Brain Injury Awareness: The Consequences of TBI - Part 2
- 7 Minutes 52 Seconds Reading Time -
I’d like to open the door for a conversation about the hidden costs of a brain injury.
Even if you don’t think this topic affects you or a loved one right now, I urge you to read on, as one thing became painfully clear to me in recent years; brain injuries do not discriminate. They can happen to anyone, anywhere, and at any time.
The true costs of TBI extend well beyond the dollars spent in the medical system each year. Lives are taken too soon. Jobs are lost. Families are torn apart. Futures are destroyed.
This week, let’s uncover the hidden costs of TBI and how it affects families, employers, and employees.
TBI by the Numbers
When talking dollars, the annual cost of all head injuries world-wide is roughly USD 200 million.
Please note two things: this is an annual cost which only seems to be rising with each passing year, and it only includes costs incurred by those who sought medical attention.
Many people who experience a mild TBI, especially a concussion, don’t even enter the medical system. That is to say, they don’t enter the medical system until years later when new or seemingly unrelated symptoms appear. In many such cases, people don’t link these symptoms to the concussion or brain injury they sustained years prior.
But for those who do enter the medical system with a TBI, costs vary considerably but are quite high.
In the US, in-hospital costs (per person) for those with a severe TBI range from $2,130 to $401,808. The vast difference in cost depends on several factors including the length of their hospital stay, any surgical interventions required, and the severity of the injury.
What has not been reported, however, are long-term costs of future required treatments, economic effects on individuals who cannot return to work (either full- or part-time), and economic effects on loved ones/caregivers.
What’s more, and less often considered, is how a TBI affects the lives of those around you - especially family members. Take it from me, the wife of a TBI survivor, when I say that the day my husband was injured, was the day my life changed forever. [quote]
These are the real hidden costs of TBI.
Hidden costs of TBI: Life-Altering Effects at Home
Let’s explore the hidden costs of TBI in greater detail, starting with the life-altering effects or symptoms that sufferers often have to deal with. For some people, the effects can last days or weeks, yet for others, they will last a lifetime.
Anxiety and/or panic attacks
Emotional changes
Personality changes
Digestive changes/upsets
A loss of identity
Some of these effects include:
Neuro-fatigue
Chronic pain
Difficulty understanding
Reduced processing speed
Poor memory
Be sure to consult last week’s post for a more comprehensive list.
Behavioural and personality changes that can accompany a TBI lead to additional hidden costs.
These costs are not monetary, but personal and life-altering all the same. These are the effects that we often sweep under the rug and don’t want to talk about; high divorce rates and the breakdown of families.
Hidden costs of TBI: Effects on Family Members
There is no doubt that a TBI significantly changes a couple’s relationship, especially if the injury is moderate, severe, or complicated. In these cases, different aspects of the lives of both survivor and partner must change.
The following changes typically affect family relationships after TBI:
Relationship roles
Responsibilities
Communication
The survivor often experiences new challenges, fears, limitations, and personality traits. Any, or all, of these can affect how the survivor behaves and feels about their relationships at home. They must also learn to deal with and accept the new role they play within the family.
These same changes also lead many spouses to feel as though they are “married to a stranger.” Partners may also have to change the focus of their lives in an effort to manage new responsibilities and the multitude of challenges that arise for their family post-injury. Spouses may also feel overwhelmed by the uncertainty of recovery and the additional responsibilities that they must now bear.
Did you know…
If the brain injury happened to affect the pre-frontal cortex of the brain (which often happens with any type of impact injury), someone’s executive function will be altered. They may become impulsive, unorganized, or forgetful. They may be unable to multi-task or handle more than 1-step instructions at a time. They may engage in risky behaviours, say inappropriate things, or do things that would otherwise be out of character for that person.
If the injury affected the temporal lobes of the brain (the area by the temples which are commonly damaged by a side impact) then more severe outbursts may result. If the temporal lobes are damaged, the injured will likely be prone to violent outbursts or fits of rage. These outbursts may be verbal or physical, but definitely scary for everyone involved.
In either case, damage to any part of the brain, in addition to making simple daily tasks challenging, can make it difficult to maintain positive relationships at home, work, or school.
The result is often a spouse who does not understand what is going on, doesn’t want to deal with added responsibilities, or becomes afraid of their loved one if they experience outbursts of anger, emotional outbursts, or changes in personality.
Stemming from all these changes and new challenges, it’s not uncommon for both parties to feel that neither partner knows what to expect from the other. Such uncertainty increases levels of stress and anxiety within the home.
The more serious the brain injury, the greater the likelihood of divorce. Statistics vary in this area but most suggest divorce rates following a TBI range anywhere from 50% to a staggering 85%. [quote]
Hidden costs of TBI: Dementia Risk
Another area of great concern is the very real link between TBI and one’s future risk of dementia.
A key study found that those with a history of moderate TBI increased their risk for developing Alzheimer’s by 2.3 times over those with no history of head injury. The same study also reported that anyone who sustained a severe TBI instantly increased their risk by 4.5 times!
Though there has been no clear evidence showing that sustaining a single mild TBI increases one's risk for dementia, emerging evidence suggests that multiple mild TBIs or concussions (as those that typically occur on the sports field, hockey rink, or in a boxing ring), is linked to an increased risk of developing a form of dementia called Chronic Traumatic Encephalopathy (CTE).
What will these costs become on society (and families) in the future?
Prevalence of Brain Injury in North America [H3]
Currently, in Canada, brain injuries impact about 1.5 million people.
In the US, approximately 5.3 million people are living with a brain injury-related disability.
Globally, 69 million people suffer from a TBI (from all causes) each year
Each year, an additional 160,000 Canadians will acquire a brain injury.
In the US, there are over 2.8 million brain injuries diagnosed each year.
On average, 70-80% of brain injuries are considered “mild.”
Falls (from a ladder, downstairs, or in the bath) account for over 45% of brain injuries, especially among the elderly and in children.
Motor vehicle accidents account for roughly 14% of brain injuries.
What is not taken into consideration with these statistics is the countless number of family members and caregivers involved.
Some TBI survivors can require long-term or even permanent care. Persistent post-injury symptoms and functional impairment affect almost 15% of TBI patients. This makes it challenging, if not impossible, for some caregivers to return to their normal work duties. When combined with the accompanying personal costs, the hidden costs of TBIs today extend well beyond the reported statistics.
As I've mentioned, a brain injury can happen to anyone at any time. However, statistics indicate that most TBIs occur among people aged 15 to 45. This is a huge age range and encompasses a large portion of the population. Moreover, this sector of the population happens to contain the most productive members of our society.
When TBI strikes, it can cause substantial morbidity, disability, and mortality. The associated health care costs for both the individual and society are high.
The individual and his familial caregiver(s) will likely lose several productive days of their lives. When added to ongoing treatment costs, this can be enough to push some households into poverty - especially if they do not have ample medical insurance or if they were at or below the poverty line before the injury.
When this happens, it has a great impact on the growth and economic development of a nation. The injured and their family may no longer be able to contribute to society as they once did.
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The impact of TBI on the workforce
Every year, thousands of people with a traumatic brain injury enter the workforce. They may be former athletes, veterans, or people returning to work after sustaining a blow to the head.You don’t have to be a former NFL player to fall into one of these categories, as many people used to play sports in school. A recent study found that about one-third of former athletes still suffer long-lasting symptoms from a TBI sustained long ago.
Another sector of the population worth mentioning here is veterans. It’s estimated that about 20% of those returning home from Iraq and Afghanistan suffered a head injury while on deployment. Actual numbers are likely much higher, however, due to injuries that have gone undetected or undiagnosed. As more veterans return home, they, too, will likely be entering the workforce.
Additionally, many other people entering the workforce could be suffering from an undiagnosed or undetected TBI. This is especially true if they sustained a mild head injury or concussion, as many people, in this case, are less likely to seek medical attention.
Many people who have sustained a TBI end up leaving their jobs, especially those who have achieved higher levels of education. In the aftermath of a concussion, a person’s ability to prioritize jobs and multi-task is often impaired. They may no longer be able to perform their duties at work to the same extent that they once did, or they may need accommodations in the workplace to properly do so. They may also lack insight into their performance at work and not even realize that they are struggling.
TBI patients often do best performing simple tasks that have to be completed one at a time. This may be one of the main reasons why people without a degree or who have limited post-secondary education are better able to keep their jobs than those who have attained higher education.
Studies have also found that people who have had a concussion have a much higher risk of losing their job or being out of a job within five years after the trauma.
Long-term symptoms like fatigue, memory lapses, and difficulty concentrating are often to blame. If proper screening and rehabilitation efforts are not sought after, even following a mild or moderate injury, then, even years later, a TBI victim may be faced with employment issues.
Conclusion
Those recovering from a TBI, including a concussion, often do best when they return to work slowly. They should be aware of their cognitive and emotional limitations and not push the boundaries beyond their mental capacity, as it may delay progress.
TBIs are often treated as physical injuries, yet they can present lifelong mental health consequences. So even though TBIs impact a relatively small portion of the workforce, it’s worth reminding employees to take serious care of the health of their brains.
We should all do well to remember this, as well.
As always, I welcome your thoughts and value your feedback. Let me know what you think by dropping me a line or commenting below.
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