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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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Nick rushworth executive officer brain injury australia

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


Peak of peaks

“…peak of peaks”


Nick rushworth executive officer brain injury australia

“…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…”


Nick rushworth executive officer brain injury australia

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


Nick rushworth executive officer brain injury australia

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


Nick rushworth executive officer brain injury australia

TRAUMATIC BRAIN INJURY (TBI)

results from external force applied to the head

  • motor vehicle accidents

  • falls

  • assaults


Tri modal age structure 1996 97

“tri-modal age structure”, 1996-97

TRAUMATIC BRAIN INJURY (TBI)


Tri modal age structure 2001 02

“tri-modal age structure”, 2001-02(?)

TRAUMATIC BRAIN INJURY (TBI)


Tri modal age structure 2004 05

“tri-modal age structure”, 2004-05

TRAUMATIC BRAIN INJURY (TBI)


Falls

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


Falls injuries in older people

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)


Falls injuries in older people1

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…


Falls injuries in older people2

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

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.”


Nick rushworth executive officer brain injury australia

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


Nick rushworth executive officer brain injury australia

COGNITIVE DISABILITY

poor memory and concentration (2 in 3)

reduced ability

- to learn

- to plan and

- to solve problems


Nick rushworth executive officer brain injury australia

“CHALLENGING BEHAVIOUR”

(for 2 out of 3, the most disabling)

  • increased irritability

  • poor impulse control

  • verbal and physical aggression

  • disinhibition


Outcomes 1

OUTCOMES 1


Outcomes 1 cont

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

OUTCOMES 2


Outcomes 2 cont

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"


Nick rushworth executive officer brain injury australia

“…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…”


Nick rushworth executive officer brain injury australia

“…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…”


Nick rushworth executive officer brain injury australia

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+)


Nick rushworth executive officer brain injury australia

NAME RECOGNITION

falls prevention programs – why?

“head injury” second to hip fracture in falls injury

ageing population + increased life expectancy

“baby boomers”


Nick rushworth executive officer brain injury australia

www.braininjuryaustralia.org.au


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