Do people with TBI change residence during the years following the injury?

Past Studies

Past studies have shown that after a moderate-severe TBI, the person often needs supervision and help from others. Many who lived alone before the injury must move in with family members after the injury. As time goes by, many people begin to live more independently again. However, studies have not followed people from the time of injury to years later to find out what factors predict whether the person will someday live independently.

The Current Study

The current study looked at information provided by 6933 participants in the TBI Model Systems Longitudinal Study who were followed from the time they received inpatient rehabilitation to the time of follow-up at 1, 2, and/or 5 years after injury. This study looked at factors that might predict with whom the person is living, including: a) living alone; b) living with spouse or significant other; c) living with parents or other family members; or d) living with others in a facility (e.g. nursing home, assisted living facility). Living alone was thought to represent more independent living than living in a facility or with parents (*but see Caveats).

This study found that

• At first, many people lived less independently than before the injury, often moving in with family when they lived alone before. Only 20% of those who lived alone before the injury were able to live alone at discharge.
• But, over time many people returned to where they had lived before the injury. The biggest change occurred during the first year after injury. By 1 year after the injury, almost half of those who lived alone before the injury were living alone again. Many people who were initially discharged to a facility returned to a private home by 1 year (15% of the sample were discharged to a facility, compared to 6% living in a facility at 1 year). However, after 1 year, the number of people living in facilities did not change.
• Over the years, there was a steady decrease in the number of people living with parents or other family members.
• Residence pre-injury was the best predictor of residence after the injury.
• As age increased, participants were more likely to eventually live alone or with a spouse during the years post-injury. Whites were more likely to eventually live alone or with a spouse than African-Americans. Persons who completed college were more likely to be living alone or with a spouse than those with a high school education.
• A person’s ability to take care of oneself was associated with whether the person was able to live in his or her pre-injury residence.

Caveats

1) It was not possible to get follow-up information for all people at all years due to loss to follow-up. By Year 5, only 51% could be contacted. There were differences between those who could and could not be contacted, and this may have had an effect on the results. 2) We do not know the extent to which a person is independent within a particular residence. Some people living alone may not be as independent as assumed by this study.

Bottom line

The study results have both positive and negative implications. The results are encouraging in that many people were able to eventually live alone or with a spouse/significant other. However, upon discharge many people are not able to immediately return to their original residence, which can present a significant challenge to the individual, family and society.

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