This report presents findings from a study commissioned by Wounded Warrior Project and conducted by the RAND Corporation to identify the long-term outcomes of traumatic brain injury (TBI) for veterans, the future needs of this population, effective treatments for TBI, and the availability of community-based resources. The information in this report can be used to better understand which approaches may offer the best care for veterans with TBI.

Cover: Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan
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Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

by Kathryn E. Bouskill, Carrie M. Farmer, Irineo Cabreros, Jonathan H. Cantor, Natalie Ernecoff, Lynn Hu, Shira H. Fischer, Aaron Kofner, Lisa S. Meredith, Matthew L. Mizel, et al.

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Research Questions

  1. What are the short- and long-term consequences of military-related TBI?
  2. What are the most-effective interventions for treating TBI?
  3. What are the long-term needs of veterans with TBI and their caregivers?
  4. What can policymakers and veteran-serving organizations do to better support veterans with TBI?

Between 2000 and 2021, the U.S. Department of Defense diagnosed more than 444,300 service members as experiencing at least one traumatic brain injury (TBI) during their military service. The number of TBIs experienced, and their severity, can affect the trajectory of and prognosis for recovery. Much progress has been made in developing, implementing, and disseminating effective treatments for TBI, yet gaps remain in understanding the long-term care and support needs for veterans who have sustained one or more TBIs during their military service.

This report presents the findings from a study commissioned by Wounded Warrior Project (WWP) and conducted by the RAND Corporation to identify the long-term outcomes of TBI for veterans serving since the terrorist attacks of September 11, 2001; the future needs of this population; effective treatments for TBI; and the availability of community-based resources. The information in this report can be used to better understand which approaches may offer the best care for veterans with TBI, as well as help inform the care and support offered to veterans and their caregivers.

Key Findings

  • Military-related TBI is complex. TBI in the general adult population encompasses a complicated spectrum of conditions with varying degrees of short-term and long-term consequences. The context of military service, including combat injuries and trauma, often adds challenges to the short-term and long-term healing and prognosis of a TBI.
  • Veteran-specific resources are essential. Given the complexity of military-related TBI, treatment and resources that are targeted to the needs of veterans are critical. Providing care that is in tune with the needs of veterans also requires responsiveness to veteran- and caregiver-specific barriers to accessing care.
  • Veterans with TBI are likely to face increasing challenges as they age, and most veterans interviewed for this study were facing such challenges. TBI results in serious long-term physical, psychological, functional, cognitive, and occupational deficits that become more complex with age and comorbidities. Functional limitations from TBI can be compounded over time and require intensive support from caregivers.
  • Evidence from systematic reviews supports cognitive rehabilitation for cognitive outcomes, psychotherapy for psychological outcomes, behavioral interventions for social outcomes, occupational rehabilitation for occupational outcomes, and psychotherapy and behavioral interventions for post-concussion syndrome. However, most TBI research is conducted among the general adult population and often includes non-TBI neurological diagnoses that may result in imprecise or inaccurate efficacy of interventions to support veterans with TBI specifically. Innovations and traditional treatments for TBI show promise, but additional high-quality research in veteran populations is essential to understanding the most-effective interventions for improving outcomes after TBI.

Recommendations

  • Create long-term systems of support. Formal long-term options for care are incomplete, and a large portion of the required support for veterans with TBI is often left to their informal family caregivers. Policymakers should expand access to long-term care for veterans and increase caregiver support.
  • Expand access to multidisciplinary treatment. Considering the co-occurrence of TBI and posttraumatic stress disorder, co-locating care and research for these conditions may better serve populations of veterans by delivering culturally appropriate, holistic care. To that end, expanding awareness of the existing programs and care models that provide integrated treatment of these conditions should be prioritized.
  • Promote health-enhancing behaviors. Health care providers should encourage fundamental wellness—a healthy diet, regular exercise, sleep hygiene, mindfulness, and abstinence from alcohol and other substances—as a key part of treatment.
  • Continue to collect and integrate better-quality data. To better support the needs of veterans with TBI or related conditions, data on TBI and comorbid conditions need to continue to be collected through existing longitudinal studies and shared across different electronic health record systems, such as those from the Department of Defense, the Department of Veterans Affairs, and community-based care.
  • Invest in research. The study findings indicate both demand and need for high-quality research examining veterans with TBI and corresponding treatments and outcomes. Researchers should conduct longitudinal studies examining variation in outcomes and across different populations and studies on evidence-based treatments, including holistic treatments, for TBI. In addition, expanding basic science research to identify biomarkers for TBI severity and chronic traumatic encephalopathy would contribute to needed improvements in diagnostics and treatment.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Long-Term Health and Well-Being Outcomes

  • Chapter Three

    Characteristics of WWP Alumni with Traumatic Brain Injury and Other Head Injuries

  • Chapter Four

    Long-Term Experiences of Traumatic Brain Injury Among Veterans and Caregivers

  • Chapter Five

    Treatments and Interventions to Address Long-Term Outcomes for Veterans with Traumatic Brain Injury

  • Chapter Six

    Resources Available to Veterans with Traumatic Brain Injury

  • Chapter Seven

    Perspectives on Addressing the Long-Term Impacts of Traumatic Brain Injury Among Veterans

  • Chapter Eight

    Conclusions and Recommendations

  • Appendix A

    Search Terms for the Umbrella Review of the Risk or Prevalence of Long-Term Outcomes Following Traumatic Brain Injury

  • Appendix B

    Additional Analyses of WWP Survey Data

  • Appendix C

    Search Terms for the Umbrella Review of Traumatic Brain Injury Treatments and Interventions

  • Appendix D

    Additional Analyses of Traumatic Brain Injury Resources

Research conducted by

This research was funded by Wounded Warrior Project and carried out within the Quality Measurement and Improvement Program in RAND Health Care.

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