Aging Issues Following Brain Injury
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Aging Issues Following Brain Injury






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Aging Issues Following Brain Injury Aging Issues Following Brain Injury Presentation 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:
    • Physical function
    • Cognitive function
    • Social function
  • 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 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 2010 )
    • Conclusion:
    • 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
    • Urinary incontinence
  • 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.
  • Recommendations
    • Maintain physical function : Assess motor status; keep mobile and provide exercises
    • Build Strength: Balance Group, Yoga, Aquatics, gym
    • Obtain equipment for safety: low profile bed, alarms, ambulation equipment
    • Assess ADL skills: modify environment
    • Maintain Cognitive function : assess cognition, provide strategies, consider technology
    • Maintain Social function: stay involved
    • Reclassify TBI as a chronic disease model & develop models of chronic disease management. (Masel, 2010)
    • Life care/resource planning considering: care giver support, nursing, therapy, technology & equipment, new medical interventions, stable activity, long term decision making.
    • Need for ongoing evaluations and episodic therapy
    • Medication evaluation : choose wisely and assess- long term impact potential