Physical and Mental Aging after a Brain Injury
Brain Injury and Aging
By Marilyn Lash, M.S.W.
Lash & Associates Publishing/Training Inc.
Aging after a brain injury
The number of elderly persons has increased dramatically along with the number of people with disabilities who are aging. The overall death rate from traumatic brain injury decreased with advances in long-term medical care, rehabilitation and social support. However, successful aging is more than simply living longer. It involves maintaining physical, cognitive and social functions (Aravich & McDonnell, 2005).
Little is still understood about the long-term impact of a traumatic brain injury. Yet researchers estimate that overall life expectancy in survivors may be reduced by 7 years. Predictors of premature death among survivors of traumatic brain injury are older age, unemployment when injured, and presence of disability when discharged from rehabilitation. Circulatory and respiratory diseases, seizures and choking have been linked to increased death rates among long-term survivors. Traumatic brain injury increases the risk of Alzheimer’s disease (Aravich & McDonnell, 2005).
While many people fear old age, aging is not a disease. Most of us are familiar with changes among elderly persons in what is called “fluid intelligence” – examples are decreases in processing speed and memory span. On the positive side, aging usually is accompanied by an increase in “crystallized intelligence” as demonstrated by an older person’s fund of general information and vocabulary (Aravich & McDonnell, 2005). Because the more disabling effects of a traumatic brain injury are cognitive changes, many families and survivors fear the double whammy of aging with an injured brain. What can be done?
Ten rules to promote successful aging in survivors of TBI
Aravich and McDonnell suggest the following…
- Take care of the survivor’s heart
- Exercise the survivor’s body
- Exercise the survivor’s brain
- Feed the survivor’s brain
- Promote mental health in the survivor
- Avoid tobacco, alcohol and other drugs of abuse
- Avoid social isolation
- Protect the survivor’s brain
- Form more partnerships for individuals with TBI
- Look for greatness in each person (Aravich & McDonnell, 2005)
Aging of survivors
Facts about mental health after brain injury…
- Suicide accounts for two-thirds of all traumatic brain injury firearm deaths.
- Traumatic brain injury increases the lifetime risk of depression by 54%.
- A mild traumatic brain injury increases the risk of a mental illness within 6 months.
- Depression affects successful aging by reducing quality of life and increasing the risk of cardiovascular disease and Alzheimer’s.
- Estimates are 57% of persons with traumatic brain injury were heavy drinkers before their injury (Aravich & McDonnell, 2005).
A review of the literature by Gaultieri and Cox identified five delayed sequelae of traumatic brain injury: delayed amnesia, affective disorders, post-traumatic epilepsy, post traumatic psychosis and dementia. Among the affective disorders, depression is a common condition that can complicate recovery from a brain injury both during the acute and long-term stages. It can be complicated to treat because it is a combination of neuroanatomical, neurochemical and psychosocial factors. Other contributing factors are social isolation, unemployment, and less leisure activity as survivors struggle to build a new life in the community (Trudel, Felicetti & Mozzoni, 2005).
Depression is not the only major disorder found among survivors. Gaultieri and Cox also found that psychosis following brain injury was found among 2-5% of persons with mild or moderate injuries and among 10% or more among those with severe injuries (Trudel, Felicetti & Mozzoni, 2005).
Post traumatic epilepsy
This was found to be a contributing factor to the probability of developing a psychosis. The risk of developing post traumatic epilepsy is related to the nature and extent of the brain injury. A mild to moderate brain injury increases the risk by 2-5 times; a severe brain injury by 10 times; and a penetrating brain injury by 50 times (Trudel, Felicetti & Mozzoni, 2005).
Three factors have been identified as risks for Alzheimer’s: age, family history of Alzheimer’s or Down’s syndrome, and traumatic brain injury. Because a brain injury can result in the death of neurons and weakening of the blood-brain barrier, one theory is that the brain is more vulnerable to neurotoxins. The deposit of beta-amyloid in the brain has been found in young and old persons with brain injury upon autopsy. This protein has been linked to the formation of senile plaques found in Alzheimer’s disease (Trudel, Felicetti Mozzoni, 2005).
Brain injury is not a short term condition, rather it is a chronic condition requiring many services and supports over the life time of an individual.
Aravich, P. & McDonnell, A. (2005). Successful Aging of Individuals with Brain Injury. Brain Injury/Professional 2(2).
Trudel, T, Felicetti, T, Mozzoni, M. (2005). The Graying of Brain Injury: An overview. Brain Injury/Professional 2(2).
This Fact Sheet is based on the special issue of Aging and TBI of the Brain Injury/Professional (vol. 2, issue 2), 2005. Back issues are available by calling the publisher at (800) 321-7037 or ordering at www.nabis.org
Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Members of NABIS receive a subscription as a benefit of NABIS.
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