Examining the Influence of Age and Depression on Participation 5 Years After Traumatic Brain Injury

PURPOSE: Participation meaningful activities is a primary focus of occupational therapy interventions and neurorehabilitation. The sequelae of traumatic Brain Injury (TBI) may impact all areas of occupational performance resulting in restricted participation. Older adults are the fastest growing age group of people with TBI, and depression is the most common mental health condition after TBI. Older age and depression are associated with poor functional outcomes after TBI, but there is a gap in understanding how depression and aging relate to participation. Therefore, this study aimed to 1) to determine differences in participation between individuals with and without depression within the same age groups and, 2) to determine the differences in participation across age groups for individuals who are depressed and for individuals who are not depressed.

DESIGN: We performed a secondary analysis of the TBI Model Systems National Database. Included participants were adults (mean age 42.24 years) with moderate to severe TBI who were living in the community 5 years post injury (n=3062).

METHOD: The Participation Assessment with Recombined Tools-Objective (PART-O) subscales of Productivity, Out and About, and Social Relations measured participation. Age groups were based on developmental life stages: 18-25 years old, 26-45 years old, 46-65 years old, 66-75 years old, and ≥76 years old. To determine differences in participation for individuals with and without depression within the same age groups, we performed independent samples t-tests for each PART-O subscale. To examine differences across age groups, we performed three Welch’s ANOVAs, one for each PART-O subscale, first with only individuals who did not have depression, and then with only individuals who had depression.

RESULTS: Within the same age group, there were significant differences between individuals who had depression and those who did not on all three subscales of the PART-O (Productivity, Out and About, and Social Relations) for the 18-25, 26-45, and 46-65 year old categories; but, there were no differences between those who were not depressed and those who were for the 65-75 and ≥76 years old categories. Results of the Welch’s ANOVA for individuals who did not have depression revealed significant differences on all 3 subscales, while the results of the Welch’s ANOVA for individuals with depression only revealed differences between age groups on the Productivity Subscale.

CONCLUSION: The results suggest that age and depression are important factors to consider when addressing participation after TBI. Individuals who are depressed have significantly lower productivity, time out of the home, and social relations than individuals who are the same age but not depressed for all age groups except those over 65 years old. Depression may have more of an impact on participation in younger individuals. When looking across age groups for those who are not depressed, older groups have significantly lower participation in all subscales. For individuals who are depressed, age is no longer a factor, except for the Productivity subscale, which could be attributed to changes in participation that occur as a part of healthy aging.

IMPACT STATEMENT: To support clients in achieving their fullest participation possible after TBI, occupational therapy practitioners must also address mental health and consider where a client is in the aging process. Participation changes over the lifespan as a part of healthy aging; therefore, OT practitioners should incorporate measures of participation that capture client preferences and satisfaction with their level of engagement as well as critically evaluate evidence that suggests lower productivity in older adulthood equates to poor overall participation.

References

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Juengst, S. B., Kumar, R. G., & Wagner, A. K. (2017). A narrative literature review of depression following traumatic brain injury: Prevalence, impact, and management challenges. Psychology Research and Behavior Management, 10, 175-186. doi: 10.2147/PRBM.S113264.

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