Kudos to Tolu Oyesanya, assistant professor, and her entire team for the submission of their application to the Research Centers Collaborative Network (RCCN) administered by Wake Forest University. The proposal title “Resilience Across the Lifespan in the Early Post-Acute Period for Patients with Traumatic Brain Injury” request funding for a two-year period with a start date of June 1, 2021.

Adults who experience a mild-to-severe traumatic brain injury (TBI) are at an increased risk for cognitive decline. Decline is exacerbated by advancing age that further increases the risk for a subsequent cascade of adverse health events, social isolation, and institutionalization. Compared to younger adults (age 18-64), older adults (age >65) have higher rates of hospitalization and slower rates of recovery after TBI. Worse outcomes persist at least to 1-year post-hospital discharge, with older TBI patients experiencing poorer psychosocial, cognitive, and functional outcomes. For those receiving TBI acute hospital care, typical discharge destinations include inpatient rehabilitation, skilled nursing facilities, or home. When TBI patients are discharged home, they often have persisting cognitive, physical, behavioral, and emotional impairments that limit their abilities to independently manage their health, wellness, and activities of daily living, causing dependence on others. However, there is limited data about resilience, defined by the Duke Pepper Center model as the ability to “bounce back” after being exposed to a stressor, in the early post-acute period (<12 weeks after discharge home from acute hospital care) for adult TBI patients, regardless of age. Without these data, we do not know how resilience differs by age or what factors are associated with resilience for younger vs. older TBI patients, what makes TBI patients resilient, or how younger and older TBI patients can be supported to be more resilient.

Thus, the purpose of this observational, prospective cohort study is to characterize resilience in the early post-acute period (<12 weeks after discharge home from acute hospital care) across the lifespan for TBI patients. We will leverage our existing research infrastructure to measure resilience and reserve factors in the early post-acute period for older TBI patients, collecting longitudinal, patient- and proxy-reported data from 60 dyads of older TBI patients and family caregivers (120 total participants) over a 21-month period. Data collection will begin at 24-72 hours prior to discharge home from Duke University Hospital; we will follow up by phone at 4-, 8-, and 12-weeks post-discharge. We will use these data to characterize trajectories of resilience in the early post-acute period for older TBI patients and will compare to our existing cohort of younger TBI patients using repeated measures analysis of change. Findings will be used to inform opportunities for intervention development that address needs, allocation of resources, and transitional care planning.

The new knowledge generated will equip our team to apply for NIA R21 funding to refine our transitional care intervention for younger TBI patients to best fit older TBI patients, with the aim to promote TBI patient resilience. We will subsequently test the feasibility and acceptability of transitional care in addressing the early post-acute needs of older TBI patients. The PI (Oyesanya) and her primary mentor (Bettger, Director of Duke Roybal Center) are well positioned to accomplish these future steps, guided by resources for intervention development and implementation within the Duke Roybal Center and for aging research within the Duke Pepper Center.