Aging and Brain Injury

Cynthia L. Boyer, Ph.DExecutive Director

Brain Injury Services

2

Statistics

•More than 5.3 million Americans are living with TBI related disabilities

•Average Span of a person with TBI injured before age 30 is 78.6 years

NORMAL AGING

Physical patterns:

Aging• Mobility Problems• Hearing and Vision Loss• Health Issues• Decreased Memory• Depression• Loss of peers/social

withdrawl

TBI• Mobility Problems• Sensory Loss• Health issues• Memory & Cognitive

Problems• Depression• Loss of peers/social;

withdrawl

What Barriers Increase Over Time?

• Aging Caregivers• Social Network & Support Failure• Functional Capacities Decrease• Loss of Life Activity Focus• Higher rates of Psychological Problems• Emergence of Additional Health Problems

Other Factors Affecting Health

• Economic and Social Status• Limited Resources/Insurance• Reduced Health Literacy• Poor Health Practices due to Cognitive

Problems• Increased Rates of Obesity, Hypertension,

Depression and Diabetes

Chronic Medical Issues• Seizure Disorder• Respiratory Problems• Late Onset Swallowing Problems• Diabetes • Skin Integrity• Circulatory Problems• GI Probles• Headaches• Pain

Caregiver Issues

• Age

• Health

• Physical Capacity

• Finances

Accelerated Decline

• Early Onset of Physical and Cognitive Decline

• Psychological Response to Long Term Disability• Gains Made in Rehab Erode

• Level of Independence Decreases

Research •Enhanced physical decline

–Colantonio, Ratcliff, Chase, & Vernich, 2004•Increased incidence of arthritis among 35-44 y/o’s•Increased prevalence of visual and hearing impairments•Increased prevalence of epilepsy•Sleep problems

(Colantonio et al., 2004)

Research

•Enhanced cognitive decline:–Corkin, Rosen, Sullican, & Clegg, 1989

•Longitudinal study examining 314 veterans sustaining head injury•Results: found that head injury was associated with decline on tests of cognitive functioning

–De Beaumont et al., 2009•Examined athletes sustaining their last concussion since years playing sports•Results: significant reductions in episodic memory, motor execution slowing, and decline with response inhibition 30 years post-injury

(De Beaumont et al., 2009; Corkin et al., 1989)

TBI Is A Chronic Disease

• Life Expectancy• Endocrine Dysfunction• Cognitive Decline• Psychiatric Conditions• Development of Neurodegenerative

Conditions

Risk Factors for Increased Mortality

• Advanced Age at Time of Injury• Seizures• Employment Status• Substance Abuse• Psychiatric Disorder• Physical Impairment

Causes of Death

• Seizures• Pneumonia/Other Respiratory• Sepsis• Choking• Suicide*• Substance Abuse Related*• Accidental Injury* *mild tbi

Endocrine Dysfunction

• Growth hormone insufficiency

• Hypothyroidism

• Gonadotropin Decrease

• Hypopituitarism

NeuroDegenerative Disorders

• Increased risk of brain atrophy

• Lack of neuronal reserve

• Breakdown of BBB

• Accumulation of protein

TBI & NeuroDegenerative Disorders

• Moderate to Severe TBI Associated with Alzheimer’sDisease

Parkinsonism

• Mild TBI ??

Age at Injury & Outcomes

• Higher rates of severe disability, PVS, and death for >55

• Severe Disability, PVS and death rates for ages 15-25 was 50% of the rate for those >55

Age & Recovery

• Older brain has decrease ability to repair itself

• Greater likelihood of repeated insults to the brain based on age

• 40-50% increase in the odds of poor outcome for every 10 yrs of age

TBI In Older Adults

FallsRisk Factors•Increasing Age•Cognitive Impairment•Medication Side Effects•Alcohol Intoxication

CASE STUDY 1

Case Study 2

Final Thoughts

• TBI is a chronic disease with lifetime effects

• TBI Increases the risk of multiple health problems

• Resources are needed for long term follow up and increased care

Thank you!

ReferencesBalcombe, N. R., & Sinclair, A. A. (2001). Ageing: Definitions, mechanisms and the magnitude of the problem.Bailliere's Best Practice And Research In Clinical Gastroenterology, 15(6), 835-849. doi:10.1053/bega.2001.0244 Bergquist, T., Micklewright, J., Yutsis, M., Smigielski, J., Brown, A., & Gehl, C. (2012). Achievement of client-centred goals by persons with acquired brain injury in comprehensive day treatment is associated with improved functional outcomes. Brain Injury,26(11), 1307-1314. doi:10.3109/02699052.2012.706355 Burbank, P. M. (1986). Psychosocial theories of aging: a critical evaluation. ANS. Advances In Nursing Science, 9(1), 73-86. Colantonio, A., Ratcliff, G., Chase, S., &Vernich, L. (2004). Aging with traumatic brain injury: Long-term health conditions. International Journal Of Rehabilitation Research, 27(3), 209-214.doi:10.1097/00004356-200409000-00006 Corkin, S. S., Rosen, T. J., Sullivan, E. V., & Clegg, R. A. (1989). Penetrating head injury in young adulthood exacerbates cognitive decline in later years. Journal Of Neuroscience, 9(11), 3876-3883 De Beaumont, L., Thoret, H., Tremblay, S., Ellemberg, D., Lassonde, M., Mongeon, D., & ... Leclerc, S. (2009). Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain, 132(3), 695-708. doi:10.1093/brain/awn347 Hao-Kuang, W., Sheng-Hsiang, L., Pi-Shan, S., Ming-Hsiu, W., Kuo-Wei, H., Liang-Chao, W., & ... Kuen-Jer, T. (2012). Population based study on patients with traumatic brain injury suggests increased risk of dementia. Journal Of Neurology, Neurosurgery & Psychiatry, 83(11), 1080.doi:10.1136/jnnp-2012-302633 Himanen, L., Portin, R., Isoniemi, H., Helenius, H., Kurki, T., & Tenovuo, O. (2005). Cognitive functions in relation to MRI findings 30 years after traumatic brain injury. Brain Injury, 19(2), 93-100.

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