Aging, Falls and Traumatic Brain Injury

1. Aging, Falls and Traumatic Brain Injury Presented at the North Carolina Conference on Aging September 11, 2007 Janice K. White M.Ed., CBIS

2. What is Traumatic Brain Injury? • 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.

4. What Are The Leading Causes of TBI? • In the US the leading causes of TBI are: • Falls 28% • Motor vehicle-traffic crashes 20% • Struck by/against events 19% • Assaults 11% Centers for Disease Control and Prevention

5. Causes of Falls • 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.

6. Causes of Falls continued • 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

7. Fall Related TBI: A Public Health Problem • Falls are the leading cause of TBI • Adults 75+ • 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

8. Falls and the Elderly • 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).

9. Falls are the Leading Cause of Brain Injury in the Elderly • Factors that contribute to this include: • Medication • Other Medical Conditions • Visual Impairments • Orthopedic Problems • Lack of Exercise • Improper Footwear • Safety Factors in the Home

10. Severity of TBI • 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.

11. Mild Brain Injury • A person with a mild brain injury may: • 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

12. Mild Brain Injury continued • 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

13. Symptoms of Brain Injury in the Elderly • 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.

14. Symptoms of Brain Injury continued • 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.

15. Symptoms may include: • 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

16. Symptoms continued: • 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)

17. Increased Severity • 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.

18. Additional Symptoms of Moderate to Severe Brain Injury: • 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.

19. Who Is At Risk? • Individuals who are on medications for other thing such as: • 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

20. Additional Risk • 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

21. Fall Prevention • Physical exercise to increase overall strength (consult your physician) • Proper footwear • Grab bars and non-slip mats in the bathroom • Medication review

22. Fall Prevention continued • Home safety checks to look for: • Uneven surfaces, inside and out. • Loose rugs and cords • Proper lighting • Keeping frequently used items in easy to reach places

23. Target Audience for Education • Health Care Professionals • Long-Term Care Facilities • Children of adults over 75 (baby boomers) • Older individuals themselves

24. Strategies • 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

25. Conclusion • 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.

26. Resources • Brain Injury Association of America • 1-800-444-6443 • www.biausa.org • Centers for Disease Control and Prevention • 1-800-311-3435 • www.cdc.gov/ncipc • See “Preventing Falls in Older Adults” • National Institute on Aging • 1-800-222-2225 • www.nia.nih.gov/healthinformation

27. Resources continued • The Fall Prevention Project and HEROS (Health, Education, Research and Outreach for Seniors) • www.temple.edu/older_adult • The U.S. Administration on Aging • www.aoa.dhhs.gov • Aging Network Services • www.agingnets.com

28. 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) Janice.White@NCMail.net