Transcript Aging, Falls and Traumatic Brain Injury

Aging, Falls and Traumatic
Brain Injury
Presented at the North Carolina
Conference on Aging
September 11, 2007
Janice K. White M.Ed., CBIS
What is Traumatic Brain
Injury?
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A traumatic brain injury (TBI) is caused by a
blow or jolt to the head or a penetrating head
injury that disrupts the function of the brain.
Not all blows or jolts to the head cause a TBI.
Severity may range from “mild” (a brief
change in mental status or consciousness) to
“severe” (an extended period of
unconsciousness or amnesia). In the United
States falls are the leading cause of TBI.
What Are The Leading Causes
of TBI?
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In the US the leading causes of TBI are:
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Falls 28%
Motor vehicle-traffic crashes 20%
Struck by/against events 19%
Assaults 11%
Centers for Disease Control and Prevention
Causes of Falls
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The causes of falls are known as risk
factors. The greater the number of risk
factors to which an individual is
exposed, the greater the probability of
a fall, and the more likely the results of
the fall will threaten the person’s health
and independence.
Causes of Falls continued
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Fall rates are highest for children age 0 to 4 years
and adults age 75 and older.
Among older people, the risk of falling increases with
age and is greater for women than for men.
Two-thirds of those who experience a fall will fall
again within six months.
At least one-third of all falls among older people
involve environmental hazards in the home.
Brain Injury Association of America
Fall Related TBI: A Public
Health Problem
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Falls are the leading cause of TBI
Adults 75+
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Have the highest rates of TBI-related
hospitalizations and death
Who fall are 4 to 5 times more likely to be
admitted to a long-term care facility for a
year or more.
60% of falls occur at home
Centers for Disease Control and Prevention
Falls and the Elderly
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Some studies indicate that the rate of injury begins to
increase by the age of 65
In older individuals there are physical changes that
make their brains more vulnerable to injury and
reduce their chances of recovery (Patrick, 1996).
Generally they take longer to recuperate, need more
time and effort to reach the same level of recovery
that younger individuals attain and often have a less
positive prognosis, recovery and outcome (Pilisuk &
Feinberg, 1996).
Falls are the Leading Cause of
Brain Injury in the Elderly
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Factors that contribute to this include:
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Medication
Other Medical Conditions
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Visual Impairments
Orthopedic Problems
Lack of Exercise
Improper Footwear
Safety Factors in the Home
Severity of TBI
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Symptoms of TBI may be mild,
moderate or severe, depending on the
extent of damage to the brain.
Some symptoms are evident
immediately, while others may not
surface until several days or weeks after
the surgery.
Mild Brain Injury
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A person with a mild brain injury may:
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Remain conscious
May experience a loss of consciousness for
a few seconds to a few minutes
May not remember losing consciousness
Have a clear MRI or CAT Scan
Mild Brain Injury continued
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This may be called a concussion and is
usually not life threatening
However the effects can be serious
People may look fine even though they
are acting or feeling differently
Symptoms of Brain Injury in
the Elderly
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With the elderly it is essential to remember
that some of the symptoms of a brain injury
may be the same symptoms they are already
experiencing from other medical conditions.
These individuals must be closely monitored
Subtle changes must be noted as well as
exaggeration of already existing symptoms.
Symptoms of Brain Injury
continued
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Symptoms may be worsened by
medications including prescription, over
the counter, or “natural remedies”.
Blood thinners may be especially
problematic.
Alcohol may increase these symptoms
and could possibly lead to seizures.
Symptoms may include:
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Headache and possibly neck pain
Lightheadedness or dizziness
Problems with balance
Confusion or getting lost
Blurred vision or tired eyes
Ringing in the ears
Loss of taste or smell
Fatigue, lethargy or a change in sleep pattern
Symptoms continued:
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Behavioral or mood changes including feeling sad,
anxious, listless, irritated or angry for no reason.
Trouble with memory, concentration, attention,
organization or thinking.
Impaired decision making or problem solving.
Increased sensitivity to light, sounds or distractions.
Change in sex drive.
Slowness in thinking, acting, speaking or reading
Dysphagia (problems swallowing)
Increased Severity
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A person with a moderate to severe
brain injury may show these symptoms
initially. If symptoms worsen over time
this may be an indication of a blood clot
forming in the tissue of one of the
sinuses, or cavities, adjacent to the
brain.
Additional Symptoms of Moderate
to Severe Brain Injury:
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Worsening Headaches
Weakness, numbness or decreased coordination
Repeated vomiting
Inability to be awakened
One pupil larger than the other
Seizures
Slurred speech
Agitation
If these symptoms are observed contact a doctor immediately
or go to the emergency department.
Who Is At Risk?
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Individuals who are on medications for other
thing such as:
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Osteoporosis
Depression
Sleep problems
High blood pressure
Diabetes
Parkinson’s
You are more likely to fall if you are taking 4
or more medications or have changed your
prescription or dosage in the past two weeks
Additional Risk
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Individuals who have had a previous fall
Have physical limitations, including vision
Have more than one chronic disease
Take more than four medications or use
psychoactive medications (such as
antidepressants)
Are cognitively impaired
Have lower body weakness or gait or balance
problems
Fall Prevention
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Physical exercise to increase overall
strength (consult your physician)
Proper footwear
Grab bars and non-slip mats in the
bathroom
Medication review
Fall Prevention continued
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Home safety checks to look for:
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Uneven surfaces, inside and out.
Loose rugs and cords
Proper lighting
Keeping frequently used items in easy to
reach places
Target Audience for Education
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Health Care Professionals
Long-Term Care Facilities
Children of adults over 75 (baby
boomers)
Older individuals themselves
Strategies
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Education that TBI is a fall-related injury
Collaboration with fall prevention
organizations to integrate fall prevention and
TBI messages
Establish partnerships with key organizations
that focus on TBI & fall prevention to get the
message out to target audiences
Conclusion
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The best cure for brain injury is
prevention. Older people in particular
should take decisive action to minimize
the risk of a fall that could result in a
TBI. However should a fall occur,
immediate medical attention should be
sought, including screening for TBI.
Resources
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Brain Injury Association of America
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Centers for Disease Control and Prevention
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1-800-444-6443
www.biausa.org
1-800-311-3435
www.cdc.gov/ncipc
See “Preventing Falls in Older Adults”
National Institute on Aging
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1-800-222-2225
www.nia.nih.gov/healthinformation
Resources continued
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The Fall Prevention Project and HEROS
(Health, Education, Research and
Outreach for Seniors)
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The U.S. Administration on Aging
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www.temple.edu/older_adult
www.aoa.dhhs.gov
Aging Network Services
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www.agingnets.com
Contact Information
Janice (Jan) White
DHHS-Division of Mental Health/DD/Substance
Abuse Services
3021 Mail Service Center
Raleigh, NC 27699-3021
919-715-5989
919-715-2360 (fax)
[email protected]