aging and brain injury
DESCRIPTION
Aging and Brain Injury. Cynthia L. Boyer, Ph.D Executive Director Brain Injury Services. 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. Physical patterns:. NORMAL AGING. Aging. - PowerPoint PPT PresentationTRANSCRIPT
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Aging and Brain Injury
Cynthia L. Boyer, Ph.DExecutive Director
Brain Injury Services
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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
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NORMAL AGING
Physical patterns:
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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
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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
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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
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Chronic Medical Issues• Seizure Disorder• Respiratory Problems• Late Onset Swallowing Problems• Diabetes • Skin Integrity• Circulatory Problems• GI Probles• Headaches• Pain
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Caregiver Issues
• Age
• Health
• Physical Capacity
• Finances
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Accelerated Decline
• Early Onset of Physical and Cognitive Decline
• Psychological Response to Long Term Disability• Gains Made in Rehab Erode
• Level of Independence Decreases
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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)
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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)
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TBI Is A Chronic Disease
• Life Expectancy• Endocrine Dysfunction• Cognitive Decline• Psychiatric Conditions• Development of Neurodegenerative
Conditions
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Risk Factors for Increased Mortality
• Advanced Age at Time of Injury• Seizures• Employment Status• Substance Abuse• Psychiatric Disorder• Physical Impairment
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Causes of Death
• Seizures• Pneumonia/Other Respiratory• Sepsis• Choking• Suicide*• Substance Abuse Related*• Accidental Injury* *mild tbi
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Endocrine Dysfunction
• Growth hormone insufficiency
• Hypothyroidism
• Gonadotropin Decrease
• Hypopituitarism
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NeuroDegenerative Disorders
• Increased risk of brain atrophy
• Lack of neuronal reserve
• Breakdown of BBB
• Accumulation of protein
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TBI & NeuroDegenerative Disorders
• Moderate to Severe TBI Associated with Alzheimer’sDisease
Parkinsonism
• Mild TBI ??
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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
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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
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TBI In Older Adults
FallsRisk Factors•Increasing Age•Cognitive Impairment•Medication Side Effects•Alcohol Intoxication
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CASE STUDY 1
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Case Study 2
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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
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Thank you!
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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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ReferencesKolias, A. G., Guilfoyle, M. R., Helmy, A., Allanson, J., & Hutchinson, P. J. (2013). Traumatic brain injury in adults. Practical Neurology, 13(4), 228-235.doi:10.1136/practneurol-2012-000268Li, Y., Baldassi, M., Johnson, E. J., & Weber, E. U. (2013). Complementary cognitive capabilities, economic decision making, and aging. Psychology And Aging, 28(3), 595-613. doi:10.1037/a0034172Li, S., Lindenberger, U., Baltes, P., Hommel, B., Aschersleben, G., & Prinz, W. (2004). Transformations in the Couplings Among Intellectual Abilities and Constituent Cognitive Processes Across the Life Span. Psychological Science, 15(3), 155-163Masliah, E., Crews, L., & Hansen, L. (2006). Synaptic remodeling during aging and in Alzheimer's disease. Journal Of Alzheimer's Disease, 9(3), 91-99.McAllister, T. W. (2011). Neurobiological consequences of traumatic brain injury. Dialogues In Clinical Neuroscience, 13(3), 287-300.McArdle, J. J., Ferrer-Caja, E., Hamagami, F., & Woodcock, R. W. (2002). Comparative longitudinal structural analyses of the growth and decline of multiple intellectual abilities over the life span.Developmental Psychology, 38(1), 115-142. doi:10.1037/0012-1649.38.1.115 Moretti, L. L., Cristofori, I. I., Weaver, S. M., Chau, A. A., Portelli, J. N., & Grafman, J. J. (2012). Cognitive decline in older adults with a history of traumatic brain injury. The Lancet Neurology, 11(12), 1103-1112. doi:10.1016/S1474-4422(12)70226-0 Raz, N., & Rodrigue, K. M. (2006). Differential aging of the brain: Patterns, cognitive correlates and modifiers. Neuroscience & Biobehavioral Reviews, 30(6), 730-748. doi:10.1016/j.neubiorev.2006.07.001
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Rowe, J., & Kahn, R. (2000). Successful aging and disease prevention... unless otherwise noted, this article is reprinted with permission from the Gerontological Society of America from the authors' earlier article "Successful Aging", Gerontologist 37:433-440, 1997. Advances In Renal Replacement Therapy, 7(1), 70-77.Schroots, J. F. (1996). Theoretical developments in the psychology of aging. Gerontologist, 36(6), 742Sendroy-Terrill, M. M., Whiteneck, G. G., & Brooks, C. A. (2010). Aging With Traumatic Brain Injury: Cross-Sectional Follow-Up of People Receiving Inpatient Rehabilitation Over More Than 3 Decades. Archives Of Physical Medicine And Rehabilitation, 91(3), 489-497.doi:10.1016/j.apmr.2009.11.011Till, C., Colella, B., Verwegen, J., & Green, R. (2008). Postrecovery Cognitive Decline in Adults With Traumatic Brain Injury. Archives Of Physical Medicine And Rehabilitation, 89(12 SUPPL.), S25-S34. doi:10.1016/j.apmr.2008.07.004Tun, P. A., Williams, V. A., Small, B. J., & Hafter, E. R. (2012). The Effects of Aging on Auditory Processing and Cognition. American Journal Of Audiology, 21(2), 344-350. doi:10.1044/1059-0889(2012/12-0030)Turner-Stokes, L., Nair, A., Sedki, I., Disler, P., & Wade, D. (2005). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Of Systematic Reviews, (3)