Cognition, Behaviour and Lifestyle Choices as Determinants of Outcome in Brain Injury Patients
In persons with brain injury, cognition and behaviour are predominant factors in determining outcome but focus only on these may result in undervaluation of an individual's preference. In order to not underrate predicted and expected outcome e.g. discharge destination, a questionnaire designed to obtain information on lifestyle preference has been produced, which incorporates cognitive testing and behaviour/mood assessment.
Purpose: To show, using case reports, that (i) reduced cognitive function does not necessarily indicate incompetence in terms of decision making and lifestyle choices and (ii) that poor choices made on another's behalf, which override a person's lifestyle preference and choice, may adversely affect behaviour and health and wellbeing, in brain injury and in elderly patients.
Results: Lifestyle decision making may be preserved when either reduced cognition and/or behaviour issues are present. Giving-in to a patient's preference, where they are able to indicate preference, rather than over-riding choice, may enhance cognitive function and have positive effects on behaviour, two important issues common to management of brain injured patients and the elderly with mild cognitive impairment. Even when clearcut assistance is required to execute decisions, because of physical handicap or frailty, the aware carer and/or therapist will acknowledge that choice perceived can be made. Action taken with this in mind maximises retained potential and allows the person to continue to enjoy living and quality of life.
Summary: The findings support greater participation and regard to patient preferences in determining outcomes per se and lifestyle issues in particular, which in turn has positive effects on cognitive function and behaviourial and/or emotional issues. Further studies, taking lifestyle decision making ability into account in the assessment and management of head injury patients, are required.