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Nick Rushworth Executive Officer Brain Injury Australia FALLS-RELATED TRAUMATIC BRAIN INJURY IN THE ELDERLY: under-recognised under-diagnosed deadly preventable AGED AND COMMUNITY SERVICES ASSOCIATION OF NSW AND ACT 2009 STATE CONFERENCE - AUSTRALIAN TECHNOLOGY PARK, SYDNEY, 12TH JUNE Slide 2 Nick Rushworth Executive Officer Brain Injury Australia Its never just about the numbers, but Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 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 Slide 3 Brain Injury Network of South Australia AGM, 2008 3 Topics of Discussion State the main ideas youll be talking about Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 3 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 3 TRAUMATIC BRAIN INJURY (TBI) results from external force applied to the head from a motor vehicle accident, a fall or an assault Slide 4 Brain Injury Network of South Australia AGM, 2008 4 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 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 4 PHYSICAL headaches fatigue seizures poor balance and coordination vision and hearing disturbance chronic pain paralysis Slide 5 Brain Injury Network of South Australia AGM, 2008 5 Next Steps Summarize any actions required of your audience Summarize any follow up action items required of you Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 5 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 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 5 COGNITIVE DISABILITY poor memory and concentration reduced ability - to learn - to plan and - to solve problems Slide 6 Brain Injury Network of South Australia AGM, 2008 6 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 6 BEHAVIOUR increased irritability poor impulse control verbal and physical aggression disinhibition Slide 7 Brain Injury Network of South Australia AGM, 2008 7 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 7 FALLS leading cause of Traumatic Brain Injury in Australia - 42% of 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 Slide 8 Brain Injury Network of South Australia AGM, 2008 8 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 8 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 3,272 TBIs 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) Slide 9 Brain Injury Network of South Australia AGM, 2008 9 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 9 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 Slide 10 Brain Injury Network of South Australia AGM, 2008 10 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 10 FALLS injury in older people 2003-2004; cost of hospitalised falls in people aged 65+ estimated at $566 million by 2051, total fall-related injury health costs for the elderly to triple to $1.375 billion per annum = an additional 886,000 hospital bed days and 3,320 extra residential aged care places Slide 11 Brain Injury Network of South Australia AGM, 2008 11 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 11 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 Slide 12 Brain Injury Network of South Australia AGM, 2008 12 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 12 OUTCOMES 1 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) Slide 13 Brain Injury Network of South Australia AGM, 2008 13 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 13 OUTCOMES 2 3X risk of intracranial bleeding than younger TBI 2X length of hospital stay longer periods of Post-Traumatic Amnesia (PTA) increased risk of developing Alzheimers 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" Slide 14 Brain Injury Network of South Australia AGM, 2008 14 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 14 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 Slide 15 Brain Injury Network of South Australia AGM, 2008 15 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 15 you are probably correct in stating that TBI in the elderly tends to get mixed in with dementia and mild cognitive impairment Of course a significant proportion of the falls that occur in the elderly happen in persons with dementia and any added TBI is seen as a dementia complication Slide 16 Brain Injury Network of South Australia AGM, 2008 16 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 16 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+) Slide 17 Slide 18 Brain Injury Network of South Australia AGM, 2008 18 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 18 NAME RECOGNITION falls prevention programs why? head injury second to hip fracture in falls injury ageing population + increased life expectancy baby boomers Slide 19 Brain Injury Network of South Australia AGM, 2008 19 Click to edit Master title style Click to edit Master subtitle style 6/13/2014 Brain Injury Network of South Australia AGM, 2008 19 www.braininjuryaustralia.org.au