Primary language as a moderator of social integration and functional independence after traumatic brain injury in U.S. older adults

Purpose This study examined whether primary language moderates the relationship between social integration and functional independence among older adults in the U.S. following traumatic brain injury (TBI).Methods A secondary analysis was conducted using data from the Traumatic Brain Injury Model System National Database (TBIMS-NDB), including 1,030 individuals aged 65–88 with mild, moderate, or severe TBI. Of these, 88.3% reported English as their primary language, while 11.7% reported a non-English language. Social integration was assessed using the Participation Assessment with Recombined Tools-Objective, and functional independence was measured via the Functional Independence Measure. Primary language was categorized as English or non-English. Hayes’s PROCESS macro was used for moderation analysis.Results Social integration significantly predicted functional independence (β = 15.94, p < .001), controlling for demographics and TBI severity. A significant interaction between social integration and primary language (β = 10.05, p < .01) indicated that the relationship was stronger among non-English speakers.Conclusion Primary language plays a moderating role in the link between social integration and functional independence post-TBI. These findings highlight the need for culturally and linguistically tailored interventions to improve outcomes for older adults with TBI.