In youth, we run into difficulties. In old age, difficulties run into us.
The above quotation, by the renowned American soprano Beverly Sills, contains more than a grain of truth. In 1900, the North American life expectancy was 48. By 1930, it had risen to 61, and by 1950, to 71. Today, it sits at 78. Improvements in medicine and healthier lifestyles have greatly extended the average lifespan. Yet at the same time, those lucky enough to live into their 70s or 80s – the so-called “golden years” – may suddenly find themselves facing a whole new set of physical and intellectual challenges. Bones become more brittle, mobility decreases, joints and muscles begin to ache, and the memory is certainly not as sharp as it once was. These are all challenges that have to be faced – and very few go through life without facing some of them.
But what about those who suffer an acquired brain injury (ABI) earlier in life? As they advance in years, the normal effects of aging interact with the disabling conditions caused by their brain trauma. And there are a myriad of ABI survivors out there. The annual incidence of ABI is greater than that of Multiple Sclerosis, spinal cord injury, HIV/AIDS and breast cancer combined. Close to half-a-million Ontarians currently live with an ABI, with 18,000 new cases added every year, at an estimated cost of $1 billion. At this point, medical practitioners are not only witnessing a greying of the population, but also a greying of the ABI-survivor population.
Long-term Effects of an ABI
Results from ongoing research is far from conclusive, but researchers seem to feel that brain injures may accelerate the aging process. Those living with an ABI may suffer from increased losses in strength, greater fatigue, difficulties with problem solving and memory, and may also experience an increased loss of hearing and vision. In addition, any psychological and behavioural problems which follow an ABI will undoubtedly persist into older age and in some cases, may increase as an individual ages. Brain injury survivors also face a risk of increased social isolation. This is a risk for many seniors, but because ABI survivors are often dependent on family for help, if those caring for them develop health issues of their own or pass away, they leave the ABI survivor particularly vulnerable. Aging with a brain injury will affect every aspect of the person’s life and their ability to maintain any degree of independence.
In her article Aging and Brain Injury written for Clinical News, (the publication of the Rainbow Rehabilitation Center of Livonia, Michigan), systems director Heidi Reyst writes of the influence of both “nurture” and “nature”.
By nurture, she refers to the external factors that influence who we are, and by nature, our genetic makeup. Reyst points out that in the case of nurture there are many ways a brain can be injured, but the end result is almost always the same. A brain’s frontal lobes are particularly vulnerable to injury, and when they’re damaged, can affect such functions as impulse control, working memory, and the ability to plan or organize. These are all elements often affected by the natural aging process anyway, so a brain injury will only compound the challenges an ABI survivor is forced to deal with.
As well, any injuries brought about by an ABI can have a decided effect on a survivor’s judgment – for example, what he or she chooses to eat, whether he or she chooses to exercise, or whether he or she adheres to a doctor’s recommendations. Poor judgment may result in overall poor health, which in turn brings on premature aging.
Reytz explains that brain injury has long been regarded as a risk factor for other neuro-degenerative diseases, such as Alzheimer’s and dementia. Studies have shown that in examining patients with Alzheimer’s, doctors found that many of them had suffered some kind of brain trauma earlier in life. Yet this is by no means always the case, and suffering an ABI doesn’t necessarily mean there will be an occurrence of Alzheimer’s at some later point. If the ABI occurs at a young age, or if it’s of a less severe nature, the chance of developing a neuro-degenerative disease is diminished even further.
Social Problems Connected with ABIs and Aging
Many ABI survivors live adequately on their own, or in congregate living conditions. Yet what happens to those who suffer brain injuries in their 20s or 30s, and who were forced to return home to live with their parents or other family members? Over time, those looking after them may begin to develop health issues of their own, and are less readily able to deal with the requirements of an ABI survivor.
There was a case cited in the U.S. of an elderly man who for many years had been caring for his 51- year- old son. For a period, the son began to experience a decline in mental health and was forced to receive acute medical care for a number of months. While his condition eventually stabilized, the father rightfully worried who would assume the role of caregiver when he was no longer around. Then, there are cases where a husband or wife suffers a brain injury, leaving the other spouse to suddenly become the caregiver. It can work as long as the unaffected partner is healthy, but when he or she advances in age, and begins to experience health issues of their own, the ABI survivor is placed in a much more vulnerable position. It may come to the point that either home care or a move to a facility is the only solution. As is the case for all seniors, any degree of isolation is to be avoided at all costs.
Steps for Improving the Lives of Aging ABI Survivors
There is still much research to be carried out on the long-term impact of an ABI. By now most of us know what to expect by the time we achieve the “three score and ten” status, but because the most disabling effects of an ABI are cognitive, survivors and their families have come to regard the effects of aging with an injured brain with some degree of trepidation. At the same time, steps can be taken to guide the survivor through the so-called “golden years” and make this period in their lives as comfortable as possible. Dr Paul Aravich and Ms. Anne McDonnell, both from the department for aging and rehabilitative services of the Eastern Virginia Medical School, recommend the following steps that an ABI survivor might consider to ensure optimal health at this time in their lives:
- Engaging in moderate physical exercise
- Engaging in brain stimulation, and promoting mental health
- Avoiding tobacco, alcohol and other drugs of abuse
- Avoiding social isolation
- Reaching out to other individuals with ABIs for moral support
- Protecting the brain from further trauma
Aging is not easy for anyone, and for an ABI survivor, it presents even greater challenges. Yet with care, consideration and some degree of caution, an ABI’s senior years can be fulfilling and productive. Don’t look back on what might have been; instead, consider the present and look to the future. Yes, it’s a challenging journey indeed, but it’s one that can be undertaken by staying healthy and remaining optimistic.
Article written by Richard Haskell