Persons with traumatic brain injuries and their families: living arrangements and well-being post injury

Who are relatives? Young adults, relatives and professionals' perceptions of relatives during the rehabilitation of young adults with a severe acquired brain injury

PURPOSE

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI).

METHODS

This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations.

RESULTS

Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network.

CONCLUSION

The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Implications for rehabilitationRehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement.The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations.Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process.Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run.

Prevalence of neuropsychiatric symptoms and psychotropic drug use in patients with acquired brain injury in long-term care: a systematic review

OBJECTIVE

Little is known about the prevalence of neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) in patients below the age of 65 years with acquired brain injury (ABI) in long-term care. The objective of this study was to review the literature about the prevalence of NPS and PDU.

METHODS

A systematic literature search of English, Dutch and German articles in Pubmed, EMBASE, PsycINFO and CINAHL was performed with the use of MeSH and free-text terms.

RESULTS

Six articles met the inclusion criteria. The place of residence was mainly a nursing home and most studies were conducted in a population of patients with traumatic brain injury. Sample sizes varied from 40 to 26,472 residents and NPS were assessed with different assessment instruments. Depressive symptoms were most common with a prevalence ranging from 13.9% to 39.3%. Two studies reported PDU in which tranquillizers (59%) were the most prevalent psychotropic drugs followed by anticonvulsants (35%) and antidepressants (26-34%).

CONCLUSIONS

Patients with ABI experience lifelong consequences, regardless the cause of ABI, that have a high impact on them and their surroundings. More insight into the magnitude of NPS and PDU, through prevalence studies, is necessary to achieve suitable provision of care for these patients.

Social work-generated evidence in traumatic brain injury from 1975 to 2014: A systematic scoping review

The International Network for Social Workers in Acquired Brain Injury (INSWABI) commissioned a systematic scoping review to ascertain the social work-generated evidence base on people with traumatic brain injury (TBI) of working age. The review aimed to identify the output, impact and quality of publications authored by social workers on this topic. Study quality was evaluated through assessment frameworks drawn from the United Kingdom National Service Framework for Long-Term Conditions. In the 40-year period from 1975 to 2014, 115 items were published that met the search criteria (intervention studies, n = 10; observational studies, n = 52; literature reviews, n = 6; expert opinion or policy analysis, n = 39; and others, n = 8). The publications could be grouped into five major fields of practice: families, social inclusion, military, inequalities and psychological adjustment. There was a significant increase in the number of publications over each decade. Impact was demonstrated in that the great majority of publications had been cited at least once (80.6%, 103/115). Articles published in rehabilitation journals were cited significantly more often than articles published in social work journals. A significant improvement in publication quality was observed across the four decades, with the majority of studies in the last decade rated as high quality.

Anxiety and comorbid depression following traumatic brain injury in a community-based sample of young, middle-aged and older adults

BACKGROUND

Anxiety is common following a traumatic brain injury (TBI), but who is most at risk, and to what extent, is not well understood.

METHODS

Longitudinal data from a randomly-selected community sample (Wave 1: 7397, Wave 2: 6621 and Wave 3: 6042) comprising three adult cohorts (young: 20-24 years of age, middle-aged: 40-44, older: 60-64), were analysed. The association between TBI history, anxiety and comorbid depression was assessed, controlling for age, sex, marital/employment status, medical conditions, recent life events, alcohol consumption, social support and physical activity.

RESULTS

Thirteen percent of the sample had sustained a TBI by Wave 3, 35% of whom had sustained multiple TBIs. Cross-sectional analyses revealed that clinically-significant anxiety was more common in people who had sustained a TBI. Longitudinal analyses demonstrated an increased risk of anxiety post-TBI, even after controlling for potential demographic, health and psychosocial confounds. Anxiety was more common than depression, although 10% of those with a TBI experienced comorbid anxiety/depression.

LIMITATIONS

TBIs were not medically confirmed and anxiety and depression were only assessed every four years by self-report, rather than clinical interview. Sample attrition resulted in the retention of healthier individuals at each wave.

CONCLUSIONS

TBIs are associated with a lifelong increased risk of experiencing clinically-significant anxiety, highlighting the chronic nature of TBI sequelae. Positive lifestyle changes (e.g., increasing physical activity, reducing alcohol consumption) may decrease the risk of anxiety problems in the early years after a TBI. Comorbid anxiety and depression was common, indicating that both should be monitored and treated.

Social Integration following Traumatic Brain Injury and Rehabilitation

The aim of this qualitative study was to examine the issues involved in social integration for those affected by traumatic brain injury, following a period of rehabilitation. Eighteen patients, their significant other* and members of the rehabilitation team involved in their care were interviewed when the patient was discharged from the ward of a neurological rehabilitation hospital, 6 months later and, again, at one year following discharge from the ward.

When the data were analysed at the time of the final interview, two respondents reported social isolation. Although many others felt that the level of social contact was that of their choice, several issues were discussed that affected social relationships. These included the impact of impairments, the social response of others and the fact that social networks change naturally over time irrespective of injury or disability.

When the data were considered from a sociological perspective, the themes of self-identity, master status and stranger status emerged. This gave a different insight into issues that could be relevant but had not been discussed widely within the head injury literature. Further consideration of the individual in the context of personhood as well as head injury is recommended as a means to develop understanding.

The influence of TBI impairments on family caregiver mental health in Mexico

PURPOSE

This study examined the influence of five types of impairments in individuals with traumatic brain injury (TBI)-and caregiver stress due to these impairments-on the mental health of family caregivers in Guadalajara, Mexico.

METHOD

Ninety caregivers completed measures of TBI impairments and of their own mental health. The majority were female (92.20%) with a mean age of 47.12 years (SD = 12.67). Caregivers dedicated a median of 50 hours weekly to caregiving and had spent a median of 11 months providing care.

RESULTS

Two canonical correlation analyses suggested that these two sets of variables were broadly related, such that more severe impairments in individuals with TBI and more caregiver stress due to those impairments were associated with lower caregiver mental health. Across both analyses, social impairments were most associated with increased caregiver burden. Follow-up analyses also uncovered that caregiver stress due to cognitive impairments was uniquely associated with caregiver burden and anxiety.

CONCLUSIONS

These results are the first to provide evidence that social and cognitive impairments in individuals with TBI from Latin America are the impairments most associated with caregiver mental health and highlight the need for interventions that target social and cognitive functioning.

Life habits performance of individuals with brain injury in different living environments

BACKGROUND

Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments.

OBJECTIVE

To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements.

METHODS

One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined.

RESULTS

The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not.

CONCLUSION

Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Exploring the connections between traumatic brain injury caregiver mental health and family dynamics in Mexico City, Mexico

OBJECTIVE

To examine the patterns of family dynamics that are most associated with the mental health of traumatic brain injury (TBI) caregivers from Mexico. It was hypothesized that healthier family dynamics would be associated with better caregiver mental health.

DESIGN

A cross-sectional study of self-reported data collected from TBI caregivers through the Mexican National Institute of Rehabilitation in Mexico City, Mexico, the premier public medical facility in Mexico that provides rehabilitation services to patients with various disabilities.

SETTING

One public outpatient medical and rehabilitation facility.

PARTICIPANTS

Sixty-eight caregivers of individuals with moderate-to-severe TBI from Mexico City, Mexico, were related to an individual with TBI who was ≥3 months after injury, a primary caregiver for ≥3 months, familiar with the patient's history, and without neurologic or psychiatric conditions. The average (standard deviation) age of caregivers was 50.94 ± 12.85 years), and 82% were women.

METHODS

The caregivers completed Spanish versions of instruments that assessed their own mental health and family dynamics.

MAIN OUTCOME MEASUREMENTS

Outcomes assessed included family dynamics (Family Adaptability and Cohesion Evaluation Scale-Fourth Edition; Family Communication Scale; Family Satisfaction Scale; Family Assessment Device-General Functioning; and Relationship-Focused Coping Scale), and caregiver mental health (Patient Health Questionnaire-9, Zarit Burden Interview, and Satisfaction with Life Scale).

RESULTS

Results of canonical correlation analyses suggested that caregiver mental health and family dynamics were positively related, with a large effect size. Caregivers with high family satisfaction and cohesion tended to have a low burden and high satisfaction with life. In addition, caregiver depression and burden were positively related to each other and were both inversely related to caregiver satisfaction with life.

CONCLUSIONS

TBI caregiver interventions in Latino populations would likely benefit from including programming or techniques to improve family dynamics, especially family cohesion, given the strong potentially reciprocal influence of these dynamics on caregiver mental health.

Community Integration Following Severe Traumatic Brain Injury: Outcomes and Best Practice

Community integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

Long-Term Outcome Following Traumatic Brain Injury

Objectives: To investigate care needs, functional outcome, role participation and community integration approximately nine years following severe brain injury. To gain an understanding of the ongoing cost of care and support needs for this group. Participants: 13 individuals who had sustained an extremely severe traumatic brain injury (TBI), between 8 and 9 years previously participated in the study. These individuals were the remaining participants of a larger sample of consecutive admissions between 1996 and 1998 at Ivanhoe Manor Rehabilitation Hospital. Measures: Structured Interview, Functional Independence Measure, Community Integration Questionnaire, Care and Needs Scale and Role Checklist. Results: The majority of the participants were reported to have high support needs, with 6 participants (46%) requiring 24-hour support. Four participants were reported to able to be left alone for between a few hours per day to almost all week. Three participants reported that they were completely independent. The participant's characteristics are described in terms of functional independence, community integration and role participation. Overall care needs appear to have remained relatively stable between 2 and 9 years postinjury. However, there was a shift in the proportion of paid and gratuitous care over time, with a decrease in paid care and increased gratuitous care noted from the 2-year to long-term follow-up time points. Conclusions: Severe TBI has a long term influence on life roles, care needs and functional independence. The current study suggests that high care needs do not necessarily preclude participants from leading active lives and participating in valued life roles. The importance of social support in facilitating participation in activity and the potential issues for caregiver burden, given the increase in gratuitous care over time, should be acknowledged and further research in this area is recommended.

An organizational perspective on goal setting in community-based brain injury rehabilitation

PURPOSE

To use a taxonomy of goal content, developed in community-based brain injury rehabilitation to examine and compare the content of goals set within two different service settings; and to further examine the potential of the taxonomy to be a reliable and comprehensive framework for classifying goals.

METHOD

Qualitative analysis and categorization of 1492 goal statements extracted from a community-based brain injury rehabilitation service over two time periods (1996--97, 1998--99), and cross-organizational comparison of ratings of goal classifications using a random sample of 100 goal statements drawn from this data set and the original 1765 goal statements used in developing the taxonomy.

RESULTS

Application of the taxonomy beyond the original service setting in which it was developed indicated a strong inter-rater reliability, with a high test-retest agreement reported over time. For both services, a small number of categories accounted for a substantial proportion of goals set within the two time periods, while considerable change was evident in goals between the two periods for one service. Further, both placed emphasis on individually focused goals rather than relationship or family-related goals.

CONCLUSION

The taxonomy provides a reliable means for classifying goals and is a useful tool for exploration of the multiple influences on goal setting. Further application of the taxonomy to examine the relative influence on goal setting of client factors versus a range of organizational factors would be beneficial.

Domains of a TBI minimal data set: Community reintegration phase

Efforts to establish a minimal data set for the period of community integration after traumatic brain injury (TBI) have been the focus of a working group of leading researchers, clinicians and advocates attending the Galveston Brain Injury Symposium in 2001 and 2002. The purpose of the data set is to increase the consistency and interpretability of TBI research and programme evaluation by providing a common set of measures to document key aspects of community integration. It is intended to be sensitive to intervention, comprehensive, reflect satisfaction and outcome and promote future treatment/therapy. In deciding on the components of a minimal data set, the tri-partite model of outcomes was adopted (initially employed in psychotherapy, adapted to TBI) which focuses on the needs of the individual, society and the health provider. Scales are recommended for the respective components of the model.

Carers' perspective on respite for persons with acquired brain injury

Persons with acquired brain injury require continuing care and support in various aspects of their lives. Although the care and support are predominantly provided by family members, little is known about the respite that these carers require to continue the care on a daily basis. This study aims to address the lack of data on respite care and people with acquired brain injury from the perspective of carers. Survey methodology was used to gather information from carers who were members of a peak brain injury association in New South Wales, Australia. The responses of 85 carers were analysed using logistic regression and frequency counts. The characteristics of carers were consistent with the research literature on respite and acquired brain injury, with carers being mainly female and there being a reliance on an informal network to assist in the care. Carers also reported that caring prevented them from obtaining gainful employment. Several factors were significantly associated with the use of respite, these were carers' single marital status; and the person with acquired brain injury's severity of disability, high level of dependency and number of days spent in coma. Carers also reported other factors that might influence them to use respite and they identified their expectations of respite. This study highlights carers' perspective on respite that is an under-researched area in acquired brain injury and reiterates ongoing need for respite.

Adapting Multiple-Family Group Treatment for Brain and Spinal Cord Injury Intervention Development and Preliminary Outcomes

OBJECTIVE

There is a need for interventions that assist in managing the multiple adjustments of persons with spinal cord and brain injuries and their families. The purpose of the present field-initiated development project was to adapt a family psychoeducation model, multiple-family group treatment (MFGT), for persons with brain and spinal cord injury and their families.

DESIGN

The experiences of survivors and caregivers in MFGT were evaluated using quantitative and qualitative methods. Twenty-seven survivors and 28 caregivers participated in MFGT for 12-18 mos. Reliable and valid quantitative measures were used to assess a variety of target outcomes. Additionally, semistructured interviews and focus groups were conducted with participants.

RESULTS

Survivors reported a decrease in depressive symptoms and anger expression toward others as well as an increase in life satisfaction. Caregivers reported a significant reduction in burden. The themes derived from the qualitative analysis addressed the normalization of the caregiving experience, importance of socialization, improvement in a variety of coping skills, and education about the injuries.

CONCLUSIONS

The findings support the adaptation of MFGT for brain and spinal cord injuries.

Mudanças nos papéis sociais: uma conseqüência do trauma crânio-encefálico para o cuidador familiar

O objetivo do estudo foi conhecer as mudanças nos papéis sociais do cuidador após o trauma crânio-encefálico (TCE), relacionando-as com o grau de importância desses papéis e com a condição da vítima seis meses ou mais após o TCE. Desenvolvido no Ambulatório de Trauma de Crânio do Hospital das Clínicas da Universidade de São Paulo com 50 cuidadores e 50 vítimas de TCE, por meio de entrevista e análise de prontuário. Foi utilizado na entrevista, com o cuidador, um checklist para identificar as mudanças e importância dos papéis sociais por eles desempenhados. Concluiu-se que os papéis que mais sofreram interrupção em razão do trauma foram: amigo, amador/passatempo, membro da família e trabalhador, o papel de ser um cuidador foi o que apresentou mais modificação. Não houve associação entre mudança de papéis e as variáveis: condição da vítima após TCE e importância dos papéis sociais para o cuidador.

Factors That Lead to Successful Community Integration Following Severe Traumatic Brain Injury

OBJECTIVE

To assess and identify predictive factors of community integration of people 3 to 15 years after severe traumatic brain injury (TBI).

PARTICIPANTS

Forty participants with severe TBI (an average of 8.8 years postinjury).

MAIN OUTCOME MEASURES

The Community Integration Questionnaire, the Community Integration Measure, and the Sydney Psychosocial Reintegration Scale. Data related to factors that may predict community integration were also collected.

RESULTS

There was considerable variation in the level of community integration. Discriminant function analyses identified the following factors as predictive of the level of community integration: severity of injury, age at the time of injury, level of disability, and challenging behavior.

CONCLUSION

Interventions that minimize challenging behavior and disability may make a significant difference to the level of community integration experienced by people with severe TBI.

Appraising evidence on community integration following brain injury: a systematic review

A systematic review of the community integration (CI) literature for persons with traumatic brain injury was undertaken to evaluate: (1) How do we best measure CI? (2) Can we predict CI following rehabilitation? (3) Does social and activity participation have an effect on CI? (4) Does CI have an effect on quality of life/life satisfaction? Seventy-two articles were analysed. The results demonstrated: (1) strong evidence supporting the use of the Community Integration Questionnaire (CIQ), (2) mixed evidence supporting the ability to predict CI, with the prominent predictive variables being severity of injury, age, gender, education, prior work, living environment, cognition, emotional status, functional performance and disability. The literature search was restricted to articles published in English and the heterogeneity in the outcomes, methods, participants and other characteristics not reported. Further research is needed to examine the complex relationship of person, environment and CI.

Psychosocial adjustment 17 years after severe brain injury

OBJECTIVES

To examine very long term psychosocial outcome following severe brain injury in a large cohort, with the aim of evaluating Thomsen's observation that even after very serious head trauma the long term outcome in some patients is reasonably good.

METHODS

The cohort consisted of 80 patients who had suffered severe brain injury evaluated at a mean time of 17 years post injury (range 10-32 years). Information regarding employment status and relationship status was obtained during clinical interview. Psychosocial outcome measures included the Supervision Rating Scale, Satisfaction with Life Scale, Hospital Anxiety and Depression Scale (HADS), Patient Competency Rating Scale, and Community Integration Questionnaire.

RESULTS

Of the cohort, 72.0% lived independently, 28.7% were in full time employment, and 60.0% were married or cohabiting. The mean rating of life satisfaction was "slightly dissatisfied", but no serious emotional problems were evident from self report ratings on the HADS. Mean functional competency ratings and community integration levels were just below those reported for non-disabled patients.

CONCLUSIONS

Results indicate that although long term psychosocial functioning in patients with severe head injury remains compromised, long term adjustment may be better than expected from data reported by studies assessing psychosocial outcome at earlier stages of recovery.

Depressão: uma possível consequência adversa do trauma crânio-encefálico para o cuidador familiar

Estudo descritivo com abordagem quantitativa, desenvolvido no ambulatório do Trauma de Crânio com 50 cuidadores e 50 vítimas de Trauma Crânio-Encefálico, com o objetivo de verificar entre os cuidadores familiares a presença de sintomas depressivos e sua associação com o tempo decorrido do evento traumático e a condição da vítima seis meses ou mais após o trauma. O Inventário de Depressão de Beck foi aplicado aos cuidadores e a Escala de Resultados de Glasgow na avaliação da condição das vítimas, aplicados o teste Qui-quadrado de homogeneidade e o coeficiente de correlação de Pearson. Dos cuidadores avaliados 34% apresentaram resultados sugestivos de depressão, não houve associação entre a categorização pelo Inventário de Beck e classificação na Escala de Resultados de Glasgow e tempo do trauma, ou seja, a presença de sintomas depressivos no cuidador não parece estar relacionada com o estado da vítima e o tempo decorrido após o evento traumático.

Os efeitos das alterações comportamentais das vítimas de trauma crânio-encefálico para o cuidador familiar

O estudo teve como objetivos identificar alterações na intensidade que os comportamentos negativos das vítimas de Trauma Craniencefálico (TCE) afetavam o cuidador familiar principal, comparando o período anterior ao posterior ao trauma e verificar a relação entre intensidade dessas alterações e tempo decorrido após o evento traumático. Incluiu 50 cuidadores de vítimas com diferentes níveis de dependência após TCE. Os efeitos dos comportamentos da vítima para o cuidador foram mensurados por meio da escala Likert, tendo em vista onze comportamentos negativos citados em literatura. Na visão do cuidador, a vítima ficou mais agressiva, ansiosa, dependente, deprimida, irritada, esquecida, com temperamento mais explosivo, após o trauma, além de mais egocêntrica, impulsiva, com maior inadequação social e oscilação de humor. Os seis primeiros comportamentos citados eram os que afetaram mais negativamente o cuidador. Não houve relação entre o tempo decorrido e os efeitos das alterações comportamentais.

Quality of life after traumatic brain injury: a review of research approaches and findings11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To assess existing knowledge of quality of life (QOL) of people with traumatic brain injury (TBI) and to make recommendations for methodologic and substantive research in this area.

DATA SOURCES

Published research on QOL of persons with TBI, identified from databases, ancestry search, and the author's files.

STUDY SELECTION

Empirical, theoretical, and methodologic articles relevant to 5 areas: QOL as achievements, QOL as subjective well-being (SWB), QOL as utility, QOL experienced, and QOL measurement instruments applicable to TBI or specifically developed for people with this impairment.

DATA EXTRACTION

Selection of QOL indicators, with focus on TBI versus non-TBI differences.

DATA SYNTHESIS

Studies of QOL as achievements show that in almost all areas, people with TBI score lower than they did before injury and lower than comparisons groups. There are limited gaps in our knowledge in this area. Research into QOL as SWB shows that after TBI, people typically report, for example, somewhat lower life satisfaction and affect than do comparison groups, and that injury severity is not necessarily a predictor of SWB. There are almost no studies of QOL as utility of life after TBI.

CONCLUSIONS

Major research recommendations include: exploring the ability of TBI subjects to self-report; determining the salience of domains of life for this group; developing utility instruments that are sensitive to differences in deficits in cognition and other health and life domains; and doing qualitative studies that explore the experience of QOL.

Measuring unmet needs and services among persons with traumatic brain injury

OBJECTIVES

(1) To develop a comprehensive list of needs and services appropriate for persons with traumatic brain injury (TBI); (2) to determine whether these needs and services formed unidimensional hierarchies from least common to most common; (3) to describe the relationship between unmet needs and services received; and (4) to estimate the extent to which a variety of demographic, injury, and service characteristics predict unmet needs.

DESIGN

Statewide mailed survey.

SETTING

Illinois communities.

PARTICIPANTS

A total of 895 persons who had had a TBI recruited from Brain Injury Association members and rehabilitation service recipients. The median time post-TBI was 7 years; the median age was 37 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A 27-item instrument assessing service needs and utilization of services, and equal-interval measures of needs and services derived with Rasch analysis.

RESULTS

The most prevalent unmet needs were improving memory or problem-solving skills (51.9%), increasing income (50.5%), and improving job skills (46.3%). The instrument defined unidimensional and reliable constructs of needs and services. Persons with greater unmet needs tended to receive fewer services; to report lower life satisfaction and worse medical health and psychologic well-being since injury; to be younger, single, black, dependent in 1 or more daily activities; and to have more recent injuries.

CONCLUSIONS

The results show the common pattern of unmet needs and services and emphasize the importance of comprehensive, statewide assessment of services and needs in developing policies.

Long-term life quality and family needs after traumatic brain injury

OBJECTIVES

This investigation assessed the life quality and long-term family needs of caregivers of persons with brain injury.

DESIGN

Respondents completed the Virginia Traumatic Brain Injury Family Needs Assessment Survey.

SETTING

Community-based sample.

PARTICIPANTS

Respondents included 57 caregivers of persons with traumatic brain injury who were at least 4 years after injury and who resided in Virginia. Respondents ranged in age from 19 to 82 years and were primarily women and Caucasian.

OUTCOME MEASURES

The Family Needs Questionnaire (FNQ) and quality of life questions.

RESULTS

Results indicate diminished life quality after injury. With regard to family needs, Health Information (51.43%) and Involvement with Care (47.93%) needs were most often rated as met. Instrumental Support (31.52%) and Professional Support (28.38%) needs were most often rated as not met.

CONCLUSIONS

Family needs and support systems for those needs change over time. This investigation provides evidence that unmet family needs extend well beyond the acute setting and that caregiver life quality diminishes over time. The importance of appreciating long-term family needs and other life quality issues should not be underestimated.