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Prevalence and correlates of traumatic brain injury (TBI) in older adults: results from the Well-being of the Singapore Elderly (WiSE) study

Published online by Cambridge University Press:  24 July 2017

Laxman Cetty*
Research Division, Institute of Mental Health, Singapore
Edimansyah Abdin
Research Division, Institute of Mental Health, Singapore
Janhavi Ajit Vaingankar
Research Division, Institute of Mental Health, Singapore
Anitha Jeyagurunathan
Research Division, Institute of Mental Health, Singapore
Boon Yiang Chua
Research Division, Institute of Mental Health, Singapore
Louisa Picco
Research Division, Institute of Mental Health, Singapore
Martin Prince
Health Service and Population Research Department, King's College London, London, UK
Siow Ann Chong
Research Division, Institute of Mental Health, Singapore
Mythily Subramaniam
Research Division, Institute of Mental Health, Singapore
Correspondence should be addressed to: Laxman Cetty, Research Division, Institute of Mental Health, 10 Buangkok View, 539747, Singapore. Phone: (65) 6389 3698. Email:



Older adults are among the most susceptible to sustain traumatic brain injury (TBI). The study aimed to determine the (1) prevalence of TBI among older adults in Singapore, and (2) socio-demographic, lifestyle, and clinical correlates of TBI.


Data were extracted from the cross-sectional, Well-being of the Singapore Elderly (WiSE) study. The study included 2,565 participants aged 60 years and above (Mean = 72.75, SD = 9.54). Information on TBI, socio-demographic, and lifestyle factors were collected using participant self-report and verified with the informant report where necessary. Disability was measured using the World Health Organization – Disability Assessment Schedule 2.0 (WHO-DAS 2.0). Data were analyzed using logistic regression analysis.


The prevalence of TBI was 3.6%. Being female (vs. male) was found to be associated with decreased odds of having TBI. Having completed secondary education or lower (vs. tertiary education) was found to be associated with increased odds of having TBI. A history of fainting and diabetes were associated with the presence of TBI. Those with TBI were associated with higher disability scores on the WHO-DAS 2.0 than those without TBI.


The current study provides information on the prevalence and associated factors of TBI in the older adult population in Singapore. Since TBI was associated with older adults with diabetes, they must be cautioned about fall risk. Also, given the association with disability, older adults with TBI are likely to require support and rehabilitative care to ensure good quality of life.

Research Article
Copyright © International Psychogeriatric Association 2017 

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Adams, R. et al. (1993). Definition of Mild Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 8, 8687.Google Scholar
Almeida, O. P., Hankey, G. J., Yeap, B. B., Golledge, J. and Flicker, L. (2015). Prevalence, associated factors, mood and cognitive outcomes of traumatic brain injury in later life: the health in men study (HIMS). International Journal of Geriatric Psychiatry, 30, 12151223.Google Scholar
Burke, J. F., Stulc, J. L., Skolarus, L. E., Sears, E. D., Zahuranec, D. B. and Morgenstern, L. B. (2013). Traumatic brain injury may be an independent risk factor for stroke. Neurology, 81, 3339.Google Scholar
Cheng, P.-L., Lin, H.-Y., Lee, Y.-K., Hsu, C.-Y., Lee, C.-C. and Su, Y.-C. (2014). Higher mortality rates among the elderly with mild traumatic brain injury: a nationwide cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 22, 7.Google Scholar
Chua, K. S., Ng, Y. S., Yap, S. G. and Bok, C. W. (2007). A brief review of traumatic brain injury rehabilitation. Annals Academy of Medicine Singapore, 36, 3142.Google Scholar
Copeland, J. R. et al. (1976). A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly: the geriatric mental state schedule. Development and reliability. Psychological Medicine, 6, 439449.Google Scholar
Department of Statistics, M. o. T. I., Republic of Singapore (2015). Population Trends 2015. In Singapore, D. o. S. (Ed.) Singapore: Department of Statistics Singapore.Google Scholar
Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. JAMA, 252, 19051907.CrossRefGoogle ScholarPubMed
Faul, M., Xu, L., Wald, M. M. and Coronado, V. (2010). Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths, 2002–2006. In Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Atlanta, Georgia.Google Scholar
Fields, G. S. (1985). Industrialization and employment in Hong Kong, Korea, Singapore, and Taiwan. In Galenson, W. (ed.), Foreign Trade and Investment: Economic Development in the Newly Industrializing Asian Countries (pp. 333375). Madison, WI: University of Wisconsin Press.Google Scholar
Finnanger, T. G., Skandsen, T., Andersson, S., Lydersen, S., Vik, A. and Indredavik, M. (2013). Differentiated patterns of cognitive impairment 12 months after severe and moderate traumatic brain injury. Brain Injury, 27, 16061616.Google Scholar
Gan, B. K., Lim, J. H. and Ng, I. H. (2004). Outcome of moderate and severe traumatic brain injury amongst the elderly in Singapore. Annals Academy of Medicine Singapore, 33, 6367.Google Scholar
Goodrich, G. L., Martinsen, G. L., Flyg, H. M., Kirby, J., Garvert, D. W. and Tyler, C. W. (2014). Visual function, traumatic brain injury, and posttraumatic stress disorder. Journal of Rehabilitation Research & Development, 51, 547558.Google Scholar
Hall, K. S. et al. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methods in Psychiatry, 3, 128.Google Scholar
Hyder, A. A., Wunderlich, C. A., Puvanachandra, P., Gururaj, G. and Kobusingye, O. C. (2007). The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation, 22, 341353.Google Scholar
Khan, A., Prince, M., Brayne, C. and Prina, A. M. (2015). Lifetime prevalence and factors associated with head injury among older people in low and middle income countries: a 10/66 study. PLoS One, 10, 114.Google Scholar
Lee, Y. K., Hou, S. W., Lee, C. C., Hsu, C. Y., Huang, Y. S. and Su, Y. C. (2013). Increased risk of dementia in patients with mild traumatic brain injury: a nationwide cohort study. PLoS One, 8, e62422.CrossRefGoogle ScholarPubMed
Manley, G. T. and Maas, A. R. (2013). Traumatic brain injury: an international knowledge-based approach. The Journal of The American Medical Association, 310, 473474.Google Scholar
Maurer, M. S., Burcham, J. and Cheng, H. (2005). Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60A, 11571162.Google Scholar
Menzel, J. C. (2008). Depression in the elderly after traumatic brain injury: a systematic review. Brain Injury, 22, 375380.Google Scholar
Munjal, S. K., Panda, N. K. and Pathak, A. (2010). Relationship between severity of traumatic brain injury (TBI) and extent of auditory dysfunction. Brain Injury, 24, 525532.Google Scholar
Ozen, L. J., Fernandes, M. A., Clark, A. J. and Roy, E. A. (2015). Evidence of cognitive decline in older adults after remote traumatic brain injury: an exploratory study. Aging, Neuropsychology, and Cognition, 22, 517533.Google Scholar
Pang, E. F. (1981). Economic development and the labor market in a newly industrializing country: the experience of Singapore. The Developing Economies, 19, 316.Google Scholar
Prince, M. et al. (2007). The protocols for the 10/66 dementia research group population-based research programme. BMC Public Health, 7, 165165.Google Scholar
Prince, M., Acosta, D., Chiu, H., Scazufca, M. and Varghese, M. (2003). Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361, 909917.Google Scholar
Rehm, J. et al. (1999). On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods in Psychiatric Research, 8, 110122.CrossRefGoogle Scholar
Roozenbeek, B., Maas, A. I. R. and Menon, D. K. (2013). Changing patterns in the epidemiology of traumatic brain injury. Nature Reviews Neurology, 9, 231236.Google Scholar
Selassie, A. W., Zaloshnja, E., Langlois, J. A., Miller, T., Jones, P. and Steiner, C. (2008). Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. Journal of Head Trauma Rehabilitation, 23, 123131.Google Scholar
Silver, J. M., Kramer, R., Greenwald, S. and Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the new haven NIMH epidemiologic catchment area study. Brain Injury, 15, 935945.CrossRefGoogle ScholarPubMed
Subramaniam, M. et al. (2015). Prevalence of dementia in people aged 60 years and above: results from the WiSE study. Journal of Alzheimers Disease, 45, 11271138.Google Scholar
Susman, M. et al. (2002). Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. Journal of Trauma, 53, 219224.Google Scholar
Thompson, H. J., Dikmen, S. and Temkin, N. (2012). Prevalence of comorbidity and its association with traumatic brain injury and outcomes in older adults. Research in Gerontological Nursing, 5, 1724.Google Scholar
Vaingankar, J. A. et al. (2016). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. International Psychogeriatrics, 28, 221231.Google Scholar
Vanderploeg, R. D., Belanger, H. G. and Curtiss, G. (2009). Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Archives of Physical Medicine and Rehabilitation, 90, 10841093.Google Scholar