Monday, March 27, 2017 CDC: TBI Due to Falls Climbing at a Disproportionate Rate Among Older Adults In brief: CDC analysis of ED visits, hospitalizations, and deaths related to TBI, 2007–2013 reveals positive and negative trends. Overall rate of visits, hospitalizations, and deaths rose from 1.9 million to 2.7 million; death rates attributable to TBI from motor vehicle accidents have dropped. Most of the increase was due to ED visits; hospitalizations remained unchanged; deaths rose slightly. Researchers noted significant and disproportionate increases in ED visits, hospitalizations, and deaths from TBIs attributable to falls, particularly among adults 75 and older—even while other age groups and categories were decreasing. Authors cite need for more widespread falls-prevention efforts. According to the US Centers of Disease Control and Prevention (CDC), better public awareness of the symptoms of and the need to treat traumatic brain injury (TBI) may partly explain why the rates of emergency department (ED) visits rose between 2007 and 2013, but that understanding doesn't account for what researchers describe as a "substantial" jump in TBI-related ED visits, hospitalizations, and deaths among adults over 75. For that older population, falls-related TBIs are growing at a disproportionate rate, even adjusting for age, and point to a need for stepped-up falls-prevention efforts. The CDC report issued on March 17 uses Healthcare Cost and Utilization Project databases to analyze TBI-related ED visits, hospitalizations, and deaths from 2003 to 2013, and it contains a mixture of good and bad news. Among the bright spots: the age-adjusted rate of TBI-related deaths attributed to motor vehicle accidents dropped from 5 per 100,000 population to 3.4 per 100,000 between 2007 and 2013, with the overall number of hospitalizations for TBI-related injuries related to car accidents also dropping from 23.5 per 100,000 hospitalizations to 18.8 per 100,000 during the same time period. Less encouraging: TBI-related deaths attributable to falls have increased among adults 75 and older, from 39.7 per 100,000 population to 50.3 per 100,000. Similarly, TBI-related hospitalizations attributable to falls also increased for this group, from 257.3 per 100,000 to 354.8 per 100,000 by 2013. According to the CDC, while the combined number of TBI-related ED visits, hospitalizations, and deaths did rise from 1.9 million in 2007 to an estimated 2.8 million in 2013, the rise was due mostly to ED visits, which accounted for 2.5 million events, compared with 282,000 hospitalizations in 2013—about the same as 2007—and 56,000 TBI related deaths, representing a slight increase from 55,920 in 2007. However, researchers explain, the overall figures don't tell the whole story. Authors believe the uptick in ED visits among youth may be attributable in part to increased awareness among the public (resulting in a higher number of individuals seeking care) and increased awareness and use of assessment tools among health care providers (resulting in more TBI diagnoses). More problematic, according to the researchers, is the fact that falls are becoming an increasingly prevalent cause for not only ED visits, but hospitalizations, and deaths—and are growing at a disproportionate rate for older adults. What kind of growth? In 2013, falls accounted for 57.3% of the increase in ED visits, representing a 50% increase in incidence from 2007. Though TBI-related hospitalizations didn't increase by much between 2007 and 2013, the number of hospitalizations related to falls did, from 33.9 per 100,000 (age adjusted) to 42.2. The same was true for TBI-related death rates attributable to falls, which increased from 3.8 to 4.5 per 100,000 between 2007 and 2013. Researchers note that those increases in falls-related TBIs were experienced disproportionately, depending on age. And the change can't be explained by increases in life expectancy from 2007 to 2013, during which time average lifespan rose from 78.1 years to 78.8 years. "The reason or reasons for this increase [in falls-related TBI injury] is unknown," authors write. "Although increases among youth were found for TBI-related ED visits, there were significant increases in the number of ED visits, hospitalizations, and deaths attributable to TBIs resulting from older adult falls," authors write. "This across-the-board increase over a relatively short time suggests the need to address preventing and reducing the number of older adult falls resulting in TBI." Among the interventions that can make a difference, researchers advocate for increased use of "empirically validated [falls] prevention measures" that include physical exercise programs, Tai chi, Vitamin D supplementation, surgeries such as cataract procedures and pacemakers when appropriate, and strategies to reduce home health hazards. Also recommended: the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program that "incorporates empirically supported clinical guidelines and scientifically tested interventions to help … address patient falls risk." APTA remains a strong advocate for greater attention to TBIs as well as community-based falls-prevention programs. Last week, representatives from the association again participated in the Brain Injury Awareness Fair on Capitol Hill, and APTA continues to work to support the physical therapist's role in concussion management. More resources can be found at APTA's Traumatic Brain Injury webpage, and in a clinical summary on concussion. On the falls front, APTA offers a variety of resources on falls prevention, including a clinical summary on falls risk in community-dwelling older adults, a practice guideline on the assessment and prevention of falls, tests and measures related to falls, a Physical Therapy-published clinical guidance statement from the Academy of Geriatric Physical Therapy, an online community for PTs and physical therapist assistants interested in falls prevention, and a balance and falls webpage. On left, Rep Bill Pascrell Jr (NJ), chair of the congressional brain injury caucus, meets with APTA Senior Congressional Affairs Specialist Michael Hurlbut during the recent Brain Injury Awareness event on Capitol Hill. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.