Seniors & Brain Injury

People ages 75 and older have the highest rates of traumatic brain injury related hospitalizations and death. They also recover more slowly and die more often from these injuries than do younger people. Falls are the leading cause of traumatic brain injury. Many of these people will need part-or full-time caregivers.

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Why Is Brain Injury and Aging So Understudied?

Why Is Brain Injury and Aging So Understudied?
The question of the effect that traumatic brain injury has on successful aging and on longevity and the ability to be vulnerable to or resist the diseases of aging is remarkably understudied. It's quite interesting how understudied it is. I think part of that is because we don't focus on the whole person who has a brain injury as much as we should. It's a really important question, whether we talk about brain injury or other forms of disability. According to the United Nations, the largest single minority group on earth is people with disabilities. And regardless of whether it's Swaziland or the United States, they're marginalized and disenfranchised and have barriers to care and are socially isolated. And so one of the things we know, for example, about successful aging is it's very much a brain thing. And we know--it's been said that the human brain is a social brain. And one of the common denominators of people who have any form of disability is psychosocial deprivation. We know that psychosocially deprived animals, rather than animals that are in psychosocially enriched environments, have a part of the brain injured; psychosocial deprivation injures a part of the brain known as the hippocampal formation that has some adult stem cells in it. And we know that in psychosocially enriched environments, or at least the animal studies show, those neurons can continue to divide really long after maturity occurs. But psychosocial deprivation is one way to injure the brain. And the hippocampal formation is associated with, among other things, short-term memory and the formation of long-term memories. So as we get older, cognitive impairment sometimes occurs. Mild cognitive impairment is a problem, and, of course, irreversible dementia is a bigger problem. And so to the extent you have an impairment in hippocampal function to begin with, then you're going to be at greater risk for just mild cognitive impairment later on. It doesn't mean you're going to get mild cognitive impairment, nor does it mean you're going to get Alzheimer's or chronic traumatic encephalopathy that's been talked about. But we do know that your risk is going to be greater, depending upon the severity of the brain injury.

Planning Your Estate

Ask the Expert: Planning Your Estate
What you need to mention to your attorney and discuss with them is the creation of a supplemental needs trust or what many people call a special needs trust. Usually the proper attorney to speak to about that are attorneys who specialize in the field called elder care, working with senior citizens, because we're talking about the same issue, which is protecting the assets so that the individual is still entitled to government benefits such as Medicaid or Medicare benefits. And what we're trying to do is ensure that the person who gets money still passes the needs or income test imposed by the government to see if they're eligible for these programs. So what we need to do is segregate these funds into a trust called a special needs trust or a supplemental needs trust that's created that will shelter the money rather than have the money go directly to the individual. And the whole purpose of this trust is in short to say this trust will fund programs that the government won't fund. So if a program will fund housing for an individual, this trust won't fund housing. If the government will pay an individual's medical or rehabilitation expenses, this trust won't do that. If the government will provide clothing for an individual, this trust won't provide clothing. What will the trust do? This trust will buy a van for the individual if they need transportation, special assistance. This trust will pay for family trips and vacations for the individual, take care of things around the house. This trust will in short do everything that the government can't do for a person, which is very important for the person to live independently and have a life that is meaningful. It's not enough that a person just live at home and watch TV all day. They have to have an existence that is a meaningful existence, and this trust will provide the funds to do that for an individual and yet still allow that individual to receive all their government entitlements.

One Way to Spell Hope: RESEARCH

One Way to Spell Hope: RESEARCH
When it comes to Alzheimer's disease, many people fear Alzheimer's [Paul Aravich, PhD; Professor Eastern Virginia Medical School] more than death itself. Kevorkian's first assisted-suicide person was a person diagnosed in the early stages of Alzheimer's. She'd rather be dead than have Alzheimer's. We fear it terribly. So when people ask about Alzheimer's disease in the context of traumatic brain injury, it's a very interesting question to ask; but, oftentimes it's asked in a vacuum. Because at the conferences that I go to and in the worlds that I travel, we have really separate, independent silos. Where we have Alzheimer's advocates and investigators on one side in one echo chamber, and we have traumatic brain injury investigators and advocates in a separate, independent echo chamber. Yet as is pointed out, a lot of people with traumatic brain injuries want to know if they're at greater risk for Alzheimer's. I was asked, for example, by a national media organization what did I think was the best outcome of this past summer's world congress on Alzheimer's disease. And to me, I thought the biggest and most impressive outcome was finally at the same conference, at the same time, we had not only Alzheimer's experts but also traumatic brain injury experts and people that were experts in post traumatic stress disorder. To me, that was fabulous because these are parallel, independent universes that otherwise at an investigator level were relatively--and at an advocacy level, oftentimes don't intersect at all. So when asked about risk of Alzheimer's disease, I think what's important to understand is we don't know what causes Alzheimer's disease, nor do we know how to effectively treat it. In that sense, we know more about HIV/AIDS than Alzheimer's disease. We know what causes HIV/AIDS, and we know how to significantly slow its progression. We don't know either of those issues definitively in Alzheimer's and the other irreversible dementias. And so one of the ways you spell hope is research. We need more research to spell hope. And so we need more public advocacy for these issues.

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