Kudos to Tolu Oyesanya, assistant professor, and her entire team for the submission of the National Institutes of Health R21 application entitled: “Improving The Transition from Acute Hospital Care to Home for Older Adults with Traumatic Brain Injury and Families." This proposal requests funding for a two-year period with a start date of September 1, 2021.
Older adults who experience a mild-to-moderate traumatic brain injury (TBI) are at an increased risk of cognitive decline and dementia and subsequently are at high risk for a cascade of adverse health events, social isolation, and institutionalization. Despite their complex health needs, there are no U.S. standards to support older TBI patients who transition home from acute hospital care. These older TBI patients (age >65) discharged home from acute hospital care have cognitive, physical, behavioral, and emotional impairments that affect their abilities to be independent in daily activities. Activity limitations often result in increased family involvement for managing the older TBI patient’s care. Yet, many family caregivers are older adults themselves who have increased risks for psychological distress.
The complexities of TBI- compounded by age-related needs, multi-morbidity, and the fragmentation of healthcare and social services- creates the perfect storm for mismanaged symptoms, adverse health events, readmissions, and a higher likelihood of poor quality of life and poor social and community re-integration. Transitional care, defined as actions in the clinical encounter designed to ensure the coordination and continuity of healthcare for patients transferring between different locations or levels of care, has led to improved outcomes among other older adult patient groups who experience acute events (e.g., stroke, myocardial infarction).
Our team’s preliminary research, in addition to the TBI literature, shows older TBI patients and their families desire and could benefit from interventions to support the transition from acute hospital care to home. The paucity of theory-driven, evidence-based TBI transitional care interventions led our team to develop an intervention called BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery). Based on the Individual and Family Self-Management Theory (IFSMT), BETTER is a patient- and family-centered, behavioral intervention for patients with TBI discharged home from acute hospital care and families. The overarching goal is to improve patients’ quality of life (primary outcome) and decrease caregiver strain at 16-weeks after hospital discharge. Skilled clinical interventionists follow a manualized intervention protocol to address patient/family needs; establish goals; coordinate posthospital care, services and resources; and provide patient and family education and training on self- and family-management coping skills in the early post-acute period (<16 weeks post-discharge).
Preliminary findings from our pilot study (NIH R03) suggest BETTER is feasible, acceptable, and appropriate with younger TBI patients (age 18-64) and families. The purpose of this study is to adapt and refine BETTER to meet the needs of older TBI patients and families when discharged home from acute hospital care and to examine the feasibility, acceptability, and preliminary efficacy of the adapted version of BETTER. The new knowledge generated will guide our team in conducting an NIH R01 implementation-effectiveness trial of BETTER for older TBI patients and families and will ultimately enhance the standard of care for older TBI patients.