Traumatic injury and dementia in New Zealand : a Palmerston North Hospital case-control study : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Health Science in Psychology at Massey University, Palmerston North, New Zealand
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Date
2015
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Massey University
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Abstract
Little is known about the relationship between traumatic injury (TI) and dementia. The
increasing prevalence of both conditions in the world and in New Zealand (NZ) drove
the Author to want to investigate whether the pathophysiological consequences of major
trauma of any kind - mostly due to falls in the dementia population - and not just
traumatic brain injury (TBI), may result in dementia.
Both TI and dementia constitute major health and socio-economic problems
contributing to long-term disability worldwide and have important implications for
health service delivery and for medico-legal compensation issues. The first specific
objective was to determine whether dementia was associated with an increased risk and
incidence of trauma in the past and whether such an association might be explained by
the injuries or by medical comorbidities. The second specific objective was to identify
whether there were any differences in the mechanisms of injury and type of discharge
from hospital between cases and controls. The research was a non-experimental,
retrospective, hospital-based, case-control study. Cases and controls were selected from
the Palmerston North Hospital (PNH) acute admissions database and were matched in
terms of exposure to traumatic injury, sex, age, ethnicity, and recorded comordibites.
Statistical and epidemiological analyses were done using RaosoftR and MedCalcR
softwares.
All medical conditions were operationally defined using the current World Health
Organization’s International Classification of Diseases (ICD-10). The results showed
that a history of TI was more frequently found in cases with dementia than in the
controls. Patients with dementia and TI were more likely to have preexisting
comorbidities and were more unlikely to be discharged to their previous habitual
residence. The findings strongly indicate that the brain is affected by the way the body
responds to TI both locally and systemically. The conclusion was that the direct and
indirect consequences of TI, mostly due to falls, could constitute a plausible risk factor
for the development or progression of dementia but that further research is needed to
assess what type of trauma and what type of dementia could be involved in the
association, one that is likely to be multifactorial in the elderly population.
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Keywords
Dementia patients, Accidents, Accident victims, Mental health, New Zealand, Research Subject Categories::MEDICINE::Social medicine::Public health medicine research areas