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Aging and Brain Injury

Aging and Brain Injury. Cynthia L. Boyer, Ph.D Executive Director Brain Injury Services. Statistics. More than 5.3 million Americans are living with TBI related disabilities Average Span of a person with TBI injured before age 30 is 78.6 years. Physical patterns:. NORMAL AGING. Aging.

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Aging and Brain Injury

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  1. Aging and Brain Injury Cynthia L. Boyer, Ph.D Executive Director Brain Injury Services

  2. Statistics • More than 5.3 million Americans are living with TBI related disabilities • Average Span of a person with TBI injured before age 30 is 78.6 years

  3. Physical patterns: NORMAL AGING

  4. Aging TBI Mobility Problems Sensory Loss Health issues Memory & Cognitive Problems Depression Loss of peers/social; withdrawl • Mobility Problems • Hearing and Vision Loss • Health Issues • Decreased Memory • Depression • Loss of peers/social withdrawl

  5. What Barriers Increase Over Time? • Aging Caregivers • Social Network & Support Failure • Functional Capacities Decrease • Loss of Life Activity Focus • Higher rates of Psychological Problems • Emergence of Additional Health Problems

  6. Other Factors Affecting Health • Economic and Social Status • Limited Resources/Insurance • Reduced Health Literacy • Poor Health Practices due to Cognitive Problems • Increased Rates of Obesity, Hypertension, Depression and Diabetes

  7. Chronic Medical Issues • Seizure Disorder • Respiratory Problems • Late Onset Swallowing Problems • Diabetes • Skin Integrity • Circulatory Problems • GI Probles • Headaches • Pain

  8. Caregiver Issues • Age • Health • Physical Capacity • Finances

  9. Accelerated Decline • Early Onset of Physical and Cognitive Decline • Psychological Response to Long Term Disability • Gains Made in Rehab Erode • Level of Independence Decreases

  10. Research (Colantonio et al., 2004) Enhanced physical decline • Colantonio, Ratcliff, Chase, & Vernich, 2004 • Increased incidence of arthritis among 35-44 y/o’s • Increased prevalence of visual and hearing impairments • Increased prevalence of epilepsy • Sleep problems

  11. Research (De Beaumont et al., 2009; Corkin et al., 1989) Enhanced cognitive decline: • Corkin, Rosen, Sullican, & Clegg, 1989 • Longitudinal study examining 314 veterans sustaining head injury • Results: found that head injury was associated with decline on tests of cognitive functioning • De Beaumont et al., 2009 • Examined athletes sustaining their last concussion since years playing sports • Results: significant reductions in episodic memory, motor execution slowing, and decline with response inhibition 30 years post-injury

  12. TBI Is A Chronic Disease • Life Expectancy • Endocrine Dysfunction • Cognitive Decline • Psychiatric Conditions • Development of Neurodegenerative Conditions

  13. Risk Factors for Increased Mortality • Advanced Age at Time of Injury • Seizures • Employment Status • Substance Abuse • Psychiatric Disorder • Physical Impairment

  14. Causes of Death • Seizures • Pneumonia/Other Respiratory • Sepsis • Choking • Suicide* • Substance Abuse Related* • Accidental Injury* *mild tbi

  15. Endocrine Dysfunction • Growth hormone insufficiency • Hypothyroidism • Gonadotropin Decrease • Hypopituitarism

  16. NeuroDegenerative Disorders • Increased risk of brain atrophy • Lack of neuronal reserve • Breakdown of BBB • Accumulation of protein

  17. TBI & NeuroDegenerative Disorders • Moderate to Severe TBI Associated with Alzheimer’sDisease Parkinsonism • Mild TBI ??

  18. Age at Injury & Outcomes • Higher rates of severe disability, PVS, and death for >55 • Severe Disability, PVS and death rates for ages 15-25 was 50% of the rate for those >55

  19. Age & Recovery • Older brain has decrease ability to repair itself • Greater likelihood of repeated insults to the brain based on age • 40-50% increase in the odds of poor outcome for every 10 yrs of age

  20. TBI In Older Adults Falls Risk Factors • Increasing Age • Cognitive Impairment • Medication Side Effects • Alcohol Intoxication

  21. CASE STUDY 1

  22. Case Study 2

  23. Final Thoughts • TBI is a chronic disease with lifetime effects • TBI Increases the risk of multiple health problems • Resources are needed for long term follow up and increased care

  24. Thank you!

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  26. Kolias, A. G., Guilfoyle, M. R., Helmy, A., Allanson, J., & Hutchinson, P. J. (2013). Traumatic brain injury in adults. Practical Neurology, 13(4), 228-235.doi:10.1136/practneurol-2012-000268 Li, Y., Baldassi, M., Johnson, E. J., & Weber, E. U. (2013). Complementary cognitive capabilities, economic decision making, and aging. Psychology And Aging, 28(3), 595-613. doi:10.1037/a0034172 Li, S., Lindenberger, U., Baltes, P., Hommel, B., Aschersleben, G., & Prinz, W. (2004). Transformations in the Couplings Among Intellectual Abilities and Constituent Cognitive Processes Across the Life Span. Psychological Science, 15(3), 155-163 Masliah, E., Crews, L., & Hansen, L. (2006). Synaptic remodeling during aging and in Alzheimer's disease. Journal Of Alzheimer's Disease, 9(3), 91-99. McAllister, T. W. (2011). Neurobiological consequences of traumatic brain injury. Dialogues In Clinical Neuroscience, 13(3), 287-300. McArdle, J. J., Ferrer-Caja, E., Hamagami, F., & Woodcock, R. W. (2002). Comparative longitudinal structural analyses of the growth and decline of multiple intellectual abilities over the life span.Developmental Psychology, 38(1), 115-142. doi:10.1037/0012-1649.38.1.115  Moretti, L. L., Cristofori, I. I., Weaver, S. M., Chau, A. A., Portelli, J. N., & Grafman, J. J. (2012). Cognitive decline in older adults with a history of traumatic brain injury. The Lancet Neurology, 11(12), 1103-1112. doi:10.1016/S1474-4422(12)70226-0  Raz, N., & Rodrigue, K. M. (2006). Differential aging of the brain: Patterns, cognitive correlates and modifiers. Neuroscience & Biobehavioral Reviews, 30(6), 730-748. doi:10.1016/j.neubiorev.2006.07.001 References

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