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- Predictors of falls in older males and females with mild traumatic brain injury
Clinical Trial
Predictors of falls in older males and females with mild traumatic brain injury
??Approximately 502,908 older adults ?65 years sustain a mild traumatic brain injury (mTBI) every year in the United States, and 80.1% of these injuries are a result of a fall.[1] There are sex differences in mTBI prevalence, such that 64.7% of older females sustain mTBI compared to 35.3% of males.[1] Older females also report more symptoms (i.e., headache, dizziness, nausea, fogginess), [2] have a longer recovery, [3] and require greater healthcare use than older males.[4] However, the reason for these sex differences is not well understood.[4] Furthermore, between 24 and 84% of those who sustain a mTBI have non-resolving issues of poor cognition and impaired eye, head, and trunk movement 3 months after injury [5], which place them at a greater risk for falls. Our recent systematic review and meta-analysis revealed that older adults with markers of frailty (i.e., mobility, cognitive, medication, and sensory risk factors) were up to 53% more likely to fall recurrently.[9] Given that older adults with mTBI express markers of frailty, and that falls are a significant public health issue,[10] more research must be done to improve the health and quality of life in this population. While substantial research exists on predictors of falls in healthy older adults [11], there is limited research on the unique risk profiles of older adults with mTBI compared to healthy older adults. A multi-domain approach, integrating balance and mobility, psychological, medical, medication, sensory and neuromuscular, environmental, and sociodemographic domains, may provide a comprehensive framework to distinguish older adults with mTBI from those without. Importantly, falls can be prevented through targeted screening and treatment protocols [11], yet no studies have examined the predictors of falls among older adults with mTBI or whether they differ by biological sex. ?References ?1. Albrecht, J.S., et al., Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010. J Head Trauma Rehabil, 2016. 31(5): p. E1-7. ?2. Sufrinko, A.M., et al., Sex Differences in Vestibular/Ocular and Neurocognitive Outcomes After Sport-Related Concussion. Clin J Sport Med, 2017. 27(2): p. 133-138. ?3. Stevens, J.A., et al., Gender differences in seeking care for falls in the aged Medicare population. Am J Prev Med, 2012. 43(1): p. 59-62. ?4. Cancelliere, C., et al., Epidemiology of Isolated Versus Nonisolated Mild Traumatic Brain Injury Treated in Emergency Departments in the United States, 2006-2012: Sociodemographic Characteristics. J Head Trauma Rehabil, 2017. 32(4): p. E37-e46. ?5. Murray, N.G., et al., Assessment of oculomotor control and balance post-concussion: a preliminary study for a novel approach to concussion management. Brain Inj, 2014. 28(4): p. 496-503. ?6. Rutherford, W.H., Post concussion symptoms: Relationship to acute neurological indices, individual differences, and circumstances of injury. Mild head injury, ed. H.M.E. H.S. Levin, A.L. Benton. 1989, New York: Oxford University Press. ?7. Fino, P.C., M.A. Nussbaum, and P.G. Brolinson, Locomotor deficits in recently concussed athletes and matched controls during single and dual-task turning gait: preliminary results. Journal of neuroengineering and rehabilitation, 2016. 13(1): p. 65-65. ?8. McInnes, K., et al., Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One, 2017. 12(4): p. e0174847. ?9. Jehu, D.A., et al., Risk factors for recurrent falls in older adults: A systematic review with meta-analysis. Maturitas, 2021. 144: p. 23-28. ?10. Smartrisk, The economic burden of injury in Canada. 2009, Social Planning Council: Toronto, Ontario. ?11. Liu-Ambrose, T., et al., Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: A randomized clinical trial. JAMA, 2019. 321(21): p. 2092-2100.
Eligibility Criteria
- 1. Concussion or mTBI group Inclusion Criteria: Participants will be eligible if they: 1) are seeking medical attention or still experiencing impairments as a result of sustaining a mild traumatic brain injury/concussion; 2) are aged 60 years and older; 3) understand, speak, and read English proficiently; 4) are able to walk 3 meters with or without an assistive device; and 5) are able to provide written informed consent. Exclusion Criteria: We will exclude those: 1) with a progressive neurological condition other than mild traumatic brain injury/concussion; 2) with a recent surgery affecting mobility; 3) who are enrolled in another research study; 4) carotid sinus sensitivity, and/or 5) receiving hospice care. 2. Healthy older adults Inclusion Criteria: Participants will be eligible if they: 1) are aged 60 years and older; 2) understand, speak, and read English proficiently; 3) are able to walk 3 meters with or without an assistive device; and 4) are able to provide written informed consent. Exclusion Criteria: We will exclude those: 1) with any progressive neurological condition; 2) with a recent surgery affecting mobility; 3) who are enrolled in another research study; 4) carotid sinus sensitivity; and/or 5) receiving hospice care.