Aging, Falls and Traumatic

Brain Injury
Presented at the North Carolina
Conference on Aging
September 11, 2007
Janice K. White M.Ed., CBIS

What is Traumatic Brain

Injury?

A traumatic brain injury (TBI) is caused by

a blow or jolt to the head or a penetrating
head injury that disrupts the function of
the brain. Not all blows or jolts to the head
cause a TBI. Severity may range from
mild (a brief change in mental status or
consciousness) to severe (an extended
period of unconsciousness or amnesia). In
the United States falls are the leading
cause of TBI.

What Are The Leading

Causes of TBI?

In the US the leading causes of TBI are:

Falls 28%
Motor vehicle-traffic crashes 20%
Struck by/against events 19%
Assaults 11%
Centers for Disease Control and Prevention

Causes of Falls

The causes of falls are known as

risk factors. The greater the
number of risk factors to which an
individual is exposed, the greater
the probability of a fall, and the
more likely the results of the fall
will threaten the persons health
and independence.

Causes of Falls continued

Fall rates are highest for children age 0 to 4

years and adults age 75 and older.
Among older people, the risk of falling increases
with age and is greater for women than for men.
Two-thirds of those who experience a fall will fall
again within six months.
At least one-third of all falls among older people
involve environmental hazards in the home.

Brain Injury Association of America

Fall Related TBI: A Public

Health Problem

Falls are the leading cause of TBI

Adults 75+

Have the highest rates of TBI-related

hospitalizations and death
Who fall are 4 to 5 times more likely to
be admitted to a long-term care
facility for a year or more.
60% of falls occur at home
Centers for Disease Control and Prevention

Falls and the Elderly

Some studies indicate that the rate of injury

begins to increase by the age of 65
In older individuals there are physical changes
that make their brains more vulnerable to
injury and reduce their chances of recovery
(Patrick, 1996).
Generally they take longer to recuperate, need
more time and effort to reach the same level
of recovery that younger individuals attain and
often have a less positive prognosis, recovery
and outcome (Pilisuk & Feinberg, 1996).

Falls are the Leading

Cause of Brain Injury in
the Elderly

Factors that contribute to this include:

Medication
Other Medical Conditions

Visual Impairments
Orthopedic Problems

Lack of Exercise
Improper Footwear
Safety Factors in the Home

Severity of TBI

Symptoms of TBI may be mild,

moderate or severe, depending on
the extent of damage to the brain.
Some symptoms are evident
immediately, while others may not
surface until several days or weeks
after the surgery.

Mild Brain Injury

A person with a mild brain injury

may:

Remain conscious
May experience a loss of consciousness
for a few seconds to a few minutes
May not remember losing
consciousness
Have a clear MRI or CAT Scan

Mild Brain Injury continued

This may be called a concussion

and is usually not life threatening
However the effects can be serious
People may look fine even though
they are acting or feeling
differently

Symptoms of Brain Injury

in the Elderly

With the elderly it is essential to remember

that some of the symptoms of a brain injury
may be the same symptoms they are already
experiencing from other medical conditions.
These individuals must be closely monitored
Subtle changes must be noted as well as
exaggeration of already existing symptoms.

Symptoms of Brain Injury

continued

Symptoms may be worsened by

medications including prescription,
over the counter, or natural
remedies.
Blood thinners may be especially
problematic.
Alcohol may increase these symptoms
and could possibly lead to seizures.

Symptoms may include:

Headache and possibly neck pain

Lightheadedness or dizziness
Problems with balance
Confusion or getting lost
Blurred vision or tired eyes
Ringing in the ears
Loss of taste or smell
Fatigue, lethargy or a change in sleep
pattern

Symptoms continued:

Behavioral or mood changes including feeling sad,

anxious, listless, irritated or angry for no reason.
Trouble with memory, concentration, attention,
organization or thinking.
Impaired decision making or problem solving.
Increased sensitivity to light, sounds or
distractions.
Change in sex drive.
Slowness in thinking, acting, speaking or reading
Dysphagia (problems swallowing)

Increased Severity

A person with a moderate to severe

brain injury may show these
symptoms initially. If symptoms
worsen over time this may be an
indication of a blood clot forming in
the tissue of one of the sinuses, or
cavities, adjacent to the brain.

Additional Symptoms of
Moderate to Severe Brain
Injury:

Worsening Headaches
Weakness, numbness or decreased coordination
Repeated vomiting
Inability to be awakened
One pupil larger than the other
Seizures
Slurred speech
Agitation
If these symptoms are observed contact a doctor
immediately or go to the emergency department.

Who Is At Risk?

Individuals who are on medications for other

thing such as:

Osteoporosis
Depression
Sleep problems
High blood pressure
Diabetes
Parkinsons

You are more likely to fall if you are taking 4

or more medications or have changed your
prescription or dosage in the past two weeks

Additional Risk

Individuals who have had a previous fall

Have physical limitations, including vision
Have more than one chronic disease
Take more than four medications or use
psychoactive medications (such as
antidepressants)
Are cognitively impaired
Have lower body weakness or gait or
balance problems

Fall Prevention

Physical exercise to increase overall

strength (consult your physician)
Proper footwear
Grab bars and non-slip mats in the
bathroom
Medication review

Fall Prevention continued

Home safety checks to look for:

Uneven surfaces, inside and out.

Loose rugs and cords
Proper lighting
Keeping frequently used items in easy
to reach places

Target Audience for

Education

Health Care Professionals

Long-Term Care Facilities
Children of adults over 75 (baby
boomers)
Older individuals themselves

Strategies

Education that TBI is a fall-related injury

Collaboration with fall prevention
organizations to integrate fall prevention
and TBI messages
Establish partnerships with key
organizations that focus on TBI & fall
prevention to get the message out to
target audiences

Conclusion

The best cure for brain injury is

prevention. Older people in
particular should take decisive
action to minimize the risk of a fall
that could result in a TBI. However
should a fall occur, immediate
medical attention should be
sought, including screening for TBI.

Resources

Brain Injury Association of America

Centers for Disease Control and

Prevention

1-800-444-6443
www.biausa.org

1-800-311-3435
www.cdc.gov/ncipc
See Preventing Falls in Older Adults

National Institute on Aging

1-800-222-2225
www.nia.nih.gov/healthinformation

Resources continued

The Fall Prevention Project and

HEROS (Health, Education,
Research and Outreach for Seniors)

The U.S. Administration on Aging

www.temple.edu/older_adult
www.aoa.dhhs.gov

Aging Network Services

www.agingnets.com

Contact Information
Janice (Jan) White
DHHS-Division of Mental
Health/DD/Substance Abuse Services
3021 Mail Service Center
Raleigh, NC 27699-3021
919-715-5989
919-715-2360 (fax)
Janice.White@NCMail.net