Risk Factors for Traumatic Brain Injuries During Falls in Older Persons

Hwang, Hei Fen; Cheng, Chui Hsuan; Chien, Ding-Kuo; Yu, Wen Yu; Lin, Mau Roung

doi:10.1097/htr.0000000000000093

Cited by 33 publications

(37 citation statements)

References 40 publications

(38 reference statements)

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“…However, we found no studies investigating the risk of head or brain injuries associated with antidepressant use. One previous study assessed risk factors for TBIs during falls among older persons, but medication use was assessed only 4 h before the fall and the number of users was small [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study

et al. 2017

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BackgroundAntidepressant use has been associated with an increased risk of falling, but no studies have been conducted on whether antidepressant use is associated with an increased risk of head injuries which often result from falling among older persons. The objective of this study was to investigate the risk of head and brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease.MethodsA matched cohort study was conducted by comparing new antidepressant users (n = 10,910) with two matched nonusers (n = 21,820) in the MEDALZ study cohort. The MEDALZ cohort includes all community-dwelling persons newly diagnosed with Alzheimer’s disease between 2005 and 2011 in Finland. Incident antidepressant users were identified based on register-based dispensing data from the Prescription register with a 1-year washout period for antidepressant use. Nonusers were matched with users based on age, gender, and time since Alzheimer’s disease diagnosis. The outcome events were defined as any head injuries and traumatic brain injuries based on diagnoses in Hospital Discharge and Causes of Death registers. Propensity score adjusted Cox proportional hazard models were utilized. Sensitivity analyses with case-crossover design were conducted. All registers are linkable with unique personal identification numbers assigned for each resident.ResultsAntidepressant use was associated with an increased risk of head injuries (age-adjusted event rate per 100 person-years 2.98 (95% confidence interval (CI) 2.49–3.06) during use and 2.43 (95% CI 2.06–2.35) during nonuse, adjusted hazard ratio (HR) 1.35, 95% CI 1.20–1.52) and traumatic brain injuries (age-adjusted event rate per 100 person-years 1.33 (95% CI 1.13–1.53) during use and 1.10 (95% CI 1.00–1.20) during nonuse, adjusted HR 1.26, 95% CI 1.06–1.50). The risk was highest during the first 30 days of use (HR 1.71, 95% CI 1.10–2.66 for head injuries; HR 2.06, 95% CI 1.12–3.82 for traumatic brain injuries) and remained at an elevated level for head injuries for over 2 years of use. In case-crossover analyses, antidepressant use was consistently associated with a higher risk of head injuries.ConclusionsAntidepressant use was associated with an increased risk of the most severe outcomes, head and brain injuries, in persons with Alzheimer’s disease. Antidepressant use should be carefully considered and the association confirmed in future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0285-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study

et al. 2017

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“…While promising, neck strength and muscle activation may together be described as a single factor in the multifactorial problem of fall-related TBIs. Other potential factors include polypharmacy, the use of antiarrhythmics, and unsafe bed or chair transfers (4). Investigations of the relationship between neck strength, muscle activation, and head acceleration during falls in older adults is warranted.…”

Section: Future Directionsmentioning

confidence: 99%

“…Several investigations have identified non-modifiable risk factors, such as gender and age, as major mitigating factors in fall-related head injuries (1–7) However, despite our understanding of the significance of this problem, there has been limited research examining modifiable risk factors of fall-related TBIs in older adults (1–7). One report concluded that older adults should attempt to avoid fall-related head impact but provided minimal insight on how to accomplish this feat (4).…”

Section: Introductionmentioning

confidence: 99%

The Role of Neck Musculature in Traumatic Brain Injuries in Older Adults: Implications From Sports Medicine

2019

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Traumatic brain injuries (TBIs) are common and serious injuries to older adults. The majority of TBIs in older adults are sustained when the head impacts the ground or other surface during a fall. While several non-modifiable risk factors have been identified for fall-related TBIs in older adults, there still remains a dearth of knowledge surrounding modifiable risk factors. Thus, this significant knowledge gap warrants an investigation into research across disciplines. The sports medicine literature has examined several modifiable risk factors to prevent a mild form of TBI known as concussion. While this research has identified several risk factors, one particular risk factor may have potential implications to fall-related TBIs in older adults. The sports medicine literature has shown that decreased neck strength and slower neck muscle activation are significant predictors for sports-related concussion. Similarly, older adults experience age-related declines to neck muscle strength and muscle activation. Consequently, these age-related declines to the neck musculature may result in the inability of older adults to control their head during a fall, which results in greater impact forces being transmitted to the brain and increases the risk of TBI. This perspective article assesses the sports medicine literature related to the implications of neck strength and muscle activation in sports-related concussion, discusses age-related declines to neck strength and muscle activation, and highlights the potential impact of the neck musculature on fall-related TBIs in older adults.

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“…Physical activity levels are closely related to health and are important to maintain [1]. Lifestyle, lifestyle diseases, or physical inactivity [2][3][4] may cause acquired brain injury. A long hospitalization may enhance an inactive lifestyle and persons with acquired brain injury resulting in reduced physical fitness as a secondary complication after the acquired brain injury [5][6].…”

Section: Senior Fitness Test; a Useful Tool To Measure Physical Fitnementioning

confidence: 99%

Senior fitness test; a useful tool to measure physical fitness in persons with acquired brain injury

Langhammer

Stanghelle

2018

Brain Injury

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Objectives: to evaluate the feasibility and usability of the Senior Fitness Test (SFT) in persons with acquired brain injury. Methods: A pilot cohort design with a convenience sample of persons with acquired brain injury. Results: Persons with acquired brain injuries [n=47] were younger than their healthy counterparts [n=172] were but performed significantly worse on sit to stand, 6 Minute-Walk-Test (6MWT) and 2.45m up-and-go. This difference was accentuated in the age groups > 60 years of age. Persons with acquired brain injuries, divided into subgroups Traumatic Brain Injury (TBI) [n=12] and Cerebral Insult (CI) [n=35], showed significant differences in leg strength, upper extremity flexibility and walking capacity. Persons with CI were weaker, less flexible in upper and lower extremities, walked shorter distance and were less mobile. CI but not TBI performed significantly worse when compared to healthy elderly persons. Conclusion: This study indicates that SFT is feasible, safe and useful tool for persons with acquired brain injury, to evaluate physical capacity, endurance, strength and flexibility. The sub maximal test was well tolerated and could be performed by all participants irrespective of age or diagnosis. The distribution of test scores indicates responsiveness to change, and no ceiling or floor effects.

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Risk Factors for Traumatic Brain Injuries During Falls in Older Persons

Abstract: Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.

Cited by 33 publications

References 40 publications

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease: a nationwide matched cohort study

The Role of Neck Musculature in Traumatic Brain Injuries in Older Adults: Implications From Sports Medicine

Senior fitness test; a useful tool to measure physical fitness in persons with acquired brain injury

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