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Traumatic Brain Injury in the Elderly

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Traumatic Brain Injury in the Elderly Focus on Research Opportunities in Older Populations Traumatic Brain Injury (TBI) Insult to the brain, caused by an external ... – PowerPoint PPT presentation

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Title: Traumatic Brain Injury in the Elderly


1
Traumatic Brain Injury in the Elderly
  • Focus on Research Opportunities in Older
    Populations

2
Traumatic Brain Injury (TBI)
  • Insult to the brain, caused by an external
    physical force (not of degenerative or congenital
    nature)
  • May produce mild to severe impairment of
    cognitive or physical abilities

3
Facts and Figures
  • Each Year in the U.S.
  • 1 million are treated and released from ERs with
    TBI
  • 80,000 experience the onset of long term
    disability with TBI
  • 50,000 die from TBI
  • 2 of the population currently live with
    disabilities from TBI

4
Facts and Figures
5
Facts and Figures
6
Why Study TBI in Older Adults?
  • Research has focused on younger populations
  • Little is known about TBI in an aging population
  • 65 is growing
  • Different health concerns than younger age adults
  • Longer, more costly stays on rehabilitation units
    than younger adults
  • Recovery post TBI is slower than in younger
    adults

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Census Projections of Centenarian Population of
U.S.
  • Year Number of Centenarians
  • 2000 61,000
  • 2010 213,000
  • 2020 505,000
  • 2030 1,048,000
  • 2040 1,842,000
  • 2050 4,057,000
  • Total population in 2050 N 400,000,000

10
Chronic Health Conditions
11
Memory Impairment
12
Estimated Percentage of Adults with Daily
Activity Limitations, by Age Group and Type of
Limitation (2006)
13
Challenge
  • Increase Research of TBI in older populations
  • Need to explore areas of opportunity

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About NIA
Overview NIA, one of the 27 Institutes and
Centers of NIH, leads a broad scientific effort
to understand the nature of aging and to extend
the healthy, active years of life. In 1974,
Congress granted authority to form NIA to provide
leadership in aging research, training, health
information dissemination, and other programs
relevant to aging and older people.
Mission NIAs mission is to improve the health
and well-being of older Americans through
research, and specifically related to Aging
processes Age-related diseases Special problems
and needs of the aged
16
NIA Research Programs
Division of Aging Biology (DAB)
Supports research and training to enhance and extend the human health span through a better understanding of the biological mechanisms underlying the aging process.  
Behavioral and Social Research (BSR)
Supports basic social and behavioral research and research training on the processes of aging at both the individual and societal level.  
Neuroscience and Neuropsychology (NNA)
Supports research and training to further the understanding of the structure and functioning of the aging nervous system in health and disease.   
Geriatrics and Clinical Gerontology (GCG)
Supports research on health and disease in the aged and research on aging over the human lifespan, including its relationships to health outcomes.
17
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18
Research Develop strategies to reduce falls and
their consequences
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21
Tai Chi, Balance, Strength
Vision, Fall hazards
Polypharmacy, Behavioral
22
Research TBI and linkages with Dementia
23
Cognition
  • Known as neurogenesis, studies suggests that
    medical and behavioral approaches could be found
    to stimulate the formation of new neurons to
    compensate for the loss and functional decline of
    neurons with aging, disease, or traumatic injury

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Older persons who exercised 3 times per week
were more likely to be dementia-free than those
who exercised fewer lt 3 times per week (N1740)
26
Research Resiliency and recovery post TBI
27
A Model of the Enabling-Disabling Process
Pathology Impairments Functional
Limitations Disability
  • TBI
  • Dysfunction and structural abnormalities in
    specific body systems (musculoskeletal,
    cardiovascular, etc.)
  • Restrictions in basic physical and mental actions
    (ambulate, reach, grasp, climb stairs, speak, see
    standard print)
  • Difficulty doing activities of daily life
    (personal care, household management, hobbies)

Verbrugge LM and Jette AM. Soc Sci Med.
1994381-4.
28
Objective Performance Measures of Functioning
  • Assessment instruments in which an individual is
    asked to perform a specific task and is evaluated
    in an objective, standardized manner
  • Assessment may include counting of repetitions or
    timing of the activity

29
Examples of Objective Performance Tests used to
Evaluate Functional Limitations
  • Grip Strength
  • Picking up object
  • Lifting 10 pounds
  • Gait speed
  • Chair rise single and repeated
  • Stair climb
  • Test of balance

30
Short Physical Performance Battery
  • Developed at the National Institute on Aging
    (NIA) for use in the Established Population for
    the Epidemiologic Studies of the Elderly (EPESE)
  • Timed standing balance (up to 10 seconds)
  • Side-by-side stand
  • Semi-tandem stand
  • Tandem stand
  • Timed 4-meter walk (or 8-foot walk)
  • Chair rise
  • Single
  • Timed multiple (5) chair rises

31
Death Rates According to Individual Performance
Testsage and sex adjusted
Walk
Chair Stands
Standing Balance
32
Death Rates According to Performance Test Summary
Scoreage and sex adjusted
Deaths per 100 PersonYears
Performance Test Summary Score
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Potential Applications of Physical Performance
Measures in TBI Research
  • Identifying levels of functioning
  • Identifying resilient and vulnerable persons
  • Clinical vital sign
  • Evaluating change
  • Intervention studies

37
Psychological Well-Being
Significance NIH to invest significant new
resources in advancing knowledge of positive
health. Such a program builds on emerging
studies of resilience and resistance to adverse
health outcomes as well as current work on
recovery from illness. National Research
Council
38
Psychological Well-Being
  • Individuals with high psychological well-being
  • Like themselves
  • Good inter-personal relationships
  • Creative at work / problem solving
  • Cognition (memory, abstract thinking)
  • Increased motivation to accomplish tasks

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ADL Recovery 1-yr. Post Stroke by Positive
Emotion Score
Baseline Model 1 (n227) Model 2 (n 221) Model 3 (n 221)
Low depressive symptoms OR (95 CI) OR (95 CI) OR (95 CI)
High positive emotion 2.55 (1.10-5.93) 2.77 (1.16-6.63) 2.70 (1.10-6.68)
Low positive emotion 1.07 (0.31-3.97) 1.07 (0.31-3.97) 1.31 (0.35-4.48)
High depressive symptoms 1.00 1.00 1.00
Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture.
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42
  • Research
  • Understand how demographic characteristics of
    cohorts reaching old age with TBI affect health
    and well-being
  • Develop a research plan to understand the dynamic
    changes that occur across the life course and
    plan appropriate interventions

43
Research Examine ethnic disparities in recovery
post TBI
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45
Infrastructure Goals
  • Develop a Translational Research program to
    provide the necessary infrastructure to support
    TBI research efforts
  • Develop a plan to recognize co-investigators
  • Train funded faculty for working in teams
  • Increase of investigators engaged in TBI
    research
  • Create Strategic Partnerships with key
    investigators
  • Maximize interschool partnership
  • Establish mechanism to enhance multi-institutional
    grants

46
Summary
  • Most of our knowledge about TBI comes from
    studies involving younger age groups
  • With the aging of the population there is a
    critical need to undertake TBI research in the
    older adult

47
Summary
  • Areas of potential multidisciplinary research
  • Falls risk / assessment
  • Cognition / Dementia
  • Functional limitations and disability
  • Psychological well-being

48
NIA strategic directions available at
www.nia.nih.gov/AboutNIA/StrategicDirections Ot
her Helpful Web Sites National Institute on
Aging Home Page www.nia.nih.gov Current Funding
Opportunities for Research and Training
www.nia.nih.gov/GrantsAndTraining NIA Extramural
Research Programs www.nia.nih.gov/ResearchInform
ation/ExtramuralPrograms Biology of Aging Program
www.nia.nih.gov/bap Behavioral and Social
Research Program www.nia.nih.gov/bsr Neuroscienc
e and Neuropsychology of Aging Program
www.nia.nih.gov/nna Geriatrics and Clinical
Gerontology Program www.nia.nih.gov/gcg NIA
Intramural Research Programs www.grc.nia.nih.gov
National Institutes of Health Home Page
www.nih.gov NIH Roadmap for Medical Research
nihroadmap.nih.gov NIH Blueprint for Neuroscience
Research neuroscienceblueprint.nih.gov
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