support worker with service user playing domino's in Kent House

The United Kingdom Acquired Brain Injury Foundation (UKABIF) in partnership with Wilmington Healthcare has published a report showing that 40% of hospital admissions in 2014 / 15 for traumatic brain injury (TBI) were for people aged over 75.

Four of the top five listed causes of TBI in 2014 / 2015 across all ages were falls, including on or from stairs and steps, and on the same level, from slipping, tripping and stumbling. In fact, ‘any type of fall’ was listed alongside 54.8% of admissions.

The Brain Injury Rehabilitation Trust’s (BIRT) service users reflect these trends with the median age of admissions increasing from age 43 in 2010 to 51 in 2016. Over this period, the age of the oldest service user in 2016 was 91, whereas it was 74 in 2010. Since 2012 the number of people admitted to BIRT with TBI who are over 60 has increased by 16%.

As more service users aged 60+ are being admitted, BIRT services are adopting new ways to support them and provide appropriate rehabilitation.

There are significant health issues attached to the care of older people and our staff are being trained to understand these, for example, limb contracture management. We have been mindful that some admissions we have received have all been prescribed anti-coagulants and therefore present an increased risk of bleeding in the event of a fall; this has to be factored in to the falls management care plan.

Another factor is increased risk to tissue viability and the need to check for any blanching. Therefore barrier spray / creams are available on admission, especially if the service user is incontinent.

We have changed and increased signage to help orientation for people with brain injury and dementia; sensory needs are much greater, due to conditions such as glaucoma and macular degeneration, and these are taken into consideration in service users’ rehabilitation needs. Ophthalmology appointments have been made as necessary and, where possible, we work closely with Visual Impairment teams at Sensory Advice Resource Centres.

An example of BIRT’s recognition of care needs in supporting older people

An 82 year old gentleman was admitted to Thomas Edward Mitton House in Milton Keynes following a stroke and was subsequently discharged home after only 12 weeks with a speech and language package provided by local acquired brain injury NHS service. Previous to this, whilst in hospital, a DNACPR (do not resuscitate) order had been put in place because he had been previously diagnosed with Aortic Stenosis. Many of our older service users have been admitted to BIRT following a stroke and have DNACPR orders which have been implemented in hospital, often due to pre-morbid conditions or diagnoses.

In this case, the gentleman’s family had reported that as this order was put in place by doctors they did not feel as though they had a say in the matter. BIRT checked with the GP and established that it was still effective until such time that the service user wanted it revoked. We arranged a meeting with him and his wife and daughter, and provided them with information regarding DNACPR and statistical evidence for and against. This was important as they had not received any of this information previously and were grateful to be able to regain some control over the decision. As a result the gentleman, who we provided with written information during the meeting, decided after a few days that he no longer wanted the order in place.

Sue Copstick, Clinical Director, said “Whilst we continue to use our neurobehavioural approach to brain injury rehabilitation, we are recognising and managing other care needs as these become more prevalent in this aging population.”

For more information about BIRT’s outcomes see our 2016 report and referring someone for rehabilitation at the Brain Injury Rehabilitation Trust (BIRT) is easy with our new, secure online referral form.