Falls and Traumatic Brain Injuries in Elderly People

Falls among older people are one of the most important public health issues in the world. Falling is the second leading cause of injury-related deaths among older people in Taiwan. Elderly falls also lead to severe physical injuries, lack of independence in daily living, psychological trauma, and social dysfunction, as well as enormous social costs. While most of elderly falls occurs in home, some home environmental hazards (e.g., smooth floor) are intuitively considered as their potential risk factors. However, few studies have provided empirical evidence for this intuition. Fall-induced traumatic brain injuries (TBIs) in the elderly can result in more severe injuries, longer stay of intensive care unit, and higher mortality rate, compared to hip fractures, and its age-sex-adjusted incidence rate is continuously increasing. However, risk factors influencing the occurrence of TBI in the elderly remain to be explored. Moreover, it is important to track longitudinal outcomes of survival status, health-related quality of life, relocation, activities of daily living (ADLs), cognitive function, and depressive symptoms among elderly persons after a TBI for understanding their healthcare needs as well as for tracking their improvement or deterioration after medical treatment. The World Health Organization has developed a quality of life instrument specifically for persons with TBI (i.e., Quality of Life after Brain Injury, QOLIBRI); however, the suitability of this instrument for elderly people after TBI remained to be validated. This 3-year project is proposed to address the above issues. In the first year, a case-crossover study will be conducted to examine the relations between home environmental hazards and other transient exposures and falls in elderly people. We plan to recruit 301 elderly subjects with newly occurring a fall from emergency rooms in five hospitals (including Taipei Medical University Hospital, Wan-Fang Hospital, Shuang-Ho Hospital, and Mackay Memorial Hospital at Taipei and its branch at Hsinchu). In the second year, both a case-crossover study and a case-control study will be conducted to determine potential risk factors for occurrence of TBI during a fall in elderly people. We will recruit 205 elderly subjects with newly diagnosed fall-induced TBIs and 410 control subjects who sustain non-TBI injuries due to a fall from the emergency rooms of the five study hospitals. In the third year, among 205 subjects with TBIs and 205 subjects with non-TBIs, their longitudinal outcomes such as survival status, changes in health-related quality of life, returning to home, ADL independence, cognitive impairment, and depression will be tracked at 12 months after the fall; influential factors for each of these longitudinal outcomes will also be identified. Furthermore, psychometric performances of the QOLIBRI in 300 elderly people with TBIs will be examined.