Does age matter? A mixed methods study examining determinants of good recovery and resilience in young and middle-aged adults following moderate-to-severe traumatic brain injury

Aim: To examine whether age contributes to functional recovery and resilience after moderate-to-severe traumatic brain injury (TBI). Background: The ability to recover from TBI may change across the lifespan, but the influence of age on TBI outcome is understudied. Design: Mixed methods study. Methods: All adults of working-age (18-64 years), discharged alive from a Level 1 trauma center between 2010-2013 after sustaining a moderate-to-severe TBI were considered. Functional recovery was assessed during a telephone interview with the Glasgow Outcome Scale-Extended (GOS-E) 12-36 months post-injury. A subgroup completed the Connor-Davidson Resilience Scale (CD-RISC) and a face-to-face interview about resilience. Results: Ninety-seven young (27±9 years; 75% male) and 47 middle-aged TBI survivors (53±6 years; 75% male) completed the GOS-E. Eight young and 5 middle-aged adults were also assessed for resilience. Overall, young participants experienced more severe head injuries. Yet, they achieved slightly higher levels of functional recovery (as per GOS-E) compared to middle-aged ones (6±2 vs. 5±2). Controlling for CT scan findings and post-traumatic amnesia duration, age was not found to predict functional recovery in adults of working age. Although both groups showed similar levels of resilience (as per CD-RISC), young participants discussed the challenges related to “having more time on their hands” and “being a changed person”, two elements that were perceived positively by middle-aged ones. Conclusion: While age does not appear to affect the potential for functional recovery in adults of working-age, younger TBI could benefit from nursing interventions to strengthen their resilience process related to re-employment orientation and identity