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. 2021 Feb;43(1):263-278.
doi: 10.1007/s11357-020-00273-2. Epub 2020 Oct 17.

Quality of life after traumatic brain injury: a cross-sectional analysis uncovers age- and sex-related differences over the adult life span

Katrin Rauen  1   2   3   4   5 , Claudia B Späni  6 , Maria Carmela Tartaglia  7   8 , Maria Teresa Ferretti  9   7 , Lara Reichelt  10   11 , Philipp Probst  12 , Barbara Schäpers  10 , Friedemann Müller  10 , Klaus Jahn  10   13 , Nikolaus Plesnila  11   14
Affiliations

Quality of life after traumatic brain injury: a cross-sectional analysis uncovers age- and sex-related differences over the adult life span

Katrin Rauen et al. Geroscience. 2021 Feb.

Abstract

Traumatic brain injury (TBI) is the leading cause of disability in the working population and becomes increasingly prevalent in the elderly. Thus, TBI is a major global health burden. However, age- and sex-related long-term outcome regarding patient's health-related quality of life (HRQoL) is yet not clarified. In this cross-sectional study, we present age- and sex-related demographics and HRQoL up to 10 years after TBI using the Quality of Life after Brain Injury (QOLIBRI) instrument. The QOLIBRI total score ranges from zero to 100 indicating good (≥ 60), moderate (40-59) or unfavorable (< 40) HRQoL. Two-thirds of the entire chronic TBI cohort (102 males; 33 females) aged 18-85 years reported good HRQoL up to 10 years after TBI. TBI etiology differed between sexes with females suffering more often from traffic- than fall-related TBI (p = 0.01) with increasing prevalence during aging (p = < 0.001). HRQoL (good/moderate/unfavorable) differed between sexes (p < 0.0001) with 17% more females reporting moderate outcome (p = 0.01). Specifically, older females (54-76-years at TBI) were affected, while males constantly reported good HRQoL (p = 0.017). Cognition (p = 0.014), self-perception (p = 0.009), and emotions (p = 0.016) rather than physical problems (p = 0.1) constrained older females' HRQoL after TBI. Experiencing TBI during aging does not influence HRQoL outcome in males but females suggesting that female brains cope less well with a traumatic injury during aging. Therefore, older females need long-term follow-ups after TBI to detect neuropsychiatric sequels that restrict their quality of life. Further investigations are necessary to uncover the mechanisms of this so far unknown phenomenon.

Keywords: Age- and sex-related outcomes; Aging; Health-related quality of life; Psychiatric disorders; QOLIBRI; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart depicting chronic TBI patients. In this cross-sectional study, 102 male (76%) and 33 female (24%) adult TBI patients reported their HRQoL up to 10 years after neurorehabilitation. QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 2
Fig. 2
Sex-related quality of life in chronic TBI patients. A QOLIBRI total score ≥ 60 indicates good health-related quality of life (HRQoL), a score of 40–59 moderate and a score < 40 unfavorable HRQoL. Analyzing good, moderate, or unfavorable HRQoL revealed highly significant differences between male and female chronic TBI patients using the Kruskal-Wallis test (p < 0.0001). HRQoL, health-related quality of life; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 3
Fig. 3
Females have an increased risk of psychiatric disorders after TBI. Seventeen percent more females (gray hatched bars) than males (white hatched bars) reported unsatisfactory HRQoL up to 10 years after TBI (p = 0.01) as indicated by the dichotomized analysis of relative frequencies distinguishing good (QOLIBRI total score ≥ 60) and unsatisfied HRQoL (QOLIBRI total score < 60) (red line) using the Fisher test. A total of 33% females and 16% males reported moderate HRQoL (QOLIBRI total score 40–59) with an increased risk of one posttraumatic psychiatric disorder. Females and males equally reported unfavorable HRQoL (QOLIBRI total score < 40), namely 16% of females (gray closely hatched bars) and 16% of males (white closely hatched bars), thereby having an increased risk of both psychiatric disorders after TBI. HRQoL, health-related quality of life; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 4
Fig. 4
Age- and sex-related differences of HRQoL after TBI. Age at TBI matters for HRQoL in female, but not in male chronic TBI patients. Descriptive analysis revealed on average unsatisfied HRQoL (QOLIBRI total score < 60) of older females (solid gray line) aged 54 to 76 years at TBI, while males (black line) constantly reported good HRQoL over their entire adult lifespan using the LOWESS function. HRQoL, health-related quality of life; LOWESS, Locally Weighted Scatterplot Smoothing; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 5
Fig. 5
Older females with TBI suffer from moderate HRQoL. Females (gray bar) aged 54 to 76 years when having experienced a TBI reported a mean QOLIBRI total score of 52.1 ± 6.8 compared with males (white bar) with a mean of 68.9 ± 3.3 (p = 0.017). Data were normally distributed (D’Agostino-Pearson, omnibus K2) and compared with the unpaired t test. The effect size indicates a moderate to large effect with an eta squared of η2 = 0.1. HRQoL, health-related quality of life; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 6
Fig. 6
Cognition rather than physical problems hamper HRQoL when TBI hits the female brain during aging. Sex- and age-related difference was particularly obvious for the two key aspects of the QOLIBRI instrument, namely satisfaction (p = 0.033) and restriction (p = 0.03), as well as for the subscales of cognition (p = 0.014), self (p = 0.009), and emotions (p = 0.016), but not relevant in terms of daily life and autonomy, social relationships, and physical problems. Data of restrictions, autonomy, social relationships, and emotions were not normally distributed and thus analyzed by the Mann-Whitney U test. All other data were compared using the unpaired t test. HRQoL, health-related quality of life; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
Fig. 6
Fig. 6
Cognition rather than physical problems hamper HRQoL when TBI hits the female brain during aging. Sex- and age-related difference was particularly obvious for the two key aspects of the QOLIBRI instrument, namely satisfaction (p = 0.033) and restriction (p = 0.03), as well as for the subscales of cognition (p = 0.014), self (p = 0.009), and emotions (p = 0.016), but not relevant in terms of daily life and autonomy, social relationships, and physical problems. Data of restrictions, autonomy, social relationships, and emotions were not normally distributed and thus analyzed by the Mann-Whitney U test. All other data were compared using the unpaired t test. HRQoL, health-related quality of life; QOLIBRI, Quality of Life after Brain Injury; TBI, traumatic brain injury
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