Nick RushworthExecutive OfficerBrain Injury Australia

New South Wales Council of Social Service; NSW Aged Care Alliance - October 22, 2009

FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS

members’ members

member organisations

BIA

“…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…”

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

2003; 347,000 reported stroke

60,000 new strokes occur every year

median age for stroke is around 80 years

STROKE/ “CVA”

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

TRAUMATIC BRAIN INJURY (TBI)

TRAUMATIC BRAIN INJURY (TBI)“tri-modal age structure”, 1996-97

TRAUMATIC BRAIN INJURY (TBI)“tri-modal age structure”, 2001-02(?)

TRAUMATIC BRAIN INJURY (TBI)“tri-modal age structure”, 2004-05

falls…1. leading cause of Traumatic Brain Injury

in Australia - 42% of TBI hospitalisations in 2004-2005

2. leading cause of injury hospitalisations overall - 1 in every 3 (126,800) injury admissions in 2003-2004

3. of all causes of TBI, falls are the most fatal. 63% resulted in death in 2004-2005

falls injuries in older people… 1. 65+ accounted for 62% of all TBI deaths in

hospital in 2004-2005 - 1 in every 6 the result of a fall

2. 3,272 TBIs the result of a fall in people aged 65+ = 1 in every 7 TBI hospitalizations in 2004-2005

3. “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 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

falls injuries in older people… by 2051; total fall-

related injury health 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 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.”

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

PHYSICAL DISABILITY

poor memory and concentration (2 in 3) reduced ability

- to learn- to plan and - to solve problems

COGNITIVE DISABILITY

(for 2 out of 3, the most disabling)

increased irritability poor impulse control verbal and physical aggression disinhibition

“CHALLENGING BEHAVIOUR”

OUTCOMES 1

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):

1. every 10 years of age increases “odds on poor outcome” 40% - 50%;

2. “optimal change points” in age at TBI were 60 years (mortality), 29 years (“unfavorable outcome“).

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 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"

OUTCOMES 2 (cont.)

“…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+)

TBI PREVENTION

falls prevention programs – why?

“head injury” second to hip fracture in falls injury

ageing population + increased life expectancy

“baby boomers”

NAME RECOGNITION

www.braininjuryaustralia.org.au