The number of emergency department visits and hospitalizations because of a bump, blow, or jolt to the head rises with age. And the rate at which older adults sustain a brain injury has steadily increased each year.
Traumatic brain injury-related hospitalizations for people age 65 and older went up by more than 50 percent between 2001 and 2010, according to the Centers for Disease Control and Prevention.
What it does to the brain
A jolt to the head can cause the brain to bang against the side, front, or back of the skull, damaging nerve cells called neurons, and resulting in a traumatic brain injury.
It can be mild, moderate, or severe, depending on whether the injury causes unconsciousness and, if so, for how long.
Most brain injuries among people 65 and older are mild. But the term mild traumatic brain injury can be misleading because it still can do significant harm. An estimated 15 percent of all people who sustain a mild traumatic brain injury suffer persistent, disabling problems that can interfere with their daily routines, relationships, and employment.
The danger to older adults
Older adults have a higher risk of sustaining brain damage than younger people do. And, while most people recover from a mild traumatic brain injury in a few days, recovery tends to be slower among older adults, who also have more difficulty regaining full function.
Older adults are also more likely to have coexisting chronic conditions, such as diabetes, high blood pressure, coronary artery disease, or frailty, all of which can inhibit their recovery.
Age makes people more susceptible to another serious complication of brain injury: a subdural hematoma. Subdural hematoma occurs when a blood vessel in the layers of tissue outside the brain itself but within the fibrous material that surrounds the brain bursts and starts bleeding.
If the blood vessel continues to bleed, a buildup of pressure between the skull and brain will eventually cause brain damage.
Traumatic brain injuries put adults at increased risk for certain health conditions, including disorders associated with aging, such as Alzheimer’s disease and Parkinson’s disease.
Some studies suggest an association between fall-related traumatic brain injuries and dementia, but other studies have found no link—although people who’ve had a traumatic brain injury are more prone to cognitive dysfunction in areas such as memory and attention. They also increase the risk of new onset seizures.
What to do about a bump on the head
If you’re over 65 and bump your head and suspect you may have a traumatic brain injury, or if you have an accident that involves even minor head impact, you should seek emergency medical care, especially if you lose consciousness or black out for even just a few seconds.
Two telltale signs that you may have suffered a concussion or other mild traumatic brain injury are feeling confused and not being able to remember what happened immediately before and after your injury—a condition called temporal amnesia.
If you take a blood thinner and hit your head, it’s crucial that you see a doctor even if you don’t have accompanying symptoms. A September 2012 review in Current Translational Geriatrics and Gerontology Reports reported that a person taking warfarin is almost three times as likely to suffer from an intracranial (within the brain tissue) hemorrhage after a minor head injury than someone not taking the anticoagulant (the same could happen from taking some of the newer anticoagulants).
It also reported that taking an antiplatelet drug like clopidogrel was associated with a three-times-higher death rate among patients older than 50 when compared with traumatic brain injury patients of the same age who weren’t taking these types of drugs.
Traumatic brain injuries—even mild ones—can cause short- or long-term problems with memory, reasoning, communicating, learning, emotions, and sensations like touch, taste and smell.
Medical attention can help keep damage at bay, but sometimes a person may not have immediate symptoms after a mild injury, especially if he or she doesn’t lose consciousness. It may take a day or two for symptoms, such as a headache or dizziness, to appear, if they appear at all.
Normal age-related changes in memory and cognitive function may also mask the signs of a mild brain injury. In fact, some people who’ve had a concussion may not even realize they’ve been injured—as many as 80 percent according to some surveys—and don’t seek a doctor’s advice.
Treating a traumatic brain injury
If a medical evaluation indicates you may have a brain injury, you’ll likely undergo a computed tomography (CT) scan to quickly screen your brain for bleeding or swelling. Your injury’s severity determines your treatment and ability to fully recover.
Other factors that affect recovery include:
• Your age
• Your overall health before the injury
• The area of your brain that was injured
• The length of time between when you were injured and when you first received proper medical attention
You should never be left alone for the first 24 hours after sustaining even a mild traumatic brain injury. Someone should check on you every few hours for developing symptoms, which could indicate that brain function is worsening. If no one is available to monitor you at home, you’ll likely be admitted to the hospital for observation.
If your injury is mild, you’ll need plenty of rest to help your brain heal. This includes avoiding activities that require intense concentration, such as balancing your checkbook, or that are physically demanding, such as heavy cleaning.
It’s important to protect yourself against another brain injury: People who’ve had a concussion are five times more likely to have a second one. Risk of brain swelling increases if the second concussion occurs before symptoms from the first go away.
Your doctor may recommend acetaminophen (Tylenol) to relieve pain. Don’t take aspirin or any other nonsteroidal antiinflammatory drug (NSAID), such as Advil or Motrin; they can provoke bleeding.
Most people who have sustained a mild traumatic brain injury recover fully within six months, but some experience certain long-term problems with memory and concentration.
About 40 percent of people who have a mild traumatic brain injury develop post concussion syndrome, even if they didn’t recognize that they had a concussion. Symptoms usually appear within seven to 10 days after injury.
People who have this condition may complain of headaches, dizziness, fatigue, irritability, anxiety, sleep difficulties, loss of concentration and memory, and noise sensitivity. Symptoms usually go away on their own in a short time, but in rare cases, they may last for years.
Most patients recover fully within three months and have no underlying long-term problems. Patients whose symptoms persist for longer than a year may require further evaluation to rule out more serious causes.
How to prevent a fall
Falls are overwhelmingly the most common cause of traumatic brain injury among adults 65 and older.
You can help prevent falls by keeping your home well lighted, getting rid of clutter, taping down or removing loose rugs, securing electric and telephone cords, using night lights, installing grab bars and nonskid mats in bathrooms, and making sure all stairways have handrails.
Exercising regularly can improve balance and coordination and dramatically reduce your risk of a fall. Having your vision checked helps, too, since poor eyesight increases fall risk.
Finally, ask your doctor whether any of your medications can cause dizziness or confusion that may cause you to fall. If so, check whether substitutions are possible.
Read more about how head injuries may negatively impact your long-term health.