Nick Rushworth Executive Officer Brain Injury Australia

1. New South Wales Council of Social Service; NSW Aged Care Alliance - October 22, 2009 FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS Nick RushworthExecutive Officer Brain Injury Australia

2. “…peak of peaks”

3. “…Brain Injury Australia works to ensure that all people living with an ABI have access to supports and resources each person needs to optimise their social and economic participation…” “…advocacy for Australian Government program allocations and policies that reflect the needs and priorities of people with an ABI and their families…” “…the provision of effective and timely input into policy, legislation and program development through active contact with Australian Government ministers, parliamentary representatives, Australian Government departments and agencies, and national disability organisations…”

4. ACQUIRED BRAIN INJURY (ABI) any damage to the brain that occurs after birth stroke brain infection alcohol or other drug abuse neurological diseases (Huntington's disease etc.) accident or trauma over 500,000 Australians have an Acquired Brain Injury

5. STROKE/ “CVA” 2003; 347,000 reported stroke 60,000 new strokes occur every year median age for stroke is around 80 years 1 in every 5 strokes happens to a person aged less than 55

6. TRAUMATIC BRAIN INJURY (TBI) results from external force applied to the head • motor vehicle accidents • falls • assaults

7. “tri-modal age structure”, 1996-97 TRAUMATIC BRAIN INJURY (TBI)

8. “tri-modal age structure”, 2001-02(?) TRAUMATIC BRAIN INJURY (TBI)

9. “tri-modal age structure”, 2004-05 TRAUMATIC BRAIN INJURY (TBI)

10. falls… • leading cause of Traumatic Brain Injury in Australia - 42% of TBI hospitalisations in 2004-2005 • leading cause of injury hospitalisations overall - 1 in every 3 (126,800) injury admissions in 2003-2004 • of all causes of TBI, falls are the most fatal. 63% resulted in death in 2004-2005

11. falls injuries in older people… • 65+ accounted for 62% of all TBI deaths in hospital in 2004-2005 - 1 in every 6 the result of a fall • 3,272TBIs the result of a fall in people aged 65+ = 1 in every 7 TBI hospitalizations in 2004-2005 • “Head injury” was the second most common falls-related injury (after those to the hip and thigh) in 65+ during 2005-2006 (17% of cases)

12. 70,000 aged 65 + admitted to hospital in 2005-2006 for a falls injury = an increase of 10% over 2003-2004 admission numbers falls injuries to the hip and thigh decreasing, rates of head injury increasing – to 1 in every 5 admissions falls injuries in older people…

13. by 2051; total fall-related injuryhealth costs for older people to triple to $1.375 billion per annum = an additional 886,000 hospital bed days and 3,320 extra residential aged care places 2003-2004; costs of hospitalised falls in people aged 65+ estimated at $566 million falls injuries in older people…

14. falls injuries in older Americans… 2003: direct costs of treating a principal diagnosis of TBI in patients aged 65+ “exceeded $2.2 billion… “…If, as expected, the older population in the United States doubles from the current 35 million to 70 million by 2030, …the costs of caring for older adults with TBI in monetary and human terms will be staggering.”

15. PHYSICAL DISABILITY paralysis poor balance and coordination chronic pain fatigue seizures (1 in 6) vision and hearing disturbance speech impairment loss of sense of taste or smell

16. COGNITIVE DISABILITY poor memory and concentration (2 in 3) reduced ability - to learn - to plan and - to solve problems

17. “CHALLENGING BEHAVIOUR” (for 2 out of 3, the most disabling) • increased irritability • poor impulse control • verbal and physical aggression • disinhibition

18. OUTCOMES 1

19. OUTCOMES 1 (cont.) 85 plus: highest age-specific falls injury, falls deaths, TBI and TBI death rates (“100% mortality”) Age = strongest clinical predictor of recovery from TBI (after measures of injury severity): • every 10 years of age increases “odds on poor outcome” 40% - 50%; • “optimal change points” in age at TBI were 60 years (mortality), 29 years (“unfavorable outcome“).

20. OUTCOMES 2

21. OUTCOMES 2 (cont.) 3X risk of intracranial bleeding than younger TBI 2X length of hospital stay longer periods of Post-Traumatic Amnesia (PTA) increased risk of developing Alzheimer’s Disease only 30%-50% returned directly home increased risk of residential aged care placement higher incidence of general brain deterioration reduced psychosocial and financial support "lowered expectations for recovery by staff and patient"

22. “…it is worth noting that many TBIs in older people occur among those who already have a measure of neurodegenerative disease and especially among those in resicare – the majority already have disabling dementia…”

23. “…you are probably correct in stating that TBI in the elderly[sic] tends to get mixed in with dementia and mild cognitive impairment… Of course a significant proportion of the falls that occur in the elderly[sic] happen in persons with dementia and any added TBI is seen as a dementia complication…”

24. TBI PREVENTION falls “from heights” 65+ men - ladders, “DIY” (up 25%, 1999-2005) women – (outlive men), home hazards “old old” – residential aged care (5X rate at home) “hit head” or no? neurological observations (72 hours+?) anti-thrombotics use, intracranial bleeding (…2005- 06 - 21,000 scripts for warfarin issued to 80 yrs+)

26. NAME RECOGNITION falls prevention programs – why? “head injury” second to hip fracture in falls injury ageing population + increased life expectancy “baby boomers”

27. www.braininjuryaustralia.org.au