Aging, Falls and Traumatic Brain Injury by puffdaddy

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									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?
   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?
   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
             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.
      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
     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
          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).
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
            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.
             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
    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
    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.
     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.
       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
         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)
          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.
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.
               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
             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
             Fall Prevention

   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

   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
Target Audience for Education

   Health Care Professionals
   Long-Term Care Facilities
   Children of adults over 75 (baby
    boomers)
   Older individuals themselves
                  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
                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.
                     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
          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
       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

								
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