Racial Differences in Discharge Location After a Traumatic Brain Injury Among Older Adults.

OBJECTIVE: To determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center. DESIGN: Retrospective cohort study. SETTING: R Adams Cowley Shock Trauma Center. PARTICIPANTS: Black and white adults aged ≥65 years treated for TBI between 1998 and 2012 and discharged to home without services or inpatient rehabilitation (N=2902). MAIN OUTCOME MEASURES: We assessed the association between race and discharge location via logistic regression. Covariates included age, sex, Abbreviated Injury Scale-Head score, insurance type, Glasgow Coma Scale score, and comorbidities. RESULTS: There were 2487 (86%) whites and 415 blacks (14%) in the sample. A total of 1513 (52%) were discharged to inpatient rehabilitation and 1389 (48%) were discharged home without services. In adjusted logistic regression, blacks were more likely to be discharged to inpatient rehabilitation than to home without services compared to whites (odds ratio 1.34, 95% confidence interval, 1.06-1.70). CONCLUSIONS: In this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.

Transitions of Care in Geriatric Medicine.

Elderly patients are at increased risk for morbidity and mortality after injury or surgery in both the inpatient and postdischarge settings. The importance of discharge destination after the index hospitalization is increasingly recognized as a determinant of long-term survival, with discharge to a post-acute care facility portending a worse prognosis. Efforts to minimize discharge to post-acute care facilities should include early discharge planning. Communication among a multidisciplinary care team sets the groundwork for effective discharge planning and transitions of care. The elderly face several systematic, psychosocial, functional, and financial barriers that pose significant challenges to successful transitions of care.