more personalized recovery plan from their medical professionals. When describing their ideal health information and services model most identified interactivity and twenty-four-hour availability as essential components. To provide Veterans and caregivers with optimal support and resources to navigate a complicated health services system, advocates and personalized care plans are needed. Future research should examine the feasibility and cost-effectiveness of these services.

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Supervision Needs Following Veteran and Service Member Moderate to Severe Traumatic Brain Injury: A VA TBI Model Systems Study

Abstract: Supervision needs are long-term features of moderate and severe TBI. Results of this study lend support to the shift toward conceptualizing TBI as a chronic disease.

Cited by 15 publications

References 33 publications

Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

Lifetime history of traumatic brain injury is associated with increased loneliness in adults: A US nationally representative study

The Development of a New Computer Adaptive Test to Evaluate Feelings of Being Trapped in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Feeling Trapped Item Bank

Health status, difficulties, and desired health information and services for veterans with traumatic brain injuries and their caregivers: A qualitative investigation

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