Concussions and Traumatic Brain Injuries
Though considered a mild traumatic brain injury (MTBI), a concussion can be a serious injury, especially as people get older. The majority of traumatic brain injuries (TBIs) tend to be of the milder form. The Centers of Disease Control and Prevention estimates that for people 65 years of age and older, TBI leads to more than 80,000 emergency department visits every year. Falls are the leading cause of TBI in older adults, and compared to younger people, older adults are twice as likely to be hospitalized due to TBI.
Falls and crashes are certainly dramatic and traumatic. But what about that little slip and fall that didn’t appear to cause any immediate damage? Nothing is broken. There was no loss of consciousness. Sure, you might be embarrassed but you basically brush it off and go about your day.
“Most people don’t want to believe something bad has happened,” says neurologist Paul M. Ves-pa, MD, David Geffen School of Medicine at UCLA. “Then they start experiencing symptoms, go to the doctor and report they hit their head three days ago.”
While the delay in symptoms is possible for anyone at any age, head injuries affect older adults differently than younger people. Sometimes the symptoms, which include increased sleepiness, headaches, short-term memory loss, and confusion, can be dismissed as just a part of getting older or having an off day. But consequences of a concussion can be very serious and should not to be ignored.
“Older adults tend to develop more problems with infection, blood pressure and glucose control,” explains Dr. Vespa. “They are also more prone to subdural hemorrhages because the brain has shrunken and the empty space can fill with blood.”
Many seniors also take bloodthinning medications, which increase the risk for internal bleeding.
WHAT YOU SHOULD KNOW
➢ Falls are the leading cause of concussion and TBI in older adults.
➢ Symptoms may be delayed for several days.
➢ Recovery can take three months or more.
➢ See your doctor any time you fall and hit your head or experience a jolt that causes whiplash.
Studies in Recovery
A recent study published in the journal Radiology underscored that older patients may have more difficulty recovering from a concussion. Specifically, researchers used functional MRI (fMRI) to evaluate the effect of age on working memory and functional activation in the brain after concussion. They compared two groups with concussions: young adults (21-30 years old) and older adults (51-68 years old). They scanned them twice. The first time was within one month of injury and the second fMRI was six weeks later.
The analysis showed that the younger patients had a significant reduction in post-concussion symptom scores. There was no significant change observed in the older patients. According to the study authors, the findings provide evidence for age differences in neural plasticity—the brain’s ability to form new connections to compensate for injury, adapt to changing environments or learn something new. Furthermore, they surmised that the results suggest that MTBI might cause a more profound and lasting effect in older patients.
Treatment and Recovery
Current treatments include medications to stabilize the pressure in the brain to stop bleeding and protect against sei-zures. In addition, physical therapy and cognitive therapy are especially important for older adults. How long it takes to re-cover depends, of course, on each person’s situation—degree of health at the time of injury and also the se-verity of the injury.
“In general, it can take at least three months to recover from a mild traumatic brain injury,” says Dr. Vespa.
Strategies for Prevention
Because falls are the number one cause of concussions and TBIs in older adults, it stands to reason that preventing them is the best course of action. That means working on balance and overall physical fitness, using devices such as canes or walking sticks when needed, and wearing a helmet when riding a bike—no matter how slowly you pedal. Likewise, if you have pets, be aware of them. “It’s not uncommon for people to trip over a cat or dog,” empha-sizes Dr. Vespa.
These extra precautions can help keep you safer. If you do fall, go see your doctor. Your brain is made of soft, delicate tissue that floats in a hard skull. Even a seemingly mild bump on the noggin can be enough to damage brain tissue.
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