Transcript Slide 1

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”
“…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
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
TRAUMATIC BRAIN INJURY (TBI)
results from external force
applied to the head
 motor vehicle accidents
 falls
 assaults
TRAUMATIC
BRAIN
INJURY
(TBI)
“tri-modal
age
structure”,
1996-97
TRAUMATIC
INJURY
(TBI)
“tri-modal
ageBRAIN
structure”,
2001-02(?)
“tri-modal
age
structure”,
2004-05
TRAUMATIC
BRAIN
INJURY
(TBI)
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 20042005
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 20052006 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…
 2003-2004;
costs of
hospitalised
falls in people
aged 65+
estimated at
$566 million
 by 2051; total fallrelated 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
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.”
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
COGNITIVE DISABILITY
 poor memory and concentration
(2 in 3)
 reduced ability
- to learn
- to plan and
- to solve problems
“CHALLENGING BEHAVIOUR”
(for 2 out of 3, the most disabling)
 increased irritability
 poor impulse control
 verbal and physical aggression
 disinhibition
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
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…”
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 (…200506 - 21,000 scripts for warfarin issued to 80 yrs+)
NAME RECOGNITION
 falls prevention programs – why?
 “head injury” second to hip fracture
in falls injury
 ageing population + increased life
expectancy
 “baby boomers”
www.braininjuryaustralia.org.au