A Very Geri Problem: Traumatic Brain Injury in Aging

Speaker0:
[0:16] I'm Emily.

Speaker1:
[0:16] And this is Eva.

Speaker0:
[0:18] And you're listening to Speech Talk.

Speaker1:
[0:20] Where you're a research book club so you can do evidence-based practice in practice.

Speaker0:
[0:24] Okay, Eva, tell me, what are your fun things for this week? What happened? What's the lowdown?

Speaker1:
[0:31] Well, I'm actually transitioning roles. So I am getting up to speed for acute rehab now and just kind of fangirling about it, I'll be honest.

Speaker0:
[0:44] I'm fangirling for you. Thank you.

Speaker1:
[0:48] I just went through and I discharged everybody. I said, good luck. And people said, wait, you're leaving. And I was like, yep. That's what giving two weeks notice means.

Speaker1:
[1:01] So I'm just like excitedly waiting for our next adventures. How about you, Ems? What happened?

Speaker0:
[1:06] Pause. We're so excited for you, Eva. I'm so excited for you, Eva. That is so exciting. Um our podcast normally like wraps around like how we are in sniffs but i'm excited to start hearing some of your acute care take on this medical side of

Speaker0:
[1:26] things because you're still working some sniff worlds too right yeah.

Speaker1:
[1:32] I'm stuck on the prn list

Speaker0:
[1:34] Oh it'll be good it'll be for our listeners to kind of see both of it, especially because sniff to acute care is a pretty typical trajectory for a lot of our SLPs. It's hard to just get right in there.

Speaker1:
[1:51] So we can work on talking about that, that handoff.

Speaker0:
[1:55] But my fun thing this week is my daughter got us sick. And you can hear it in my voice. I sound like poop.

Speaker1:
[2:06] The naughty words were used with kids.

Speaker0:
[2:09] Please excuse my voice. I know it sounds terrible and if I'm sniffling, I do solely apologize. I hate it, too.

Speaker1:
[2:19] I think you sound lovely. All right. What are we talking about this week, Emily?

Speaker0:
[2:23] TBIs with our Very Jerry's. So.

Speaker1:
[2:28] I want it on a shirt so bad. Very Jerry's.

Speaker0:
[2:30] I know. It's the new tagline. Because, I mean, I don't know about you, but I've been seeing more and more TBIs lately.

Speaker1:
[2:39] Yeah, dude, they've been piling up.

Speaker0:
[2:41] And I just kind of felt like a loss. Like, how am I supposed to address a TBI? What am I supposed to do? Most of my TBI experience came from... You know, just talking about it in class and it was really about, you know, more of the aphasia side or the problem solving when it comes to going to work or something like that. And that's just not what we're addressing in our setting.

Speaker1:
[3:10] Yeah. And I think for being in the SNF, so much of what we do is educating people on going home safely, giving information on, you know, prognostic outcomes, on what do we think are safety concerns for people in the community. And so I think you chose a great article this week on as it relates to how is this happening why are geriatric folks falling so much it's really important because old people be falling you know they're like out here all the time on the ground occasionally with motor vehicle accidents I recently had a car accident patient and there was no concussion diagnosis on her paperwork so So we just got to figure out that she had a crazy TBI. I was talking to my DOR.

Speaker1:
[4:03] Someone was like, oh, yeah, she was in a crash. She's having some memory problems. Go talk to her. Great. Love my vague directions. Go in there. She's like, yeah, light really hurts my eyes and sort of sound. I think I'm having trouble remembering things last night. Like I woke up vomiting. It was so scary. And I went and I talked to my DOR and I reported her symptoms. She's like, oh, my God. So she has a concussion. I was like, oh, yeah, that's totally the conclusion I came to as well, because I super know concussion symptoms off the top of my head, because I know TBI is back and forth.

Speaker1:
[4:42] So I'm really glad we're talking about this today.

Speaker0:
[4:46] No, that's so funny. Like, I wouldn't I wouldn't have put those dots together either. Sometimes when people are talking to me about stuff, I'm like, I don't know. You got to you want me to get the nurse.

Speaker1:
[4:56] Slow down. Talk to me like I'm dumb. I love it. Okay, so what is our article this week?

Speaker0:
[5:02] It is called Traumatic Brain Injury in Older Adults, Epidemiology, Eteology, Rehabilitation, and Outcomes by Erin Mattingly and Carol R. Roth.

Speaker1:
[5:13] And I just wanted to say, when they were talking about how they gathered research, some of the sources they cited were called neurotrauma investigators and i just want to hear that with like the csi sound like it's like this week from neurotrauma investigators dun dun an old lady fell and hit her head what happens next so what is a tbi let's start at the basics a

Speaker0:
[5:39] Tbi aka a traumatic brain injury so it's an injury to the brain from an outside source So like hitting your head on something, something hitting your head, or something goes through your head.

Speaker1:
[5:52] The least fun one is something going through your head.

Speaker0:
[5:56] I once saw someone who had a cyst removed from their brain. And then after that, they were presenting with TBI-like symptoms. So it's really like any kind of injury to your head that's not... It's true. Caused by something going on in your body, but something is acting upon your brain in some way. Yeah.

Speaker1:
[6:23] And I just want to throw in some other terms here that are frequently related to TBI because I've had patients who do not have traumatic brain injury on their diagnoses, but they'll have all these words that are essentially associated with TBI. Some of these fun terms include sub- and epidural hematoma, intracranial hemorrhage, midline shift, mid-surface shift, contusion, coup-contra-coup, concussion, and cerebral edema. So anytime you're seeing some of those on your patient's chart, Just, you know, a little light bulb in your head and think, oh, there may be some TBI-like symptoms here because these are instances in which something is acting on the brain, like a hematoma where blood is like— There's a bruise. Yeah. Well, yes. There's a bruise, like a contusion or a coup-contract coup, but like a hematoma is where there's swelling that is now putting pressure on

Speaker1:
[7:20] the brain, which acts like a TBI. Let's get into the epidemiology of what they reviewed here.

Speaker0:
[7:26] They showed that older adults have the highest rate of hospitalization, mortality, and morbidity from TBI.

Speaker1:
[7:34] Just how much? That's how much you ask.

Speaker0:
[7:35] Oh, cute.

Speaker1:
[7:38] Twinsies. Yeah, for patients 65 and older, there were more than 80,000 ER trips every year, with the majority of those leading to hospitalization. So, like the least fun Uber ride.

Speaker0:
[7:53] Or a sheriff's office, if that's your flavor.

Speaker1:
[7:58] If you wanted to know more about what over 80,000 trips to the ER looks like, that's more than 1 in 200 Americans aged 65 to 74 having a TBI. And the odds of getting one only get worse as you get older.

Speaker0:
[8:12] Not to put a price tag on everything, but there are some pretty shocking numbers we want to share with you. In 2003, the total national medical charges for patients with TBI as their primary diagnosis, only those who are, you know, over 65, was 2.2 billion. In our aging population, it's hypothesized to double from 35 to 70 million. So, you know, do the math because I'm not.

Speaker1:
[8:40] It's a lot. It's expensive. It's a lot. and remember the falls don't stop and the falls don't stop when they walk in um to the hospital when they walk into the hospital or they're transferred to a sniff because we have like disorientation from the tbi it could be cognition or a pre-existing condition there's like tubes and lines and wires and cords and chairs and tables and everything else to fall over um so yeah you guys quick reminder leave the bed on low when you're leaving the room you know when they're a fall risk yeah

Speaker0:
[9:14] And then you go to the room and they're like trying to like pick their body up from that lowest.

Speaker1:
[9:19] Setting yeah they're like trying

Speaker0:
[9:21] To do a full stand.

Speaker1:
[9:23] Yeah i mean that's not how i get out of bed it's really tough i hear you guys uh mike maybe helps keep you limber i don't know so what are what are causing all of these tbis well we've definitely covered falls the next most common is a motor vehicle crash and attempted suicide and chronic health conditions And quickly on the motor vehicle crash, we actually had a TBI patient who, spoiler for later in this episode, sexual disinhibition is a part of it. And he looked at her, he looked at my DOR and said, oh my God, did you lose your butt in a motor vehicle crash? And it was just so specific. And he said the whole phrase, motor vehicle crash. So it was just like an interesting combination of things because while I don't think his TBI was from a motor vehicle crash, he did have sexual disintimition and it certainly came out. So yeah.

Speaker0:
[10:28] But now I'm curious about what your DOR's butt looks like.

Speaker1:
[10:31] I don't really feel like I can comment appropriately. Well, leave it to y'all's imagination. So yeah, falls are the most common. Falls are responsible for 82% of TBI hospitalizations. They can also just like happen at home.

Speaker0:
[10:50] The authors found that the most common indoor activities being performed when a fall occurred were walking on stairs and housekeeping.

Speaker1:
[10:58] Classic. That's why I don't walk on stairs or do chores.

Speaker0:
[11:01] Right. it's like if that's one of the first things that we're asking people whenever we're thinking about discharging is do you have stairs at home and who is doing your cleaning what is like a cleaning routine look like for you yeah so it's always the best when they're like oh i live in a ranch style house and my son comes over and cleans the house like exactly you lucky woman if in.

Speaker1:
[11:24] The honor of legally blonde you can't do a bend and snap you can't be doing your laundry it's just You can't go from the washer to the dryer safely.

Speaker0:
[11:33] I'm just trying to think of like or picture any of my 80 plus year old people with a walker doing a bend and snap.

Speaker1:
[11:42] I hope to be doing a bend and snap in my 80s. Yoga, baby. It's going to get me there.

Speaker0:
[11:48] Yeah. Yoga and Qigong.

Speaker1:
[11:49] And Qigong. That's right. The most common outdoor activities before a fall were walking and cycling. Now, walking is probably a really high rate because it's one of our most common activities besides sitting. So, yeah. You had to get outside somehow. You had to get outside somehow. But this is, I think, a really important moment for hashtag collaboration. PTs and OTs, we want to make sure that we are assessing the functionality of performing these tasks. Like, talk to your PT. Do we think that they can safely walk? Do we think they can safely do stairs? OTs, are we checking their ability to move in a safe, balanced way when making a cup of tea, which I love to have people do. It's a great, it's a great memory and sequencing task in our little rehab kitchen.

Speaker0:
[12:40] Yeah. And I, sometimes like I'm not comfortable leading people through the problem solving of going for a walk or using a walker, but there are resources on Teachers Pay Teachers that have quizzes, basically, that are all set up. And I'll link it on our website that has multiple choice questions for walking with a walker, being in the community. So it goes through those safety and fall risk things without having to take your homie to Walmart.

Speaker1:
[13:19] That's right. That's right. Right. And some quick sad facts related to those other ideologies. Motor vehicle crashes are a serious contributor. So help your patients explore other options from driving, like walking if they can tolerate it, getting a ride, maybe having groceries delivered. Obviously, we want people to be as independent and active and participatory in their IADLs, but if it's genuinely unsafe for them to be walking longer distances or driving, maybe we do a, I don't know, like an Instacart or... Delivery for groceries once a week. So quickly back to our side facts. The other issue is suicide. So older adults are most likely to try to commit suicide compared to other ages, and it's most likely to be done via a firearm or jumping. So while it's unlikely that you'll have a suicide attempt TBI, just, you know, be aware that they can happen and be aware of what the counseling resources are at your facility.

Speaker0:
[14:25] I've had people say, I just want to die. Like, I don't want to be here. I'd rather die. Always taking those things very seriously, reporting to your nurse and to your social worker so they can go through the necessary precautions because it's not anything to joke around with.

Speaker1:
[14:41] Yeah. To that point, I had a family member who had a really bad TBI and luckily they've recovered significantly. But we were having a conversation about their progress that they've made. And they said, you know, it's gotten to a point where my symptoms have gotten so much better that I feel like I can keep living. And it was such a shocking statement because I didn't realize that they were considering the alternative, you know, and that was just a moment where you went, oh, right, this was a huge change for you. It was really hard. And we have to be aware that our patients can be going through that.

Speaker0:
[15:19] So then we talk about chronic health. So dementia, Parkinson's, depression, hypertension, cardiac arrhythmias, fluid and electrolyte imbalances, all of these pre-existing conditions or comorbidities result in longer rehabilitation studies.

Speaker1:
[15:36] Yeah, and I say this with love, but hospitals and SNFs, they are bad for you, babe, if you don't need to be there. Like, you don't want hospital-acquired pneumonia. You don't want people who have disorientation and confusion trying to wander into other people's rooms or getting tripped up on their hospital table that they're not used to having by their bedside. They're great while you need them and getting the care you need, but also some people need to go home.

Speaker0:
[16:04] Oh, clap it out.

Speaker1:
[16:08] Like folks who need one-to-one caretakers. They got to get out back to where their one-to-one care is available. And I think overall, I'm going to throw my two cents in here, people with motor degenerative conditions, especially when it's paired with a communication deficit are at such high risk for a fall in facility they have trouble getting their needs known so they try to do things on their own or independently and then a falling in the process it's it's a bad cycle and and it's

Speaker0:
[16:41] Always like oh i used to be able to do that like yes degeneration it goes away.

Speaker1:
[16:48] Yeah a hundred percent And Emily and I will talk about it till the cows come home. But those mild cognitive impairments really start to show. So you've got a TBI and a pre-existing mild cognitive impairment, and you think you can do everything, and you can't. From what I've seen at work, again, research opportunity here, I think you're way more likely to fall. That's just been my experience.

Speaker0:
[17:15] So go home. Call you out.

Speaker1:
[17:17] Call you out. Go home. Get well there.

Speaker0:
[17:20] The research then really goes into kind of what a TBI looks like in our aging population. But I also kind of wanted to look at this from what is a TBI anyways how does a TBI typically relate to those things so I made it into a chart and I'll probably redo this chart so that you guys can print it out and keep it handy just so that you can look back and say okay this is a TBI this is kind of what I'm looking for versus what's normal with someone who just is aging they broke it down into different sections starting with processing speed. So, this is all according to ASHA's practice portal. I'm sure you guys have all been there. If you're a speech therapist, we live in that area. So the article breaks everything down into areas of interest. So we're going to examine those areas with what's healthy or typical in the aging population versus what's typically impaired for a TBI and what we can kind of look for.

Speaker1:
[18:30] So Emily did this incredible thing and she broke out what a healthy or typical aging process looks like in different areas of interest. And then she juxtaposed that against what happens for TBI. So Emily is going to be doing the role of healthy typical and I'm going to be doing the role of TBI.

Speaker0:
[18:49] So typically our processing speed in our healthy aging population will become slower with time.

Speaker1:
[18:55] And for our TBI folks, we are going to have reduced processing speed and resulting confusion. Also, there's going to be increased response latencies.

Speaker0:
[19:05] Then for attention... Our divided, alternating, and selective attention will decline with age.

Speaker1:
[19:13] And for TBIs, they're going to have a lot of impairments in selective attention, sustained attention, and reduced attention span. All right, next up is memory. What does that look like for healthy folks?

Speaker0:
[19:25] Encoding and working recall should be relatively intact.

Speaker1:
[19:29] For our TBI folks, we're going to see deficits in short-term memory, working memory, deficits in remembering to perform planned action. So that's perspective memory. It's kind of a tricky one, remembering to do something in a head. And difficulty retrieving information from memory. And then there's a fun one of post-traumatic amnesia. So that's marked by impaired memory of events that happened shortly before the injury.

Speaker0:
[19:55] Then we go to language. So typically response inhibition declines. So they're not guarding their words as much. And for our folks up until about age 70, their pragmatics stays relatively intact as well as their verbal fluency.

Speaker1:
[20:15] And let's see what that looks like for our TBI people. Their pragmatics and social communication, they're getting real rambly. They are having trouble with maintaining topics. They are having trouble with turn-taking. Pretty much all of the boxes you can check on NetHealth for pragmatics, they're starting to have difficulty with.

Speaker1:
[20:34] Tangential stuff, reading facial expressions, impertability for nonverbal communication, like the works. For spoken language, we're seeing some anomia, word retrieval deficits, difficulty in organized conversation, following directions, formulating flow and speech. Again, the impairments are piling up. And finally, they're also having difficulty with written language. They're having difficulty comprehending written text, particularly with like syntax and figurative language, and difficulty planning, organizing, writing, and editing written products. And quick pause I just had a patient like this she had a subdural hematoma

Speaker1:
[21:15] They did a craniotomy. They took out a section of that skull, and it allowed the hematoma to have space, and then they drained it. And as she was recovering, she had really fluent speech, but there was word retrieval problems. She couldn't organize her sentences, and she could not remember anything written. And it was so surprising because I go in, and she appears to be reading Jane Austen. I was like wow she is doing so well and then I read her a sentence and from her book and I was like what does this mean and she had no idea like wow this book is largely a prop um but it was just one of those moments where you you think about who the patient is and she's presenting much more like her former self but there are these huge deficits that if you don't do something basic like ask someone to read what's on the page, you don't know.

Speaker0:
[22:15] And that's such a good like informal measure. So then we go into executive function. So for healthy, normal people or typical people, our familiar situations are going to be super easy. Anyone over the age of 70, new situations are starting to get pretty tricky.

Speaker1:
[22:35] Yeah. Asher Portal says, following a TBI, age-related declines in executive function are generally exacerbated and reflect atypical behaviors like impulsivity, poor judgment, and reasoning. So we're having some lack of insight. Reduce monitoring, and reduce awareness of deficits, that anosognosia.

Speaker0:
[22:57] Such a fun word.

Speaker1:
[22:59] Yeah, I said that the other day at work and someone was like, what in the world?

Speaker0:
[23:03] Our next section was neurobehavioral. We should see nothing in this area as far as deficits. Our population should be perfect.

Speaker1:
[23:14] But if you throw a TBI into the mix, you can have effective changes like over-emotional reactions, flat affect, agitation, combativeness, anxiety, depression, a lot of those emotional impairments like lability, drowsiness, generally getting disoriented or foggy, having increased states of sensory sensitivity. So making sure that people overall are having I'd say like typical reactions to the situations around them. If they are not, that is potentially an indicator of, or I should say, is potentially symptomatic of their TBI and shouldn't be attributed to who they are as a person.

Speaker0:
[24:00] If we think about vision, do our elder population have vision problems? Yeah.

Speaker1:
[24:08] As a glasses-wearing person who's getting older, I can tell you that I do not know what's happening around me in the morning without my glasses on.

Speaker0:
[24:18] Okay, Velma.

Speaker1:
[24:20] So anyways, older people, they're getting vision problems. But there are typical vision problems, right? Age-related ones are like, you know, cataracts or macular degeneration. Having deficits in a visual field, however, is not a typical sign of aging. Or photosensitivity, like you can't look at the light, things like that.

Speaker0:
[24:44] Again, not surprising. Hearing, it can decline with age. What?

Speaker1:
[24:52] Sorry, throwaway joke. Yeah, of course there are age-related declines in hearing loss and speech perception, things like that. But we can increase risk of accidents that can result in TBI. So...

Speaker1:
[25:06] We're not saying that TBI is causing the hearing loss, but we do know that hearing loss can be related to falls and subsequently potentially related to a TBI.

Speaker0:
[25:14] And then they go into balance and dizziness and gait.

Speaker1:
[25:18] So that's our bend and snap issue.

Speaker0:
[25:20] Yeah. Yeah. We talked about this earlier. You know, as you get older, all of those comorbidities that involve degeneration of your motor neurons.

Speaker1:
[25:32] Your vestibular system. your

Speaker0:
[25:34] Vestibular system it's going to affect your balance your dizziness your gait.

Speaker1:
[25:39] Yeah so those are those do get affected when you get older and for our tbi folks dizziness and nausea particularly say for concussion is very common it's one of like the five key symptoms of concussion so making sure that if you have someone who's been concussed that they should be put on a fall risk Not just because they may have had a fall that caused the TBI, but they may now have increased dizziness or nausea that could perpetuate additional falls.

Speaker0:
[26:08] All of our TBIs that we're talking about today, they have chronic consequences, right? Compared to younger people, older adults with severe TBI are at an increased risk for post-traumatic neurological disorders, including stroke, epilepsy, and neurogenitive diseases. Depression has also been identified as an outcome in TBI in older adults.

Speaker1:
[26:31] Yeah. And I personally have never really had to do an immediate assessment, but I think, Emily, you said that the article lists some, and you had a friend who does TBI testing.

Speaker0:
[26:46] I do have a friend who works at a post-acute rehab where... The number one test that they like to use is the SCA TBI. I don't know if it's called a SCAT BI, but the ones in this article, I looked up all the ones they were talking about, and this was one of the cheapest ones that they had listed. The other tests they used were slums or the mocha, and the slums and the mocha are free. We talked about mocha having an app, but even as you mentioned earlier, Eva, having as much of the pragmatic language deficits as our TBI people have, including informal assessments in your assessment battery, like a reading and doing.

Speaker1:
[27:34] Just like knowing some of the signs and symptoms.

Speaker0:
[27:37] Yeah.

Speaker1:
[27:37] Asking questions like, have you been feeling, you know, having difficulty with anger or sadness? Do you feel like you're maybe getting more emotional than you typically do? So just being able to ask people, having a knowledge of the symptoms and being able to ask people, are you feeling any of these? And that was, for me, a really big question. So we looked a lot at the etiology of TBI through this article and what some of the contrasts are between healthy populations and TBI populations. But i don't know if you've had a lot of tbi folks who present with these symptoms but it can be hard man like really hard because these are some of the symptoms listen up denial apathy confusion rambling making stuff up aka confabulation emotional ups and downs memory impairments verbal or physical aggression sexual disinhibition and self-centeredness so when you're working with With a patient who has one or multiple of these, it can be really hard to proceed with therapy. Like, how do we actually get through a session when the person... Doesn't believe they have impairments, they are making things up. And so I looked at a quick reference guide from the University of Kansas for a few tips. Emily, you want to read some of the don'ts and I'll read some of the do's.

Speaker0:
[29:05] I love how we have this like yin yang thing all this episode. So don't. Don't expect insight into their limitations. Don't demand that large or simultaneous tasks be completed all at once. I hope you won't do those with anybody, but don't scold, accuse, or label. Don't accept false statements as truth. Don't call the person a liar. Don't overreact to emotional outbursts or try to analyze or humor them. Don't get angry, impatient, or expect memory of recent events. And don't take verbal attacks personally. And, This is the list. This is listed. Don't escalate to physical aggression. If you're escalated to physical aggression, we need to have more than one conversation.

Speaker1:
[30:02] Yeah, seriously. But I think on that point, it's check out the resource, you guys. But one of the things we're talking about is when somebody is getting physically aggressive with you, things don't don't do in response. Like don't stare them down. Don't like try and like get in their face. Don't try and like meet aggression with aggression. So now that we've heard the don'ts, which, as Emily pointed out, this should just be the list for being a clinician.

Speaker0:
[30:28] Or like a good person.

Speaker1:
[30:30] Or a good person. Um, emphasize the consequences of actions rather than their problems, a redirect towards progress made, break large tasks into simpler ones, praise accomplishments, reduce distractions like noise, TV, conversations, acknowledge their confusion and help them organize their thoughts, reflect back key phrases to show that you're understanding when they're talking about their feelings. Yeah. Correct misinformation calmly and provide accurate details. Remind them that confusion or memory loss is part of the injury. And stay calm, speak soothingly during emotional swings, and have a safe timeout plan for physical aggression. Been there. Don't leave room door closed. Anyways, I thought that was a really helpful series of tips.

Speaker0:
[31:22] It is nice to have, like, those reminders in general that, like, as we were talking about our three-nagers, earlier like sometimes when someone has an emotional swing that is just coming out of nowhere just like take a time out yourself because at the end of the day we're still people too and while we can say like don't take it personally if someone's swinging at you like you might have some feelings about it it's okay to say like i just need a break and just get out of there like yeah.

Speaker1:
[31:52] And i've if someone's taking swings or i've had people i know they say don't take verbal attacks personally, but I've been called a lot of really mean things at work. And you do sometimes have to step aside and be like, it's not about me. And that's hard. And so while none of these things are saying it's okay to be treated this way, knowing that this is part of what people are experiencing as a result of their TBI means that we need to have a plan for when they happen, not that they quote unquote should happen.

Speaker0:
[32:25] And then our treatment should be function focus. What are the specific deficit and how can we fix it? So if, You know, cognitive load is a problem. Writing down all the steps to complete something and doing them one at a time. Maybe setting yourself a timer and taking breaks. You know, if your problem is really managing spills or if we're talking about falls, you know, let's practice. Let's make a huge mess and clean it together. You know, how are we going to do this? How are we going to make sure that while this looks overwhelming, if we take this down into small little steps and we do our safe strategies, then, you know, we can do things on our own.

Speaker1:
[33:16] Yeah, and teaching folks to manage their environment. If they are just so overstimulated by light, sounds, excessive talking, or things that are distracting them, teaching them how to manage their environment. Like, oh, somebody came in and you're watching a show. Let's pause the show so that you can listen. And just really being there with them in those day-to-day interactions and showing them how to manage what is going on around them to the best of their ability. And, of course, fall education.

Speaker0:
[33:50] We love fall education.

Speaker1:
[33:52] If you haven't learned today that falls are real bad for people, we weren't doing a good job. That's on us. Sorry.

Speaker0:
[34:01] So this is, I mean, and you can, I mean, this is one of the best times to do a group. And I am not a group person. Like, my facility is like, oh, be productive. Do a group. I'm like, no.

Speaker1:
[34:12] Not a group person. I don't like people.

Speaker0:
[34:14] No, no. But this is like, okay, I have three people who are on for cognition. All of them are planning on going home. I'm going to put them with my TBI person. We're going to do a falls group together and just wham, bam, thank you, ma'am, that one. Because I can only do so much of the same spiel in a week.

Speaker1:
[34:35] Yeah. And if you're picking somebody up because they had a TBI and they're demonstrating cognitive deficits, but you, given the amount of time you have with them, don't think you're actually going to be able to target rehabilitating those deficits, you can always get in there and say, we're going to do a few sessions on education. One, fall risk. Two, managing your memory deficits. Three, self-disclosure. I'm a big fan of self-disclosure. Or, you know, three, how to get rest because people think they're relaxing, but then they're actually watching TV and listening to music and texting their friends. And for our TBI folks, that is not really resting, you know. So going in there and just making sure that you can educate them on the experience of TBI, what they can expect, how to prevent future falls, so on and so forth.

Speaker1:
[35:32] Those are very productive things to do with a limited number of treatment sessions.

Speaker0:
[35:37] And then after we finish with our limited number of treatment sessions, they're off out of those wonderful gubble doors.

Speaker1:
[35:47] They're out in the world, out in the wild.

Speaker0:
[35:49] So the research talked about the patients who were discharged, and they were discharged home, either with or without services. And some patients were discharged into inpatient hospital facilities, long-term care, or other hospital facilities. or some even died in the hospital.

Speaker1:
[36:09] Right. So what are some outcomes that they talked about?

Speaker0:
[36:12] Recent large-scale studies demonstrated more encouraging outcomes for older peoples. In a retrospective study.

Speaker1:
[36:20] The older peoples of older peoples,

Speaker0:
[36:22] Over 2,000 elderly patients over 65 years old had a survival rate of over 80% at a level 2 trauma center. That happened in Florida.

Speaker1:
[36:33] Wrapping it up, how are we going to apply this research?

Speaker0:
[36:35] We're just trying to understand our very Jerry's from a TBI perspective, that just because they're old and maybe have dementia, that their TBI symptoms are not the same as their other comorbidities. And we should try and treat the TBI and those symptoms and see if, you know, we can help them stop hitting their head and falling off the top. Yeah.

Speaker1:
[37:00] Applying research, we're just going to see if we can help people.

Speaker0:
[37:04] And if we can't, that's okay, too, because you tried your best, and you get a gold star.

Speaker1:
[37:08] Gold stars for everybody.

Speaker0:
[37:10] All right, folks, we'll pick this up next time. Until then, keep your research close and your sticky notes closer. You've been listening to Speech Talk.

Speaker1:
[37:21] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker0:
[37:27] If you like this episode and you want to give us some love, please rate us on your favorite podcasting app. Leave a review and tell the world. Because as podcasters, our love language is in positive affirmations.

Speaker1:
[37:38] If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, send us an email at hello at speech talk pod.com.

Speaker0:
[37:52] If you want even more speech talk content, check out our website at speech talk pod.com where you can find all of our resources we made for you copies of articles covered and Eva's blog, following these topics and more.

Speaker1:
[38:05] We're your hosts, Eva Johnson and Emily Brady.

Speaker0:
[38:08] Our editor and engineer is Andrew Sims.

Speaker1:
[38:10] Our music is by Omar Benzvi.

Speaker0:
[38:12] Our executive producers are Aaron Corney, Rob Goldman, and Shanti Brooke.

Speaker1:
[38:17] To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers.

Speaker0:
[38:29] Speech Talk is a proud member of the Human Content Podcast Network.

Speaker1:
[38:42] He will talk to it. Thank you.