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FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS

FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS. FALLS PREVENTION PROGRAM NETWORK MEETING, DEPARTMENT OF HUMAN SERVICES, VICTORIA - 27 AUGUST, 2009. Nick Rushworth Executive Officer Brain Injury Australia. ACQUIRED BRAIN INJURY (ABI) any damage to the brain that occurs after birth

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FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS

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  1. FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS FALLS PREVENTION PROGRAM NETWORK MEETING, DEPARTMENT OF HUMAN SERVICES, VICTORIA - 27 AUGUST, 2009 Nick Rushworth Executive Officer Brain Injury Australia

  2. ACQUIRED BRAIN INJURY (ABI) • any damage to the brain that occurs after birth • stroke • brain infection • alcohol or other drug abuse • neurological diseases like Huntington's disease • accident or trauma over 500,000 Australians have an Acquired Brain Injury It’s never just about the numbers, but… Click to edit Master title style Nick Rushworth Executive Officer Brain Injury Australia Click to edit Master subtitle style 9/29/2014 Brain Injury Network of South Australia AGM, 2008 2

  3. Click to edit Master title style Click to edit Master subtitle style Click to edit Master title style Click to edit Master subtitle style TRAUMATIC BRAIN INJURY (TBI) results from external force applied to the head from a motor vehicle accident, a fall or an assault Topics of Discussion • State the main ideas you’ll be talking about 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 3 9/29/2014 Brain Injury Network of South Australia AGM, 2008 3

  4. Click to edit Master title style Click to edit Master subtitle style • PHYSICAL • headaches • fatigue • seizures • poor balance and coordination • vision and hearing disturbance • chronic pain • paralysis What This Means • Add a strong statement that summarizes how you feel or think about this topic • Summarize key points you want your audience to remember 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 4

  5. Click to edit Master title style Click to edit Master subtitle style • COGNITIVE DISABILITY • poor memory and concentration • reduced ability • - to learn • - to plan and • - to solve problems Click to edit Master title style Next Steps What This Means Click to edit Master subtitle style • Summarize any actions required of your audience • Summarize any follow up action items required of you • Add a strong statement that summarizes how you feel or think about this topic • Summarize key points you want your audience to remember 9/29/2014 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 5 5

  6. Click to edit Master title style Click to edit Master subtitle style • BEHAVIOUR • increased irritability • poor impulse control • verbal and physical aggression • disinhibition 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 6

  7. Click to edit Master title style Click to edit Master subtitle style 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 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 7

  8. Click to edit Master title style Click to edit Master subtitle style FALLS injury 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) 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 8

  9. Click to edit Master title style Click to edit Master subtitle style FALLS injury in older people • 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 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 9

  10. Click to edit Master title style Click to edit Master subtitle style FALLS injury in older people • 2003-2004; cost of hospitalised falls in people aged 65+ estimated at $566 million • 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 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 10

  11. Click to edit Master title style Click to edit Master subtitle style FALLS-RELATED TBI in older people United States, 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” 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 11

  12. OUTCOMES 1 Click to edit Master title style • 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“) • Click to edit Master subtitle style 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 12

  13. OUTCOMES 2 Click to edit Master title style • 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" • Click to edit Master subtitle style 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 13

  14. Click to edit Master title style Click to edit Master subtitle style “…it is worth noting that many TBI’s 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…” 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 14

  15. Click to edit Master title style Click to edit Master subtitle style “…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…” 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 15

  16. Click to edit Master title style Click to edit Master subtitle style 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+) 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 16

  17. Click to edit Master title style Click to edit Master subtitle style NAME RECOGNITION • falls prevention programs – why? • “head injury” second to hip fracture in falls injury • ageing population + increased life expectancy • “baby boomers” 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 18

  18. Click to edit Master subtitle style Click to edit Master title style www.braininjuryaustralia.org.au 9/29/2014 Brain Injury Network of South Australia AGM, 2008 Brain Injury Network of South Australia AGM, 2008 19

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