OBJECTIVES: Caregiver burden and distress are well documented in younger adults with traumatic brain injury (TBI) but not for elderly sustaining TBI (65 years and over). The objectives of this study were to: (1) describe subjective and objective burden and psychological symptoms (anxiety and depression) of close relatives of elderly persons with TBI four months post-injury, and (2) to explore if subjective burden is explained by age of the injured person, perceived social support, and subjective complaints relative to the injured elder.
METHODS: Participants were 36 relatives of elders with TBI aged between 29 and 84 years (mean age = 65.1±12.2; 89% women; 67% spouses living with the injured elder; 17% children). Elders with TBI were aged 65-90 years and were admitted to a Level I trauma centre in Québec, Canada (25% mild, 47% complicated mild, and 28% moderate/severe TBI). The Zarit Burden Interview (ZBI) measured subjective burden. A checklist was used to assess objective burden (i.e., significant changes in activities or roles since the injury). Psychological symptoms of the close relative were assessed with the Hospital Anxiety and Depression Scale (HADS) using a cut-off>8 on either subscale to identify clinically significant symptoms. The participant’s perceived social support was measured with the Modified MOS Social Support scale. The Brain Injury Complaint Questionnaire (BICoQ) assessed a variety of problems and complaints observed by the relative regarding the injured person (e.g. memory, fatigue, motivation). 
RESULTS: Twenty-nine percent of relatives presented mild-moderate subjective burden on the ZBI at 4 months post-injury and 6% presented moderate-severe burden. Almost all participants (87%) reported some form of objective burden (e.g. spending more time caring for their loved one or having less time for themselves). Regarding psychological symptoms, 17% of relatives presented significant depressive symptoms and 11% significant anxiety symptoms. In total 25% had either significant anxiety or depression. Subjective burden and psychological symptoms (total HADS) were strongly correlated (r=.54, p<.001). A first exploratory stepwise linear regression including the number of subjective complaints (BICoQ) and age of the caregiver significantly contributed to predict subjective burden on the ZBI, (adjusted R2=.46). A second exploratory stepwise linear regression including subjective burden and social support significantly contributed to predict psychological symptoms on the HADS, (adjusted R2=.40)
CONCLUSIONS: The present study shows that important proportions of close relatives of elderly persons with TBI report either anxiety or depression and perceive significant burden which is related to the injured elder’s ongoing issues. They take on new or increased responsibilities of support and care which are essential to support the quality of life of the injured elderly person. Given the increasing incidence of TBI in the elderly, it is warranted to increase attention towards the wellbeing of their caregivers.

Subjective and objective burden and psychological symptoms in close relatives of elderly persons with traumatic brain injury