Abstract
The demographic transition towards an aging population stems from a drop in birthrates, a reduced mortality rate, and the general aging of the world population. This phenomenon requires changes in disease profiling and healthcare policies and services. Developing countries are characterized by an epidemiological transition in tandem with communicable diseases, the growing role of chronic disease, the reappearance of diseases (such as cholera), or illnesses that were once controlled (malaria, tuberculosis, and dengue), the appearance of new diseases (AIDS), and the escalating problem of trauma caused by violence or accidents. More developed countries face pathologies that are endemic to their societies, including degenerative cardiovascular illness and mental health issues, originating in part from lifestyle and environmental factors.
The aging of the global population generates a series of pathologies associated with age that were not seen years ago. Thus, it is imperative to act on illness related to aging, differentiating the primary processes of growing old from secondary factors, and indentifying elements of risk and protection at environmental, cultural, economic and personal levels. Diagnoses must take into account personal clinical history, genetics, family and social relations, drug use, lifestyle and behavior, in order to develop strategies and treatment that can slow down the aging process and generate a better quality of life for older people.
TBI is responsible for more than 80,000 emergency department visits each year, approximately three-quarters of which result in hospitalization. The age-adjusted rate of hospitalization for nonfatal TBI in the general population is 60.6 per 100,000 population; for adults aged 65 and older, this rate more than doubles—to 155.9. The incidence rate for all subtypes of stroke increases with age until the age of 85. The overall prevalence of stroke is 8.2% in males and 5.1% in females. In the very elderly, this increases to 10.7% in males and 10% in females and decreases only in males aged 90 years or over.Rehabilitation of behavioral and cognitive deficits in pathologies associated with aging is always possible, even in very old patients, using the adequate treatment program.
The rehabilitation of cognitive deficits in elderly patients with TBI and stroke is advisable using a holistic, intensive and multidisciplinary program. However, the course of cognitive recovery after acquired brain injury is not uniform and depends on which cognitive functions are impaired and the severity of this impairment. Research has demonstrated that a certain degree of spontaneous recovery occurs during the first few weeks, and even months, after TBI. In a previous study, we found that neurocognitive deficits consequential to TBI appeared to be established within the first 8 months post-trauma. Successful treatment of these deficits varies in terms of time and effort. The number of sessions needed to rehabilitate impaired cognitive functions differs depending on the function. For example, our results show that the restoring of“planning” and “memory” require the highest number of rehabilitation sessions to achieve near normalcy. As cognitive functions are interrelated, their rehabilitation must be structured to maximize outcome. While the consolidation of cognitive gain requires time, proper training, and well-programmed therapy, older patients with TBI and stroke do benefit from this rehabilitation, with significant functional gain and a high rate of return to home and community.
