Impact of Cognitive Status at Skilled Nursing Facility Admission on Days Spent at Home Over the Year Following Traumatic Brain Injury Among Older Adults.
Natavia L Crandall, Jason R Falvey, Ann L Gruber-Baldini and 1 others
PMID 42705123WHAT IT FOUND
Among older adults with traumatic brain injury discharged to skilled nursing, lower brief cognitive screen scores at admission were linked with fewer days at home over the next year.
Severe impairment had the lowest days at home.
Key findings
01In the adjusted model, moderate cognitive impairment at skilled nursing facility admission was associated with fewer days at home (rate ratio 0.82; 95% CI 0.77 to 0.86), and severe impairment was associated with fewer days at home (rate ratio 0.63; 95% CI 0.59 to 0.67).
02Adjusted mean days at home over the year were 220.0 for cognitively intact individuals, 181.1 for moderate impairment, and 139.8 for severe impairment.
03In sensitivity analysis restricted to people without missing BIMS scores, the results were unchanged.
STILL TO COME
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What it does not show
This was a retrospective claims study, so it shows association rather than causation. The study had no measure of cognition before TBI, so it cannot separate pre-existing dementia from injury-related or delirium-related impairment. The BIMS does not identify which cognitive domains are affected. 9.2% of BIMS scores were missing and imputed, although a sensitivity analysis excluding them gave similar results. The study did not know why residents received skilled nursing care or what rehabilitation they received. Days at home cannot capture when staying in a facility is the best clinical outcome. Education was not available for adjustment.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not treat a low cognitive screen as proof that cognitive impairment caused fewer days at home, or as a reason to withhold rehabilitation. The study did not test rehabilitation, did not measure cognition before TBI, and the authors describe the screen as a prognostic marker rather than a cause.