Social Integration and Cognitive Function Following Geriatric Traumatic Brain Injury

Abstract

Background: Traumatic brain injury is one of the leading causes of life-long disability and death. The incidence of TBI in older adults has been increasing, in part due to the growing population of older adults. While numerous studies focus on the prevention of TBI in older adults, little is known about illness perception in TBI among older adults and how they return to daily life after TBI. Purpose: The overall purpose of this dissertation is to better understand older adults’ lives after traumatic brain injury (TBI). In particular, this dissertation aims to explore how older adults integrate the experience of injury into their lives and how social integration may influence cognitive functioning. The first paper (Chapter 2) describes the perceived meaning of TBI to older adults over the first-year post-injury. The second paper (Chapter 3) aims to clarify the concept of social integration and to identify attributes, antecedents, and consequences. The third paper (Chapter 4) examines the interrelationship among social integration, functional outcome, and cognition in older adults in years 1- , 2- , and 5-year post-injury, and examines if there is a mediating role of social integration and cognition in overall functional outcome. Methods: Three research papers in this dissertation include qualitative, concept analysis, and quantitative study. The first paper is a longitudinal multiple-case study using secondary data. This study utilized secondary data from 13 older adults who were interviewed over 12 months post-injury (n=57 interviews). The second paper is a concept analysis of social integration following Walker and Avant’s framework. The third paper is a longitudinal mediation analysis using data from Traumatic Brain Injury Model System National Database (TBIMS-NDB). A total of 1469 older adults aged 65 and over were included in this study. Results: In the first study, I revealed five main themes regarding how older adults process and perceive meaning from their TBI: 1) gratitude, 2) vulnerability and dependence, 3) slowing down and being more careful, 4) a chance for reflecting on life, and 5) an unexpected event. The majority of participants (12/13) did not change their perspective regarding their injury in the 12 months following the injury. They had either consistently positive or negative illness perceptions about their injury. In the second study, the proposed concept of social integration was a process of incorporation and inclusion in society through productive activities, social relationships, community engagement, and leisure activities. The findings of the concept analysis suggest that social integration is affected by individual, social, and environmental factors. The analysis also found improved physical and mental health, healthy aging, and life satisfaction as a result of higher social integration. Finally, in the third study, I revealed significant positive interrelationships between social integration and concurrent functional outcome and cognition at 1-, 2-, and 5-year post-injury in older adults. Using longitudinal mediation analysis, I found that functional outcome mediated the pathway between social integration and concurrent cognition over time. Conclusions: The findings from this dissertation contribute to understanding older adults’ beliefs about their brain injury and the role of social integration in improving cognitive function following TBI. Future research is needed to understand the longitudinal interrelationships between illness perception, social integration, and cognitive function in older adults following TBI.