Functional Limitations and Caregiver Need After Traumatic Injury: A Multi-Institutional Study.

INTRODUCTION: Trauma is a leading cause of disability in the United States, leaving many patients with new functional limitations requiring long-term caregiving. The objective of this study was to determine predictors of having a caregiver at 6 mo postinjury among patients who were functionally independent at baseline. METHODS: We performed a secondary analysis of a prospective cohort study of patients admitted to one of three level I trauma centers and interviewed at 6 mo postdischarge. A multivariable logistic regression was generated to determine what clinical and patient-level factors were associated with having a caregiver at 6 mo postinjury. RESULTS: A total of 1876 participants were included in the analysis, 507 (27.0%) of whom had a caregiver who completed a proxy interview. On multivariable logistic regression, in addition to new limitations in bathing, eating, toileting, and cooking, age ≥65, male sex, Hispanic ethnicity, injury severity score ≥25, and longer length of stay were independently associated with having a caregiver at 6 mo postinjury (P < 0.05). A subgroup analysis of high-need patients (i.e., 2+ new functional limitations) demonstrated that discharge to an acute rehabilitation facility or nursing home, as well as preinjury employment were independent risk factors for not having a caregiver when one was needed (i.e., unmet need). CONCLUSIONS: New functional limitations requiring long-term caregiving are common after trauma. Identifying predictors of having a caregiver and risk factors for unmet caregiver need may allow for proactive resource allocation.