Nick Rushworth Executive Officer Brain Injury Australia 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 It’s never just about the numbers, but… Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, 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

Brain Injury Network of South Australia AGM, Topics of Discussion State the main ideas you’ll be talking about Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, TRAUMATIC BRAIN INJURY (TBI) results from external force applied to the head from a motor vehicle accident, a fall or an assault

Brain Injury Network of South Australia AGM, What This Means Add a strong statement that summarizes how you feel or think about this topic Summarize key points you want your audience to remember Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, PHYSICAL  headaches  fatigue  seizures  poor balance and coordination  vision and hearing disturbance  chronic pain  paralysis

Brain Injury Network of South Australia AGM, Next Steps Summarize any actions required of your audience Summarize any follow up action items required of you Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, What This Means Add a strong statement that summarizes how you feel or think about this topic Summarize key points you want your audience to remember Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, COGNITIVE DISABILITY  poor memory and concentration  reduced ability  - to learn  - to plan and  - to solve problems

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, BEHAVIOUR  increased irritability  poor impulse control  verbal and physical aggression  disinhibition

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, FALLS  leading cause of Traumatic Brain Injury in Australia - 42% of TBI hospitalisations in  leading cause of injury hospitalisations overall - 1 in every 3 (126,800) injury admissions in  of all causes of TBI, falls are the most fatal. 63% resulted in death in

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, FALLS injury in older people  65+ accounted for 62% of all TBI deaths in hospital in 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  “Head injury” was the second most common falls-related injury (after those to the hip and thigh) in 65+ during (17% of cases)

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, FALLS injury in older people  70,000 aged 65 + admitted to hospital in for a falls injury - an increase of 10% over admission numbers  Falls injuries to the hip and thigh decreasing, rates of head injury increasing – to 1 in every 5 admissions

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, FALLS injury in older people  ; 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

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, 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”

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, 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“)

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, 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 Alzheimer’s 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"

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, “…it is worth noting that many TBI’s 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…”

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, “…you are probably correct in stating that TBI in the elderly[sic] tends to get mixed in with dementia and mild cognitive impairment… Of course a significant proportion of the falls that occur in the elderly[sic] happen in persons with dementia and any added TBI is seen as a dementia complication…”

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, TBI PREVENTION  falls “from heights”  65+ men - ladders, “DIY” (up 25%, )  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 (… ,000 scripts for warfarin issued to 80 yrs+)

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM, NAME RECOGNITION  falls prevention programs – why?  “head injury” second to hip fracture in falls injury  ageing population + increased life expectancy  “baby boomers”

Brain Injury Network of South Australia AGM, Click to edit Master title style Click to edit Master subtitle style 5/16/2015 Brain Injury Network of South Australia AGM,