Brain injury and older adults
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Brain Injury and Older Adults. A Product of the Maryland Traumatic Brain Injury Partnership Implementation Project 2006-2009. Agenda. The incidence and prevalence of TBI What is brain injury? What are the types of brain injury? Brain Injury and Older Adults. Incidence of TBI CDC 2007.

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Brain injury and older adults

Brain Injury and Older Adults

A Product of the Maryland Traumatic Brain Injury Partnership Implementation Project

2006-2009


Agenda

Agenda

  • The incidence and prevalence of TBI

  • What is brain injury?

  • What are the types of brain injury?

  • Brain Injury and Older Adults


Incidence of tbi cdc 2007

Incidence of TBICDC 2007

In the United States, at least

1.6 million sustain a TBI each year


Of those 1 6 million cdc2007

Of Those 1.6 Million CDC2007

  • 51,000 die;

  • 290,000 are hospitalized; and

  • 1,224,000 million are treated an released from an emergency department


Annual incidence of tbi with disability an estimated 124 000 american civilians

Annual Incidence of TBI with DisabilityAN ESTIMATED 124,000 American civilians

Cited by Jean Langlois ScD,MPH NASHIA Conference 2007

Preliminary findings as analyzed by Selassie, et. al


Causes of tbi cdc 2006

Causes of TBICDC 2006


Brain injury and older adults

Adults age 75 years or older have the highest rates of TBI related hospitalization and death CDC 2004


In 2000 tbi accounted for 46 of fatal falls among older adults stevens et al 2006 cdc website 2007

In 2000, TBI Accounted for 46% of fatal falls among older adults (Stevens et. al. 2006)CDC Website 2007


Types of tbi

Types of TBI

  • Distribution of Severity:

    • Mild injuries = 80%(LOC < 30 min, PTA ,1 hour)

    • Moderate = 10 - 13%(LOC 30 min-24 hours, PTA 1-24 hours)

    • Severe = 7 - 10% (LOC >24 hours, PTA >24 hours)


Brain injury and older adults

The HELPS Brain Injury Screening Tool(see handout)The original HELPS tool developed by M. Picard, D. Scarisbrick, R. Paluck, 9.1991Updated by the Michigan Department of Community Health


H elps

HELPS

  • Have you ever Hit your Head or been Hit on the Head?

  • Prompt individual to think about; TBI at any age, MVAs. Assaults, Sports injuries, Service related injuries, Shaken baby and/or adult


H e lps

HELPS

  • Were you ever seen in the Emergency room, hospital, or by a doctor because of an injury to your head?

  • Explore the possibility of unidentified traumatic brain injury many do not present in medical settings


He l ps

HELPS

  • Did you ever Lose consciousness or experience a period of being dazed and confused because of an injury to your head?

  • Remember, a LOC isnt required for someone to develop symptoms subsequent to a blow to the head. alteration of consciousness AKA post traumatic amnesia (PTA). At this point, the interviewer may consider asking the individual if they have had multiple mild TBI


Hel p s

HELPS

  • Do you experience any of these Problems in your daily life since you hit your head?

  • You want to know when any problems began (or began to be noticed) Remember, lack of awareness is a hallmark of brain injury, you might ask if anyone close to the individual has made any observations regarding changes in function.


Hel p s1

Headaches

Dizziness

Anxiety

Depression

Difficulty concentrating

Difficulty remembering

Difficulty reading, writing, calculating

Poor problem solving

Difficulty performing your job/school work

poor judgement (being fired from job, arrests, fights, relationships affected)

HELPS


Help s

HELPS

  • Any significant Sickness?

  • Acquired Brain Injury (ABI) can result in many of the same functional impairments as traumatic brain injury (TBI). For example, brain tumor, meningitis, West Nile virus, stroke, seizures, toxic shock syndrome, aneurysm, AV malformation, any history of anoxic injury, e.g. heart attack, near drowning,carbon monoxide poisoning can all result in multiple deficits


Scoring the helps positive for a possible brain injury when the following three are identified

Scoring the HELPSPositive for a possible Brain Injury when the following three are identified:

  • An event the could have caused a brain injury (YES to H, E, or S), and

  • A period of loss of consciousness or altered consciousness after the injury or another indication that the injury was severe (YES to L or E), and

  • the presence of 2 or more chronic problems listed under P that were not present before the injury.


Scoring the helps

Scoring the HELPS

  • A positive screening is not sufficient to diagnose TBI as the reason for current symptoms and difficulties-other possible possible reasons need to be ruled out

  • Some individuals could present exceptions to the screening results, such as people who do have TBI-related problems but answered no to some questions

  • Consider positive responses within the context of the persons self-report and documentation of altered behavioral and/or cognitive functioning


Additional comments and observations of the interviewer

Additional comments and observations of the interviewer

  • Any visible scars?

  • Walks with a limp?

  • Uses a cane or walker?

  • Has a foot brace?

  • Limited use of one hand?

  • Appears to have difficulty focusing vision?

  • Difficulty answering questions?

  • Answers are unorganized and/or rambling

  • Becomes easily distracted, agitated or is emotionally labile


What you are looking for and why

What you are looking for..And Why

  • Any reported or suspected functional difficulties that are interfering with home, work or community activities

  • With the identification a history of brain injury, professionals can better support the individuals served and make informed referrals to brain injury specialists when appropriate


Brain injury in the news

Brain Injury in the News

  • Veterans:

  • NFL Players

  • Prominent Older Americans with fall related brain injuries


Impact of brain injury

Impact of Brain Injury

  • Physical; balance, coordination, headaches, fatigue, visual problems

  • Cognitive; memory, attention, concentration, processing, receptive and expressive language difficulties, new learning difficulties

  • Emotional/Behavioral; depression, impulse control, mood swings, irritability and emotional lability


Lack of awareness

Lack of Awareness

A common and difficult to remediate hallmark of a brain injury


Brain injury and alzheimer s disease

Brain Injury and Alzheimers Disease

  • Some evidence to suggest that severe brain injury is a risk factor in development of Alzheimers especially in individuals lacking the ApoEepsilon4 genotype( Jellinger et. al. 2001)

  • An earlier study by Schofield (1997) found that subjects who had a head injury with a loss of consciousness or amnesia exceeding 5 minutes were at significantly increased risk of developing Alzheimers Disease.


Nfl concussion alzheimer s disease guskiewicz et al 2005

NFL, Concussion &Alzheimers Disease (Guskiewicz et. al. 2005)

  • 61% of the former players sustained at least one concussion in their career

  • 24% sustained 3 or more concussions

  • Retired players with 3 or more concussions had a fivefold prevalence of reported significant memory problems compared to players with no hx of concussion

  • Researchers also observed an earlier onset of Alzheimer's disease in retirees than in general male population.


What can older adults professionals and family members do

What can older adults, professionals and family members do?

Preventive measures

Screen for a history of brain injury

Strategies to support

Resource and Referral


Prevention tips from the centers for disease control

Prevention Tips from the Centers for Disease Control

  • Exercise: activities that address balance and coordination are especially helpful

  • Review medicines with health care provider

  • Have vision checked

  • Fall proof homes and facilities


Screen for a history of brain injury

Screen for a History of Brain Injury

  • Review medical records

  • Take a detailed history

  • Use the HELPS Screening

  • Observe, does the individual have difficulty learning new routines, information, retaining names, difficulty communicating thoughts either verbally or in writing?


Strategies

Strategies

  • Use of a journal/calendar

  • Create a daily schedule

  • To do lists and shopping lists

  • Labeling items

  • Learning to break tasks into small manageable steps

  • Use of a tape recorder


Strategies1

Strategies

  • Encourage use of rest and low activity periods

  • Work on accepting feedback or coaching from others

  • Work on generalizing strategies to new situations

  • Use of a high lighter

  • Alarm watch


Strategies2

Strategies

  • Review schedule each day

  • Post signs on the wall etc.

  • Try to routinize the day as much as possible


Strategies3

Strategies

  • Safety checklist (e.g. for use of stove)reinforces attention

  • Checklists- things to do before leaving the house (turn off all the appliances?, lock all the doors?, did I take my morning medications? turn down the heat/turn off the air conditioner?, do I have money or keys?, where am I going?, how will I get there? What time should I leave? Etc.) Very good for routine tasks, reinforces memory

  • Place visual cues in the environment (cupboard labels, written directions, calendars, list of emergency phone numbers) reinforces memory


Brain injury and older adults

Even for individuals with poor new learning capacity due to a brain injury,keep in mind the three Rs ReviewRehearse&RepeatCan lead to mastery of tasks as they eventually enter into memory


Resource and referral information

Resource and Referral Information


Resource coordination in maryland

Resource Coordination in Maryland

  • Charlotte Wisner, Resource Coordinator for Frederick & Washington Counties, call 301-682-6017

  • Lauren Dorsey, Resource Coordinator for Baltimore & Howard Counties, call 301-529-1508

  • Catherine Reinhart, Resource Coordinator for Montgomery County, call 301-586-0900

  • Any questions regarding resource coordination or free trainings for professionals regarding brain injury, call Anastasia Edmonston, Project Director 410-402-8478


Resources

Resources

  • Brain Injury Association of America 703-236-6000, www.biausa.org

  • Brain Injury Association of Maryland 410-448-2924, www.biamd.org

  • Ohio Valley Center For Brain Injury Prevention and Rehabilitation, 614-293-3802, www.ohiovalley.org.

  • www.headinjury.com. Good resource for memory aides and tips


Resources1

Resources

  • Centers for Disease Control www.cdc.gov/injury. 770-488-1506

  • Http://www.neuro.pmr.vcu.edu/ National Resource Center for Traumatic Brain Injury, developed by the Medical College of Virginia and Virginia Commonwealth University. Offers useful articles that are very user friendly, and a catalogue of nicely priced resources for working with people with brain injury


Resources2

Resources

  • The University of Alabama Traumatic Brain Injury Model System has created the UAB Home Stimulation Program. This program offers many activities for use by individuals with brain injuries, their families and the professionals who work with them. The activities are designed to help support cognitive skills and can be done in the home setting. The Home Stimulation Program can be accessed from the Internet at htt://main.uab.edu/show.asp?durki=49377. For further information contact: Research Services, Dept. of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 619 19th St. S SRC 529, Birmingham, AL 35249-7330/ 206-934-3283. [email protected]


Resources staff training

Resources staff training.

  • http://www.webaim.org/simulations/cognitive - this is a site that can be used in staff training. It is a simulation of the effects of cognitive disabilities. You will be asked to complete simple tasks, but other tasks will get in the way.


Resources staff training1

Resources staff training.

  • http://www.biausa.org/Pages/related_articles.html - links to many online articles, written not for professionals in the field, but for people learning about brain injury. They cover all types of topics, from substance abuse and brain injury to cognition and brain injury. Written by various experts in the brain injury field.

  • Certified Brain Injury Specialist (CBIS) Training offered through the American Academy for the Certification of Brain Injury Specialists, www.biausa.org


The michigan department of community health web based brain injury training for professionals

The Michigan Department of Community HealthWeb-Based Brain Injury Training for Professionals

www.mitbitraining.org

This free training consists of 4 module that take an estimated 30 minutes each to complete. The purpose of the training is twofold, to ensure service providers understand the range of outcomes following brain injury and to improve the ability of service providers to identify and deliver appropriate services for persons with TBI


Anastasia edmonston tbi projects director mental hygiene administration

Anastasia EdmonstonTBI Projects DirectorMental Hygiene Administration

[email protected]

410-402-8478


Brain injury and older adults

A Product of the Maryland TBI Partnership Implementation Project, a collaborative effort between the Maryland Mental Hygiene Administration, the Mental Health Management Agency of Frederick County and the Howard County Mental Health Authority2006-2009

Support is provided in part by project H21MC06759 from the Maternal and Child Health Bureau (title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Service

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