Nick Rushworth

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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

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Its never just about the numbers, but
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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

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• Nick Rushworth
• Executive Officer Brain Injury Australia

10/22/2014
Brain Injury Network of South Australia AGM, 2008
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Topics of Discussion
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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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Brain Injury Network of South Australia AGM, 2008
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Brain Injury Network of South Australia AGM, 2008
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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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Brain Injury Network of South Australia AGM, 2008
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Next Steps
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• COGNITIVE DISABILITY
• poor memory and concentration
• reduced ability
• - to learn
• - to plan and
• - to solve problems

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What This Means

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Brain Injury Network of South Australia AGM, 2008
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10/22/2014
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• BEHAVIOUR
• increased irritability
• poor impulse control
• verbal and physical aggression
• disinhibition

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Brain Injury Network of South Australia AGM, 2008
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• FALLS
• leading 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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• FALLS injury 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

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• FALLS injury in older people
• 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 Alzheimers 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 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

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you are probably correct in stating that TBI in
the elderlysic tends to get mixed in with
dementia and mild cognitive impairment Of course
a significant proportion of the falls that occur
in the elderlysic 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
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