Quality of Life Following Traumatic Brain Injury Among Older Adults.

Importance: The Glasgow Outcome Scale-Extended (GOS-E), Quality of Life After Brain Injury-Overall Scale (QOLIBRI-OS), and Patient Health Questionnaire-9 (PHQ-9) are commonly used to evaluate recovery after traumatic brain injury (TBI), but they may not fully reflect the lived experiences of older adults (≥65 years). As the population of older adult survivors of TBI grows, understanding the factors that shape recovery becomes increasingly important. Objective: To explore how older adults adapt to life in the first year after TBI and whether qualitative analysis of patient and caregiver interviews identifies aspects of recovery not captured by conventional outcome measures. Design, Setting, and Participants: This qualitative study used multiple-methods combining standardized surveys and semistructured interviews and was conducted from October 2023 to January 2025 at a level I trauma center in the US. Adults aged 65 years and older hospitalized for TBI were recruited through the institutional trauma registry and interviewed approximately 1 year after hospitalization. Patients with cognitive limitations could participate if a consenting caregiver proxy was available. Recruitment continued until theoretical saturation. Main Outcomes and Measures: The primary outcome was qualitative findings from thematic analysis of semistructured interviews. Secondary outcomes were health-related quality of life (QOLIBRI-OS); scale of 0 to 100 with higher scores indicating better perceived quality of life, functional status (GOS-E); scale of 8 levels with higher levels indicating good recovery, and depressive symptoms (PHQ-9); scale of 0 to 27 with higher scores indicating severe depression. Results: A total of 29 patients (12 [41.4%] female; mean [SD] age, 77.4 [7.2] years) and 13 caregivers participated in interviews and surveys, with 21 (73%) classified as having good recovery on GOS-E. Mean (SD) QOLIBRI-OS score was 70.1 (18.8), and median (IQR) PHQ-9 score was 4 (1-6). Three themes emerged from analysis of interviews: (1) influence of support systems on independence and quality of life; (2) adapting to postinjury life through grief, acceptance, and gratitude; and (3) desire for more information and guidance on life postinjury. Conclusions and Relevance: In this study, older adults and their caregivers reported that their post-TBI recovery was impacted by physical and emotional adaptation, caregiving dynamics, and understanding of their clinical course-factors not entirely reflected in standard outcome scales. These findings suggest that clear discharge counseling, structured caregiver education to maximize safety and independence, and regular follow-up could improve quality of life for older adults post-TBI.