It’s never just about the numbers, but…

Nick Rushworth Executive Officer Brain Injury Australia

It’s never just about the numbers, but…

TRAUMA RESEARCH METHODS AND PRACTICE WORKSHOP - UNIVERSITY OF MELBOURNE, 2008

“…peak of peaks”

BIA

member organisations

members’ members

Brain Injury Network of South Australia AGM, 2008

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04/20/23 Brain Injury Network of South Australia AGM, 2008

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“Brain Injury Australia works to ensure that all people living with an ABI have access to supports and resources each person requires to optimise their social and economic participation.”

“…advocacy for Australian Government program allocations and policies that reflect the needs and priorities of people with an ABI and their families.”

“…the provision of effective and timely input into policy, legislation and program development through active contact with Australian Government ministers, parliamentary representatives, Australian Government departments and agencies, and national disability organisations.”






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In 2003, 432,700 people (2.2% of the population) had an Acquired Brain Injury with “activity limitations” or

“participation restrictions”

- Australian Bureau of Statistics’ 2003 Survey of Disability, Ageing and Carers


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Topics of Discussion

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Almost 3 out of every 4 PWABI were aged less than 65 years, half of them between 15 and 34 years of age2 out of every 3 said that they acquired their brain injury when they were aged under 25 years9 out of every 10 said their ABI was caused by accident or injury (more than half of them said the accident or injury occurred on a “street, road or highway”) 3 out of every 4 were men






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27,300 people with an ABI aged under 65 years experiencing “activity limitations” or “participation restrictions” said their ABI was their “main disabling condition…the one reported as causing the most problems”. A traffic injury was the main cause for more than half of these people

One in four reported four or more disability groups, compared with one in eighteen of all people with disability

One in three reported 5 or more health conditions, compared with about one in eight of all people with disability


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11,866 people with an ABI accessed Commonwealth State/Territory Disability

Agreement (CSTDA)-funded services in 2004-05


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What This Means

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“outcomes”1?20-26 year follow-up of 100 men with TBI admitted to Sydney’s Lidcombe Hospital between 1976 and 1981:

“…85% had used at least one service in the preceding 12 months, most commonly financial (69%), transport (64%) and home support (52%). Unmet needs were high, especially in the social participation (73%), vocational (67%), and respite (38%) areas…”

“Significant proportions of the series continued to experience activity limitations in mobility (25%) and basic self-care tasks (21%), although restrictions in social participation were much more prevalent (e.g., 66% for employability, 54% for interpersonal relationships)…”

- “Long-Term Outcomes After Traumatic Brain Injury: Following up a Consecutive Series at 20-26 Years Post-Trauma - Final Report to theMotor Accidents Authority Of New South Wales”, R Tate et al. Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, 2004


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Next Steps

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What This Means

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“outcomes”2?Brain Injury Outcomes Study (BIOS) - 198 clients with severe TBI sustained between 1999 and 2001:

“…good recovery in the Physical domain, with only 10% continuing to have significant impairments that interfered with everyday functioning in mobility at three years post trauma…”

“By contrast, clinically significant impairments persisted in the Cognitive and Behavioural domains for many clients: for example, 61% for memory, 52% for problem solving and 20% for social interaction…”

“ At three years, the longest PTA [Post-Traumatic Amnesia] group had significantly lower levels of [community] participation…”

- Brain Injury Outcomes Study (Final report) May 2004, Robyn Tate, Ian Cameron, Julie Winstanley, Bridget Myles, Ross Harris, Rehabilitation Studies Unit, Northern Clinical School, Faculty of Medicine, The University of Sydney.


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injury prone:People with an ABI are drawn from the same populations as those at the greatest risk of any injury:

low levels of educationlow workforce participation ratespoor housinglarge family sizehistories of marital breakdown, of neglect, physical and sexual abuseparental drug or alcohol abuse and substance abusemental illness

Australian Institute of Health and Welfare, Key National Indicators of Children’s Health, Development and Wellbeing: Indicator Framework for a Picture of Australia’s Children 2009, Canberra, 2008.


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prisoners - “research priority”?2003-04 survey of 200 New South Wales prisoners: 82% had experience of TBI with over half reporting ongoing effects (headaches, memory loss, personality or behavioural change, anxiety, depression etc.) 22% had sustained four or more TBIs

2003 Young People in Custody Health Survey (NSW): 40% of young men had sustained an ABI resulting in “significant loss of consciousness”

NSW Prison Injury Surveillance Program: assaults accounted for 80% of violence in prisons - the second most common injury treated in prison clinics

- “Prison Violence: Perspectives And Epidemiology”, Tony Butler and Azar Kariminia, Centre for Health Research in Criminal Justice, NSW Justice Health and School of Public Health and Community Medicine, University of New South Wales NSW Public Health Bulletin Vol. 17 No. 1–2, and Peter Schofield et. al, “Traumatic brain injury among Australian prisoners: rates, recurrence and sequelae”, Brain Injury, May 2006.


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homeless - “research priority”?10% of people using inner-city Sydney hostels and refuges had cognitive impairment as a result of alcohol-related brain injury or TBI Two Victorian studies of pension-only Supported Residential Services found between 13 per cent and 17 per cent of residents had a history of ABIThree-year study of outreach service use found 33% of clients had a diagnosed alcohol-related brain injury

- Hatzitaskos., P. (1995) “Crime Times”, Vol. 1, No.1-2, p.5., Byrne, B. (1997) SRS Socialization Facilitation Project (Caulfield General Medical Centre, Melbourne) and Community (Residential Services) Visitors’ Board, Annual Report of Community Visitors, 1996, Health Services Act 1988 (Office of the Public Advocate, Melbourne) cited in HACC Program Development & Access SRS/Rooming House Project, Final Report December 1998, McGregor, Robb (2000) “Comparative data between clients with alcohol related brain injuries and other clients, Ozanam Community Support Services Outreach Program.


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Indigenous - “research priority”?the transport injury rate for Indigenous Australians is up to three times that of non-Indigenous Australiansthe rate of “head injury” due to assault in the Indigenous populations of QLD, WA, SA and the NT was more than 20 times that of non-Indigenous populations. The rate of head injury due to assault in Indigenous women was almost 70 times that for non-Indigenous womenthe median age for stroke in the Northern Territory is 20 years below the national average between 1999 and 2006, 60 Indigenous Australians in the Northern Territory have died from petrol-sniffing and a further 120 have suffered permanent “brain damage”

- Australian Institute of Health and Welfare, “Hospitalisation for head injury due to assault among Indigenous and non-Indigenous Australians, July 1999-June 2005”, Jamieson et al., Medical Journal of Australia, May 2008; Australasian Consortium of Rehabilitation Outcomes;l “Beyond Petrol Sniffing: Renewing Hope for Indigenous Communities”, report of the Australian Senate’s Community Affairs Reference Committee

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falls-related TBI – “research priority”?

- Helps Y, Henley G and Harrison JE. 2008. Hospital separations due to traumatic brain injury, Australia 2004–05. Injury research and statistics series number 45, Adelaide: AIHW

22,710 hospitalisations for TBI in 2004–05

most common causes of TBI were falls (42%), transportation (29%) and assault

(14%)”

“while traffic accidents and assault are the main mechanisms of injury in younger

people, falls are the foremost mechanism of TBI in older people, followed by traffic

accidents as pedestrians, drivers or passengers…”

rates of TBI due to falls…were highest in the 85 plus age bracket

the proportion of hospitalisations with TBI as Principal Diagnosis that resulted in

death were highest for falls (63%) followed by transportation (27%) and assault (4%)


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falls-related TBI – “research priority”?

- Helps Y, Henley G and Harrison JE. 2008. Hospital separations due to traumatic brain injury, Australia 2004–05. Injury research and statistics series number 45, Adelaide: AIHW

United States: “geriatric TBI” costs $2.2 billion per annum

“Major reason” for up to 40% of residential aged care admissions

Population 65+ - to double to 70 million by 2030

“…the costs of caring for older adults with a TBI in monetary and human terms will be staggering…”

Australia: older demographic profile than US

Falls-related TBI: rates triple by 2050 = 750,000 additional hospital bed days, 3,320 additional residential aged care places


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stroke – “research priority”?

Between 40,000 and 48,000 strokes each year (and growing)

70% are first-ever strokes

cause 7% of all deaths in Australia

highly preventable

highly costly ($1.3 billion in 1997)


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www.braininjuryaustralia.org.au

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