Unpacking Traumatic Brain Injury in Aotearoa: Debunking Myths and Highlighting Realities
Traumatic brain injury (TBI) is a significant health concern in Aotearoa, impacting an estimated 110 individuals daily. Despite its prevalence, TBI is frequently misunderstood, underestimated, and often dismissed as a problem that doesn’t concern us directly. These injuries, caused by external forces like falls or impacts, can result in a spectrum of effects, from minor, transient symptoms to severe, lifelong disabilities. However, crucial gaps remain in our understanding of who is affected, where these injuries occur, and their root causes.
Recent research delving into TBI cases within the Waikato region between 2021 and 2022, and subsequently compared with a decade-old study, offers fresh insights. These newly published findings challenge long-held misconceptions about a health risk that is far from inevitable and certainly within our capacity to mitigate.
Myth Busting: The Truth About Traumatic Brain Injury
Let’s address some common assumptions surrounding TBI:
Myth #1: Most Traumatic Brain Injuries are Severe
While the consequences of TBI can be devastating for those affected, the reality, as highlighted by the study, is that the vast majority of cases – a staggering 93% – are mild in severity, often presenting as concussions. However, the sheer volume of these injuries paints a much larger picture than often acknowledged. The research indicates that for every 100,000 people, 852 experience a TBI, translating to at least 40,000 New Zealanders affected annually. This highlights that even “mild” injuries, when occurring at such a scale, constitute a substantial public health challenge.
Myth #2: It’s Primarily a Sports and Car Crash Problem
The popular image of TBI is often linked to high-impact scenarios like car accidents, sporting collisions, or instances of assault. While media attention on sports-related concussions has undeniably increased awareness of the issue and its ramifications, the more prevalent cause of TBI is far more mundane: falls.
Data gathered from both the current and previous studies consistently points to falls as the leading cause, responsible for nearly half of all TBI cases. This includes tripping hazards and falls from heights. Furthermore, a comparable proportion of these injuries occur within the home environment, underscoring the need for greater attention to domestic safety.
Myth #3: Only Young People Are Vulnerable
It’s a common perception that young children are the most at risk of TBI. Indeed, the data did show children aged 0–4 years as a demographic more likely to experience these injuries.
However, the most recent study revealed a concerning trend: the largest proportion of TBIs were sustained by adults aged 65 and over, with falls being the primary cause in 39% of these cases. This is particularly worrying given New Zealand’s demographic trajectory, with projections indicating that by 2029, the population aged 65 and over will approach one million.
Myth #4: Risk is Uniform Across All Demographics
The research also identified disparities in TBI rates, with higher incidences observed among males and Māori populations. For Māori, this elevated risk is likely attributable to persistent systemic disadvantages, including lower incomes, substandard housing, barriers to accessing education and healthcare, and the ongoing intergenerational impacts of colonisation.
Certain patterns observed in the data appear to be influenced by the period of the study, particularly the COVID-19 pandemic. During this time, an increase in TBIs was noted among females aged 15–64, often linked to assault. This rise correlates with the societal pressures of the pandemic, including job insecurity, mental health challenges, and strain on family and social life, aligning with broader evidence of increased violence against women during that period. Brain injuries stemming from intimate partner violence remain a critical area of concern in New Zealand.
Conversely, fewer injuries were recorded among children (aged 0–15) and individuals residing in rural areas. This reduction may not reflect a genuine decrease in risk but rather the impact of COVID-19 restrictions, difficulties in accessing healthcare services, and reports of some parents avoiding medical attention due to fears of infection.
Myth #5: Traumatic Brain Injuries are Unavoidable
While it might be tempting to view brain injuries as an unfortunate and unavoidable aspect of life, this perspective is inaccurate. A significant number of TBIs are, in fact, preventable.
The study’s findings suggest that more concerted efforts are needed, particularly within younger and older demographics, and among Māori communities. Fortunately, a variety of prevention initiatives are already in place.
Prevention Strategies: A Multi-faceted Approach
A range of existing programs and strategies are working to reduce the incidence of TBI:
- Government-funded Fall Prevention Programs: These initiatives aim to equip individuals with the knowledge and tools to minimise fall risks.
- ACC’s Community Strength and Balance Classes: Designed to enhance the strength, stability, and safety of older adults, thereby reducing their susceptibility to falls.
- Safekids Aotearoa: This organisation focuses on delivering home safety programmes and distributing free safety devices to prevent serious injuries, especially falls, in young children.
- Māori-led Fall Prevention Programmes: Programmes like Taurite Tū, a strength and balance wellness initiative, are developed by Māori for Māori aged 50 and over, and their whānau, incorporating culturally relevant approaches.
- Public Health Messaging: Campaigns such as ACC’s “Have a hmmm” encourage personal responsibility for safety and community well-being.
The private sector is also increasingly investing in TBI prevention, with a growing interest in innovative technologies. This includes the development of smart-home devices and wearable technology aimed at reducing the risk of falls and head injuries.
However, the effectiveness of these investments hinges on rigorous evaluation. It is crucial to ensure that these efforts are genuinely making a difference and are strategically directed towards those most in need. This will necessitate close collaboration with younger and older individuals, their families and carers, and Māori communities to co-design, implement, and assess prevention strategies.
The author acknowledges the significant contributions of study collaborators Nicola Starkey, Shanthi Ameratunga, Alice Theadom, Braden Te Ao, Laura Wilkinson-Meyers, Irene Zeng, and Valery Feigin. Kelly Jones receives funding from the Health Research Council of New Zealand and serves as Vice President of Brain Injury New Zealand.
