Championing Healthy Aging: The Critical Role of Brain Injury Screening in Supporting Older Adults

To: Directors of Aging, Area Agencies on Aging, Aging and Disability Resource Centers, Americans with Disabilities Act National Network, and Directors of Brain Injury Programs

The purpose of this memorandum is to provide an overview on the intersection of brain injury, older Americans, falls, and dementia, highlight the importance of screening for brain injury, and introduce a comprehensive solution that aligns with the recent requirements set forth by the Administration for Community Living (ACL) under the Supporting Older Americans Act of 2020(P.L. 116-131).

Older Adults and Brain Injury

TBI is responsible for more than 80,000 older adult emergency department visits each year, andthree-quarters of these visits result in hospitalization as a result of the injury. Falls can causeserious injury and are the second leading cause of traumatic brain injury (TBI)–related deaths.While falls impact all ages, they are particularly prevalent among older adults. Research showsthat adults aged 75 and older have the highest rates of TBI-related hospitalization and death.Older age is known to negatively influence outcome after TBI.

Additionally, research has increasingly linked brain injury to a higher risk of cognitive differences and Alzheimer’s/dementia in older adults. Numerous key studies have demonstrated that seniors with a history of moderate brain injury have a 2.3 times greater risk and those with a history of severe brain injury have a 4.5 times greater risk of developing Alzheimer’s disease compared to those without a history of brain injury. It is evident that brain injury remains a serious public health concern for older Americans, leading to death and disability for thousands each year.

The Importance of Screening for Older Adults

History of brain injury is often hidden among individuals and may be conflated with cognitive challenges, other disabilities, or behavioral health challenges such as mental health and substance use. Screening and identification of a history of brain injury can ensure engagement from the start of the relationship to make the appropriate referrals, support simple accommodations, and provide psycho education for the individual-equipped to self-advocate.

Specific to older Americans, brain injury may often be confused for or overlap with poor nutrition, depression, memory loss, sleep disturbances, chronic pain, and Alzheimer’s and dementia, which health professionals may attribute to aging itself rather than brain injury. This can be problematic because some medicines prescribed for these symptoms could actually worsen challenges due to brain injury. Since we know that falls often lead to brain injury, screening and identification of a history of brain injury is important to ensure that older Americans get the supports they need related to the brain injury itself, rather than the other challenges outlined.

The Supporting Older Americans Act of 2020, which reauthorized the Older Americans Act, allows funding under the Older Americans Act to facilitate falls related brain injury screening, marking a crucial step towards improving the identification and management of brain injury in older adults. As part of their state plans, states are required to outline how they are moving toward falls related brain injury screening, as per the Guidance for Developing State Plans on Aging issued on August 5, 2021. The Administration for Community Living released a proposed Older Americans Act rule in June 2023 to bring conformity between the 2020 legislation and state plans, which again underscores the recognition around brain injury screening.

Introducing the Online Brain Injury Screening & Support System (OBISSS)

As states look to develop their state plans, including describing how they are moving toward fall related brain injury screening, Area Agencies on Aging should consider utilizing the National Association of State Head Injury Administrator’s (NASHIA) Online Brain Injury Screening &Support System (OBISSS). OBISSS is a comprehensive and validated subscription service that utilizes the standardized and validated OSU TBI-Identification Method and the Symptoms Questionnaire for Brain Injury (SQBI).

OBISSS allows individuals to self-administer the screening online, in partnership with a provider, making it easily accessible across various settings. The System is accessible and accommodating to individuals age 10 and up. Upon completion, the System collects demographic information, identifies a potential history of brain injury, and detects if challenges related to brain injury exist. Tip sheets addressing identified challenges are then provided to both the individual and their respective provider. Additionally, OBISSS offers customized referral information to connect participants with appropriate resources and supports.

Addressing the overlap between brain injury, older Americans, falls, and Alzheimer’s/dementia is crucial for promoting public health and enhancing the well-being of our aging population. By implementing the OBISSS, we can effectively screen for brain injuries, identify associated challenges, and provide appropriate support and resources to those in need, all while fulfilling the Older American Act 2020 changes and the regulations.

Click to learn more about our Online Brain Injury Screening and Support System.

Article from National Association of State Head Injury Administrators

Leading source of information on national trends and best practices for state employees, public brain injury programs, and agencies across the country. Visit them at: nashia.org