Traumatic Brain Injury in the Elderly

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Traumatic Brain Injury in the Elderly

• Focus on Research Opportunities in Older
  Populations

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Traumatic Brain Injury (TBI)

• Insult to the brain, caused by an external
  physical force (not of degenerative or congenital
  nature)
• May produce mild to severe impairment of
  cognitive or physical abilities

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Facts and Figures

• Each Year in the U.S.
• 1 million are treated and released from ERs with
  TBI
• 80,000 experience the onset of long term
  disability with TBI
• 50,000 die from TBI
• 2 of the population currently live with
  disabilities from TBI

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Facts and Figures
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Facts and Figures
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Why Study TBI in Older Adults?

• Research has focused on younger populations
• Little is known about TBI in an aging population
• 65 is growing
• Different health concerns than younger age adults
• Longer, more costly stays on rehabilitation units
  than younger adults
• Recovery post TBI is slower than in younger
  adults

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Census Projections of Centenarian Population of
U.S.

• Year Number of Centenarians
• 2000 61,000
• 2010 213,000
• 2020 505,000
• 2030 1,048,000
• 2040 1,842,000
• 2050 4,057,000
• Total population in 2050 N 400,000,000

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Chronic Health Conditions
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Memory Impairment
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Estimated Percentage of Adults with Daily
Activity Limitations, by Age Group and Type of
Limitation (2006)
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Challenge

• Increase Research of TBI in older populations
• Need to explore areas of opportunity

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About NIA
Overview NIA, one of the 27 Institutes and
Centers of NIH, leads a broad scientific effort
to understand the nature of aging and to extend
the healthy, active years of life. In 1974,
Congress granted authority to form NIA to provide
leadership in aging research, training, health
information dissemination, and other programs
relevant to aging and older people.
Mission NIAs mission is to improve the health
and well-being of older Americans through
research, and specifically related to Aging
processes Age-related diseases Special problems
and needs of the aged
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NIA Research Programs
Division of Aging Biology (DAB)
Supports research and training to enhance and extend the human health span through a better understanding of the biological mechanisms underlying the aging process.  
Behavioral and Social Research (BSR)
Supports basic social and behavioral research and research training on the processes of aging at both the individual and societal level.  
Neuroscience and Neuropsychology (NNA)
Supports research and training to further the understanding of the structure and functioning of the aging nervous system in health and disease.   
Geriatrics and Clinical Gerontology (GCG)
Supports research on health and disease in the aged and research on aging over the human lifespan, including its relationships to health outcomes.
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Research Develop strategies to reduce falls and
their consequences
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Tai Chi, Balance, Strength
Vision, Fall hazards
Polypharmacy, Behavioral
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Research TBI and linkages with Dementia
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Cognition

• Known as neurogenesis, studies suggests that
  medical and behavioral approaches could be found
  to stimulate the formation of new neurons to
  compensate for the loss and functional decline of
  neurons with aging, disease, or traumatic injury

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Older persons who exercised 3 times per week
were more likely to be dementia-free than those
who exercised fewer lt 3 times per week (N1740)
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Research Resiliency and recovery post TBI
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A Model of the Enabling-Disabling Process
Pathology Impairments Functional
LimitationsDisability

• TBI
• Dysfunction and structural abnormalities in
  specific body systems (musculoskeletal,
  cardiovascular, etc.)
• Restrictions in basic physical and mental actions
  (ambulate, reach, grasp, climb stairs, speak, see
  standard print)
• Difficulty doing activities of daily life
  (personal care, household management, hobbies)

Verbrugge LM and Jette AM. Soc Sci Med.
1994381-4.
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Objective Performance Measures of Functioning

• Assessment instruments in which an individual is
  asked to perform a specific task and is evaluated
  in an objective, standardized manner
• Assessment may include counting of repetitions or
  timing of the activity

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Examples of Objective Performance Tests used to
Evaluate Functional Limitations

• Grip Strength
• Picking up object
• Lifting 10 pounds
• Gait speed
• Chair rise single and repeated
• Stair climb
• Test of balance

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Short Physical Performance Battery

• Developed at the National Institute on Aging
  (NIA) for use in the Established Population for
  the Epidemiologic Studies of the Elderly (EPESE)
• Timed standing balance (up to 10 seconds)
• Side-by-side stand
• Semi-tandem stand
• Tandem stand
• Timed 4-meter walk (or 8-foot walk)
• Chair rise
• Single
• Timed multiple (5) chair rises

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Death Rates According to Individual Performance
Testsage and sex adjusted
Walk
Chair Stands
Standing Balance
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Death Rates According to Performance Test Summary
Scoreage and sex adjusted
Deaths per 100 PersonYears
Performance Test Summary Score
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Potential Applications of Physical Performance
Measures in TBI Research

• Identifying levels of functioning
• Identifying resilient and vulnerable persons
• Clinical vital sign
• Evaluating change
• Intervention studies

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Psychological Well-Being
Significance NIH to invest significant new
resources in advancing knowledge of positive
health. Such a program builds on emerging
studies of resilience and resistance to adverse
health outcomes as well as current work on
recovery from illness. National Research
Council
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Psychological Well-Being

• Individuals with high psychological well-being
• Like themselves
• Good inter-personal relationships
• Creative at work / problem solving
• Cognition (memory, abstract thinking)
• Increased motivation to accomplish tasks

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ADL Recovery 1-yr. Post Stroke by Positive
Emotion Score
Baseline Model 1 (n227) Model 2 (n 221) Model 3 (n 221)
Low depressive symptoms OR (95 CI) OR (95 CI) OR (95 CI)
High positive emotion 2.55 (1.10-5.93) 2.77 (1.16-6.63) 2.70 (1.10-6.68)
Low positive emotion 1.07 (0.31-3.97) 1.07 (0.31-3.97) 1.31 (0.35-4.48)
High depressive symptoms 1.00 1.00 1.00
Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture. Model 1 adjusted for age Model 2 adjusted for age, gender, race, education, marital status, ADLs in event yr, and cognitive status Model 3 adjusted for Model 1 and 2 variables, and heart attack, stroke, diabetes, cancer and hip fracture.
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• Research
• Understand how demographic characteristics of
  cohorts reaching old age with TBI affect health
  and well-being
• Develop a research plan to understand the dynamic
  changes that occur across the life course and
  plan appropriate interventions

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Research Examine ethnic disparities in recovery
post TBI
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Infrastructure Goals

• Develop a Translational Research program to
  provide the necessary infrastructure to support
  TBI research efforts
• Develop a plan to recognize co-investigators
• Train funded faculty for working in teams
• Increase of investigators engaged in TBI
  research
• Create Strategic Partnerships with key
  investigators
• Maximize interschool partnership
• Establish mechanism to enhance multi-institutional
  grants

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Summary

• Most of our knowledge about TBI comes from
  studies involving younger age groups
• With the aging of the population there is a
  critical need to undertake TBI research in the
  older adult

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Summary

• Areas of potential multidisciplinary research
• Falls risk / assessment
• Cognition / Dementia
• Functional limitations and disability
• Psychological well-being

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NIA strategic directions available at
www.nia.nih.gov/AboutNIA/StrategicDirections Ot
her Helpful Web Sites National Institute on
Aging Home Page www.nia.nih.gov Current Funding
Opportunities for Research and Training
www.nia.nih.gov/GrantsAndTraining NIA Extramural
Research Programs www.nia.nih.gov/ResearchInform
ation/ExtramuralPrograms Biology of Aging Program
www.nia.nih.gov/bap Behavioral and Social
Research Program www.nia.nih.gov/bsr Neuroscienc
e and Neuropsychology of Aging Program
www.nia.nih.gov/nna Geriatrics and Clinical
Gerontology Program www.nia.nih.gov/gcg NIA
Intramural Research Programs www.grc.nia.nih.gov
National Institutes of Health Home Page
www.nih.gov NIH Roadmap for Medical Research
nihroadmap.nih.gov NIH Blueprint for Neuroscience
Research neuroscienceblueprint.nih.gov