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New South Wales Council of Social Service; NSW Aged Care Alliance - October 22, 2009. FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS. Nick Rushworth Executive Officer Brain Injury Australia. “…peak of peaks”.

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Nick Rushworth Executive Officer Brain Injury Australia

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New South Wales Council of Social Service;

NSW Aged Care Alliance - October 22, 2009


Nick RushworthExecutive Officer

Brain Injury Australia

“…peak of peaks”

“…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…”


any damage to the brain that occurs after birth


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


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


results from external force applied to the head

  • motor vehicle accidents

  • falls

  • assaults

“tri-modal age structure”, 1996-97


“tri-modal age structure”, 2001-02(?)


“tri-modal age structure”, 2004-05



  • 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

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)

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…

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…

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.”



poor balance and coordination

chronic pain


seizures (1 in 6)

vision and hearing disturbance

speech impairment

loss of sense of taste or smell


poor memory and concentration (2 in 3)

reduced ability

- to learn

- to plan and

- to solve problems


(for 2 out of 3, the most disabling)

  • increased irritability

  • poor impulse control

  • verbal and physical aggression

  • disinhibition


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“).


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"

“…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…”

“…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…”


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+)


falls prevention programs – why?

“head injury” second to hip fracture in falls injury

ageing population + increased life expectancy

“baby boomers”

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