nick rushworth executive officer brain injury australia falls-related traumatic brain injury in...

Nick Rushworth Executive Officer Brain Injury Australia

FALLS-RELATED TRAUMATIC BRAIN INJURY IN OLDER AUSTRALIANS

FALLS PREVENTION PROGRAM NETWORK MEETING, DEPARTMENT OF HUMAN SERVICES, VICTORIA - 27 AUGUST, 2009

Nick Rushworth Executive Officer Brain Injury Australia

It’s never just about the numbers, but…

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04/18/23 Brain Injury Network of South Australia AGM, 2008

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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

Brain Injury Network of South Australia AGM, 2008

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Topics of Discussion

State the main ideas you’ll be talking about




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TRAUMATIC BRAIN INJURY (TBI)

results from external force applied to the head from a motor vehicle accident, a fall or an assault


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What This Means

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PHYSICAL

headaches fatigue seizures poor balance and coordination vision and hearing disturbance chronic pain paralysis


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Next Steps

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Summarize any follow up action items required of you




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What This Means

Add a strong statement that summarizes how you feel or think about this topic

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COGNITIVE DISABILITY

poor memory and concentration

reduced ability

- to learn

- to plan and

- to solve problems


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BEHAVIOUR

increased irritability

poor impulse control

verbal and physical aggression

disinhibition


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FALLSleading 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


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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)


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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


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2003-2004; cost of hospitalised falls in people aged 65+ estimated at $566 million

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


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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”


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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“)


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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"


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“…it is worth noting that many TBI’s 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…”


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“…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…”


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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+)


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NAME RECOGNITION falls prevention programs – why?

“head injury” second to hip fracture in falls injury

ageing population + increased life expectancy

“baby boomers”


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www.braininjuryaustralia.org.au

nick rushworth executive officer brain injury australia falls-related traumatic brain injury in...

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