Residence following traumatic brain injury: a longitudinal study.

Objective: To examine change in residence following traumatic brain injury (TBI) as a function of preinjury residential status, demographic factors, and injury-related characteristics. Design: Prospective, observational study. Setting: Inpatient, comprehensive rehabilitation programs for persons with TBI. Participants: A total of 7925 patients with moderate or severe TBI receiving acute rehabilitation, and enrolled in the TBI Model Systems National Database. Main Measures: Preinjury and discharge residential status determined during rehabilitation, and at 1, 2, and 5 years postinjury by telephone interview. Variables contributing to residential status included Injury severity, demographic information, and functional status. Results: There was significant change in residence across 5 years characterized by discharge to a less independent residence following injury, with a return to a more independent residence over time. The most significant transition took place in the first year after injury. Residence prior to injury was the strongest predictor of residence after injury. Age and race were significantly associated with residence following TBI, with increasing age related to more independent residence, and whites more likely to live independently than are African Americans. Severity of injury had little impact, although functional status at rehabilitation discharge was associated with residence, with higher functional status associated with a more independent residence. Conclusion: Among persons who received acute rehabilitation for TBI, 35.4% were discharged from rehabilitation to a setting different from the one in which they resided before injury. The degree of change varied on the basis of preinjury residence. Overall, the results indicate that while many patients are discharged to a different residential setting than prior to their injury, some patients recover to the point where they are able to return to their premorbid residential setting. The most substantial change was for those living alone at the time of injury, and within the first year of injury.