OBJECTIVES  <ul><li>Describe long term issues after TBI </li></ul><ul><li>Identify resources required as an individual age...
Successful Aging Requires Maintenance of: <ul><li>Physical function </li></ul><ul><li>Cognitive function </li></ul><ul><li...
Age  at Injury Affects Plasticity & Recovery Issues <ul><li>Adult brain has decreasing ability to repair itself as it ages...
Long Term Outcome Profile in Community Based TBI Clients <ul><li>5-7 years post injury, it was found significant deficits ...
TBI As Risk Factor for AD <ul><li>Moderate to severe TBI- 2 times the risk for Alzheimer’s and other dementias  (Zaszler, ...
TBI and Age:  Newer Review of the Literature <ul><li>Cognitive decline  ( Himanen, 2006) </li></ul><ul><li>Poorer function...
Aging: Over More than Three Decades  (Sendroy-Terrill, M et.al 2010) <ul><li>Decline of physical and cognitive function </...
Aging: Over More than Three Decades  (Sendroy-Terrill, M et.al 2010 ) <ul><li>Conclusion:  </li></ul><ul><li>Cognitive, ph...
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 difficult...
Acute  and Worsening Neurologic and Physical Changes <ul><li>Neglect and sensory changes </li></ul><ul><li>Increased frequ...
Cognitive & Functional Changes <ul><li>Diminished attention and concentration </li></ul><ul><li>Slowed processing, disorie...
Impact on Daily Life <ul><li>Altered daily routines </li></ul><ul><li>Recreational & Vocational changes </li></ul><ul><li>...
Recommendations <ul><li>Maintain physical function : Assess motor status; keep mobile and provide exercises </li></ul><ul>...
<ul><li>Reclassify TBI as a chronic disease model & develop models of chronic disease management.  (Masel, 2010) </li></ul...
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Aging Issues Following Brain Injury

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Aging Issues Following Brain Injury

  1. 1. OBJECTIVES <ul><li>Describe long term issues after TBI </li></ul><ul><li>Identify resources required as an individual ages </li></ul><ul><li>Identify directions for prevention and treatment planning </li></ul>
  2. 2. Successful Aging Requires Maintenance of: <ul><li>Physical function </li></ul><ul><li>Cognitive function </li></ul><ul><li>Social function </li></ul>
  3. 3. Age at Injury Affects Plasticity & Recovery Issues <ul><li>Adult brain has decreasing ability to repair itself as it ages because of a decreasing number of neurons </li></ul><ul><li>Greater likelihood of repeated insults to the brain based on age at onset. </li></ul><ul><li>40-50% increase in the odds of a poor outcome for every 10 years of age at onset. </li></ul><ul><li>( Hukkelhoven, C. et al, 2003 ) </li></ul>
  4. 4. Long Term Outcome Profile in Community Based TBI Clients <ul><li>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 ) </li></ul><ul><li>Lifespan of a person with a TBI injured before age 30 is 78.6 years. ( NIH 2000 ) </li></ul><ul><li>Overestimate their function and competencies with aging ( Prigatano 2005 ) </li></ul>
  5. 5. TBI As Risk Factor for AD <ul><li>Moderate to severe TBI- 2 times the risk for Alzheimer’s and other dementias (Zaszler, 2007, Mazel, 2009) </li></ul><ul><li>APOEe4 allele and TBI may have synergistic effect as risk factors for AD </li></ul><ul><li>Neuropsychological testing to assess ongoing cognitive function </li></ul>
  6. 6. TBI and Age: Newer Review of the Literature <ul><li>Cognitive decline ( Himanen, 2006) </li></ul><ul><li>Poorer functional outcomes with age at injury (Testa, 2005 ) </li></ul><ul><li>Deficits more pronounced. (Goldstein, 2001) </li></ul><ul><li>Arthritis and sleep ( Colantoni, 2004 ) </li></ul><ul><li>Increased seizures, pain and medication use . (ACRM, 2001) </li></ul><ul><li>Persistent affective and behavioral symptoms (Colantoni, 2004) </li></ul>
  7. 7. Aging: Over More than Three Decades (Sendroy-Terrill, M et.al 2010) <ul><li>Decline of physical and cognitive function </li></ul><ul><li>Decline in societal participation and social isolation </li></ul><ul><li>Increase in contractures </li></ul><ul><li>Increase in fatigue </li></ul><ul><li>Decline in perceived environmental barriers. </li></ul>
  8. 8. Aging: Over More than Three Decades (Sendroy-Terrill, M et.al 2010 ) <ul><li>Conclusion: </li></ul><ul><li>Cognitive, physical and social functioning all were significantly influenced by severity of injury over time. </li></ul><ul><li>With overuse and/or natural aging process, produces an increase in secondary conditions characteristic of aging with TBI </li></ul>
  9. 9. One Post Acute Brain Injury Profile- Medically Compromised- (n=58)
  10. 10. 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%
  11. 11. Acute and Worsening Neurologic and Physical Changes <ul><li>Neglect and sensory changes </li></ul><ul><li>Increased frequency of seizures </li></ul><ul><li>Hemiparesis and decreased trunk control; Changes in balance and righting reactions </li></ul><ul><li>Dystonia, increased tone and spasticity </li></ul><ul><li>Diabetes insipidus/changes in sodium </li></ul><ul><li>Dysphagia with aspiration pneumonia and difficulties with maintaining hydration and nutrition </li></ul><ul><li>Urinary incontinence </li></ul>
  12. 12. Cognitive & Functional Changes <ul><li>Diminished attention and concentration </li></ul><ul><li>Slowed processing, disorientation and confusion </li></ul><ul><li>Increased supervision and safety measures to prevent falls </li></ul><ul><li>Observations and care for seizures </li></ul><ul><li>Toileting every two hours to prevent incontinence </li></ul><ul><li>Increased physical assistance for AM and PM routines and transfers </li></ul><ul><li>Supervision for meals </li></ul><ul><li>All household activities requiring minimal assistance eventually changed from moderate to maximum assistance. </li></ul>
  13. 13. Impact on Daily Life <ul><li>Altered daily routines </li></ul><ul><li>Recreational & Vocational changes </li></ul><ul><li>Additional staff for safety and support </li></ul><ul><li>Environmental changes with grab bars, equipment etc. </li></ul><ul><li>Less participation in community : work, volunteering, church, gym & out to dinner. </li></ul><ul><li>Development of quiet, in-home pursuits. </li></ul>
  14. 14. Recommendations <ul><li>Maintain physical function : Assess motor status; keep mobile and provide exercises </li></ul><ul><li>Build Strength: Balance Group, Yoga, Aquatics, gym </li></ul><ul><li>Obtain equipment for safety: low profile bed, alarms, ambulation equipment </li></ul><ul><li>Assess ADL skills: modify environment </li></ul><ul><li>Maintain Cognitive function : assess cognition, provide strategies, consider technology </li></ul><ul><li>Maintain Social function: stay involved </li></ul>
  15. 15. <ul><li>Reclassify TBI as a chronic disease model & develop models of chronic disease management. (Masel, 2010) </li></ul><ul><li>Life care/resource planning considering: care giver support, nursing, therapy, technology & equipment, new medical interventions, stable activity, long term decision making. </li></ul><ul><li>Need for ongoing evaluations and episodic therapy </li></ul><ul><li>Medication evaluation : choose wisely and assess- long term impact potential </li></ul>Conclusions

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