Aging Issues Following Brain InjuryPresentation Transcript
Describe long term issues after TBI
Identify resources required as an individual ages
Identify directions for prevention and treatment planning
Successful Aging Requires Maintenance of:
Age at Injury Affects Plasticity & Recovery Issues
Adult brain has decreasing ability to repair itself as it ages because of a decreasing number of neurons
Greater likelihood of repeated insults to the brain based on age at onset.
40-50% increase in the odds of a poor outcome for every 10 years of age at onset.
( Hukkelhoven, C. et al, 2003 )
Long Term Outcome Profile in Community Based TBI Clients
5-7 years post injury, it was found significant deficits in cognition, ADL’s and psychosocial areas; Noted reasonably good motor recovery within first decade post TBI. ( Oddy, Brooks, Tate, Hibbard 1998 )
Lifespan of a person with a TBI injured before age 30 is 78.6 years. ( NIH 2000 )
Overestimate their function and competencies with aging ( Prigatano 2005 )
TBI As Risk Factor for AD
Moderate to severe TBI- 2 times the risk for Alzheimer’s and other dementias (Zaszler, 2007, Mazel, 2009)
APOEe4 allele and TBI may have synergistic effect as risk factors for AD
Neuropsychological testing to assess ongoing cognitive function
TBI and Age: Newer Review of the Literature
Cognitive decline ( Himanen, 2006)
Poorer functional outcomes with age at injury (Testa, 2005 )
Deficits more pronounced. (Goldstein, 2001)
Arthritis and sleep ( Colantoni, 2004 )
Increased seizures, pain and medication use . (ACRM, 2001)
Persistent affective and behavioral symptoms (Colantoni, 2004)
Aging: Over More than Three Decades (Sendroy-Terrill, M et.al 2010)
Decline of physical and cognitive function
Decline in societal participation and social isolation
Increase in contractures
Increase in fatigue
Decline in perceived environmental barriers.
Aging: Over More than Three Decades (Sendroy-Terrill, M et.al 2010 )
Cognitive, physical and social functioning all were significantly influenced by severity of injury over time.
With overuse and/or natural aging process, produces an increase in secondary conditions characteristic of aging with TBI
One Post Acute Brain Injury Profile- Medically Compromised- (n=58)
Reported Health Issues (n=58) Abnormal Blood Pressure 67% Balance 60% Muscle/Joint stiffness 55% Urinary control difficulty 53% Weight gain greater than 10 lbs. 48% Sleep disorder 41% Spasticity 41% Chronic headache 34% Hospitalizations/ER visits in the last year 28% Thyroid condition 21% Skin-vascular changes 17% Symptomatic Epilepsy 17% Diabetes Mellitus 1%
Acute and Worsening Neurologic and Physical Changes
Neglect and sensory changes
Increased frequency of seizures
Hemiparesis and decreased trunk control; Changes in balance and righting reactions
Dystonia, increased tone and spasticity
Diabetes insipidus/changes in sodium
Dysphagia with aspiration pneumonia and difficulties with maintaining hydration and nutrition
Cognitive & Functional Changes
Diminished attention and concentration
Slowed processing, disorientation and confusion
Increased supervision and safety measures to prevent falls
Observations and care for seizures
Toileting every two hours to prevent incontinence
Increased physical assistance for AM and PM routines and transfers
Supervision for meals
All household activities requiring minimal assistance eventually changed from moderate to maximum assistance.
Impact on Daily Life
Altered daily routines
Recreational & Vocational changes
Additional staff for safety and support
Environmental changes with grab bars, equipment etc.
Less participation in community : work, volunteering, church, gym & out to dinner.
Development of quiet, in-home pursuits.
Maintain physical function : Assess motor status; keep mobile and provide exercises