Assessing Quality of Life (QoL) Measures for Elderly Traumatic Brain Injury (TBI) Survivors: A Systematic Review
This project will guide future research on the elderly, as quality of care for elderly traumatic brain injury (TBI) survivors cannot be improved until valid and reliable measures of quality of life (QoL) are used and then combined with better management.
Findings: Our search yielded 3,145 citations. Of these 15 were duplicates and 2,663 were excluded based on the titles and abstracts, leaving 467 full text articles for review. Of these, 72 papers met the inclusion criteria. A total of 27 validated Qol tools were identified predominantly SF-36, EQ-5D, the WHO-QoL, Sickness Impact Profile and the QOLIBRI. Validity of the QoL tools were assessed by locating one publication using the measure in addition to the study included in the review. Seniors, particularly older women and mild TBI (compared to moderate and severe combined) are underrepresented in studies on QoL on traumatic brain injury.
Impact of findings: Seniors are more likely than younger adults to suffer emotional, physical and behavioural consequences and often require a longer period of time for recovery following Traumatic Brain Injury. It is difficult to make inferences on the QoL of elderly patients surviving TBI when the majority of the study populations are younger adults. This also suggests that perhaps many investigators are not taking in account specific QoL issues facing the elderly. More research on QoL after mild traumatic brain injury in the elderly is required to better understand the burden of mild traumatic brain injury. Our Head Injury Clinic is developing a mild TBI clinical data base with patient data on type of injury, symptoms, medical history, family history, community participation and QoL. This systematic review has helped guide our team to select the EQ-5D as our QoL measure. Our data base is establishing common data elements for a larger Ontario Concussion Strategy (public policy development) and as such this systematic review has helped to establish a key parameter QoL for the future provincial data base on common data elements for TBI.
About the Project
TBI can be most alarming for the elderly and signal the end of independent living. Much of what is currently known about recovery is based on information provided by family or clinician ratings. Recently, there has been increased interest in the patients’ perception of problems post injury.
Nevertheless, there is a significant absence of synthesized evidence on characteristics of measures of QoL following this life-changing injury and it is unclear which tools are best suited for the distinctive elder population. Without this knowledge, the full impact of clinical interventions may go undetected, clinical decision-making may be less informed and comparisons across studies difficult. That’s why our objective was to systematically review the literature for QoL measurements for elderly TBI survivors and summarize the evidence on reliability, validity and implementation.
Donna Ouchterlony, MD, CCFP — St. Michael’s Hospital
Andrew Baker, PhD, MD — University of Toronto
Shree Bhalerao, MD — St. Michael’s Hospital
Michael Cusimano, MD — University of Toronto
Cindy Hunt, BScN, DrPH, MPH — St. Michael’s Hospital/Dalla Lana School of Public Health, University of Toronto
David Lightfoot, PhD — St. Michael’s Hospital
Cheryl Masanic, MD — St. Michael’s Hospital
Alicja Michalak, RN — St. Michael’s Hospital
Jane Toplovec-Vranic, PhD — University of Toronto
Chantal Vaidyanath, MD — St. Michael’s Hospital
Knowledge Users and Partners:
Charissa Levy, MHSc, BScOT — GTA Rehab Network
Shawn Marshall, MD, MSc — Ottawa Hospital Rehabilitation Centre
Bonny Pietkiewicz — St. Michael’s Hospital
Camilla Wong, MD — St. Michael’s Hopsital
Project Contact: Cindy Hunt — firstname.lastname@example.org
Key words: traumatic brain injury; brain injury; concussion; head injury
Key Findings for Families
There are five quality of life tools that may be useful among elderly patients who have survived a TBI.
- This study found that all tools for measuring quality of life after TBI were not used very often in the elderly or in those with mild brain injury
Why This Matters
Being able to measure the quality of life of the elderly after a TBI is an important tool for doctors to inform what care this population needs. But, there is not much known about what tools to use to measure quality of life in the elderly after TBI.
About This Study
- This study used systematic review methods. A systematic review is a way to find all research on the use of measurement tools for the elderly with TBI
- Studies were included in this review if they studied elderly patients (>65 years old) that had survived a TBI, and looked at how to measure quality of life
Key Findings for Policy
- Five tools were identified as promising measures of quality of life in this population
- The elderly, especially women, were not well represented in the current evidence on quality of life after a TBI
The results of this study can inform policy around the use of measurement tools for the care of the elderly who have survived a TBI.
- These results can improve the appropriateness of care for the elderly who have survived a TBI by using measurement tools to inform clinical decision-making
Why This Study was Needed
There is little known about which measures of quality of life are most appropriate for elderly who have survived a TBI. Using the most appropriate measures of qualtity of life in this population can inform clinicians about changes in quality of life in the management of this population, and can be used to inform clinical decisions.
- Six databases (CINALH, All EBM Reviews, Health and Psychosocial Instruments, Embase, Psych Info and Web of Science) were systematically reviewed using search terms for TBI, the elderly and quality of life. 3,145 references were identified, and ultimately 72 articles were included. In the 72 references, 27 measures were identified
- Studies were included if they reported on the quality of life in the elderly (>65 years old) who had survived a TBI, as measured using a quality of life measurement tool
Key Findings for Researchers
Five quality of life measures were identified for use among elderly patients who have survived a TBI.
- This study found that the evidence for quality of life after TBI in the elderly was lacking, especially for women and those with mild traumatic brain injury
- The five most promising measures (based on frequency and currency of use) to consider for use in measuring an elder’s QoL after TBI included: the generic measure of the SF-36 (also the short version SF-12), the EQ-5D, the WHO-QoL (also the short version WHO-QoL BREF) the Sickness Impact Profile and the TBI specific measure, the QOLIBRI
Why This Study was Needed
There is little known about which measures of quality of life are most appropriate for elderly who have survived a TBI. Using the most appropriate measures of qualtity of life in this population can inform clinicians about changes in quality of life in the management of this population, and can be used as patient-reported outcome measures in clinical research.
How This Study Addresses the Gap
Six databases (CINALH, All EBM Reviews, Health and Psychosocial Instruments, Embase, Psych Info and Web of Science) were reviewed. 3,145 references were identified, and ultimately 72 articles were included. In the 72 articles, 27 measures were identified. Studies were included if they reported on the quality of life in the elderly (>65 years old) who had survived a TBI, as measured using a quality of life measurement tool.
Greater focus on measuring and reporting on the quality of life among the elderly who have survived TBI is needed.
Hunt, C., Ennis, N., Baluch, N., Topolovec-Vranic, J., Baker, A., Cusimano, M., Masanic, C., Vaidyanath, C., Bhalerao, S, Ouchterlony, D. (October 2014). Assessing Quality of Life Measures for Elderly Traumatic Brain Injury Survivors: A Systematic Review. Canadian Association on Gerontology Conference. Niagara Falls, ON.
Ouchterlony, D., Hunt, C., Ennis, N., Baluch, N., Topolovec-Vranic, J., Baker, A., Cusimano, M., Masanic, C., Vaidyanath, C., Bhalerao, S. (September 21-23, 2014). Assessing Quality of Life Measures for Elderly Traumatic Brain Injury Survivors: A Systematic Review. 2nd Annual TVN Conference on Improving Care for the Frail Elderly, Toronto, ON.
Rationale: Valuing the ‘insider’s perspective’ requires measuring QoL. Gathering information on the breadth and scope of the patient’s QoL is crucial information for clinicians caring for the seniors and for researchers seeking to study the burden of TBI. As, no current review of QoL measures for following TBI exists, it is unclear which tool is best suited for the vulnerable senior population. Common use of standardized QoL measurements will facilitate comparison within a clinical practice for a single patient over time and across multiple patients in research studies. However, it is unclear if QoL tools exist for seniors experiencing a TBI. As such, clinicians and researchers may struggle to identify a suitable tool.
Objectives: This systematic review aimed to determine the type, scope, characteristics, timing and methods of administration of the QoL tools used with seniors following TBI.
CFN Webinar (September 16, 2015): Assessing quality-of-life measures for elderly traumatic brain injury survivors