Depression Among Older Adults After Traumatic Brain Injury: A National Analysis

Objective: Sequelae of traumatic brain injury (TBI) include depression, which could exacerbate the poorer cognitive and functional recovery experienced by older adults. The objective of this study was to estimate incidence rates of depression after hospital discharge for TBI among Medicare beneficiaries aged at least 65 years, quantify the increase in risk of depression after TBI, and evaluate risk factors for incident depression post-TBI. Methods: Using a retrospective analysis, the authors studied Medicare beneficiaries at least 65 years old hospitalized for TBI during 2006 to 2010 who survived to hospital discharge and had no documented diagnosis of depression before the study period (N = 67,347). Results: The annualized incidence rate of depression per 1,000 beneficiaries was 62.8 (95% confidence interval [CI]: 61.6, 64.1) pre-TBI and 123.9 (95% CI: 121.6, 126.2) post-TBI. Annualized incidence rates were highest immediately after hospital discharge and declined over the 12 months post-TBI. TBI increased the risk of incident depression in men (hazard ratio: 1.95; 95% CI: 1.84, 2.06; Wald chi(2) = 511.4, df = 1, p < 0.001) and in women (hazard ratio: 1.69; 95% CI: 1.62, 1.77; Wald chi(2) = 589.3, df = 1, p < 0.001). The strongest predictor of depression post-TBI for both men and women was discharge to a skilled nursing facility (men: odds ratio, 1.91; 95% CI, 1.77, 2.06; Wald chi(2) = 277.1, df = 1, p < 0.001; women: odds ratio, 1.72; 95% CI, 1.63, 1.83; Wald chi(2) = 324.2, df = 1, p < 0.001). Conclusion: TBI significantly increased the risk of depression among older adults, especially among men and those discharged to a skilled nursing facility. Results from this study will help increase awareness of the risk of depression post-TBI among older adults.