OBJECTIVES: The incidence of traumatic brain injury (TBI) is rapidly increasing in older adults, yet the consequences of such injuries on elderly persons and their caregivers are still understudied. The objectives of this project were (1) to document self- and informant-reported subjective complaints in older adults with TBI including discrepancies in perception of problems, and (2) to explore the link between discrepancies and self-reported cognition, depression, and anxiety. 

METHODS: This project is part of an on-going longitudinal cohort study on mental health after TBI in the elderly. Participants were elders who sustained a TBI and were hospitalized in a Level I trauma center in Québec, QC, Canada, and relatives who were the primary non-professional support providers of the injured persons. The preliminary sample included 25 elders with TBI (mean age = 72.9 ± 5.9 years; 26% women; 46% mild, 30% complicated mild, 23% moderate/severe TBI) and 17 relatives (mean age = 64.2 ± 13.9 years) who completed the four-month questionnaire. The main outcome measure was the Brain Injury Complaint Questionnaire (BICoQ), a 25-item instrument (with self- and informant-reported versions) measuring the presence/absence of a wide range of cognitive, behavior, fatigue/sleep, mood, and somatic problems. Both elders and relatives also completed the MOS Cognitive Functioning Subscale (MOS-COG) and the Hospital Anxiety and Depression Scale (HADS). 

RESULTS: Four months post-TBI, injured older adults reported, on average, 7.3 ± 5.7 complaints on the BICoQ. The most common complaints were slowness (68% of sample), fatigue (52%), increased sleep (52%), need for calm (52%), and concentration problems (48%). For the 15 pairs of older adults and relatives who both completed the BICoQ, the correlation between the two versions was high (r = .71, p = .003). For 27% of the items overall, the relative reported the symptom as present while the injured elder reported the symptom as absent, suggesting a lack of awareness by the patient, whereas the opposite pattern was observed for only 10% of the items. Memory problems were endorsed by relatives but denied by older adults with TBI in 46% of cases. A higher number of item discrepancies between self- and informant versions of the BICoQ was significantly associated with poorer cognitive functioning on the MOS-COG in the elders with TBI (r = -.52; p = .046), and higher anxiety symptoms on the HADS in the relatives (r = .59; p = .021). 

CONCLUSIONS: Subjective complaints are common in older adults four months after TBI. While there is a strong association between the number of problems reported by injured elders and close relatives, discrepancies are common, especially for memory problems. The perspectives of both elders and relatives should be considered when assessing symptoms, as discrepancies may suggest the presence of other problems.

Self- and informant-reported subjective complaints in older adults with traumatic brain injury: Preliminary data from a longitudinal cohort study