Brain Injuries in the Elderly

• Elderly patients are at an increased risk of traumatic brain injuries (TBI) due to factors of aging such as loss of balance, confusion, vision loss, etc.
• Understand these risk factors and how to prevent TBIs, as well as secondary brain injuries that may occur after an initial head trauma.
• Learn how to recognize the symptoms of traumatic brain injuries, diagnosis TBI, and how to treat it in elderly patients.

The elderly population is at an increased risk for traumatic brain injury (TBI) due to their increased risk of falls and several other factors, such as changes due to aging, loss of balance, confusion, vision loss, medication side effects, and medical conditions such as hypertension, heart disease, diabetes, and stroke. 

 The CDC estimates that more than 80,000 elderly patients experience traumatic brain injury every year, with 75% of those resulting in hospitalizations. Traumatic brain injury is a serious medical concern, and older adults have a more difficult time recovering from a traumatic brain injury.  

However, with early interventions and the right approach, elderly patients can recover well from traumatic brain injury. Let’s discuss traumatic brain injury in further detail, its risk factors, prevention, symptoms, and different types.  

Causes and Risk Factors of Traumatic Brain Injury  

Traumatic brain injury results from an impact on the head that disrupts normal brain function. The leading causes of TBI that result in emergency department visits are falls, being struck by an object, and motor vehicle crashes.  

Indirect forces that shake the brain violently within the skull, such as shock waves from battlefield explosions, can also cause TBI. In addition, TBI can result from bullet wounds or other injuries that penetrate the skull and brain.  

However, it is important to note that not all blows or jolts to the head result in TBI. 

Falls are the most common cause of TBI, and falling poses an especially serious risk for older adults. When a person over 65 years old sustains a serious TBI in a fall, the direct effects of the injury may result in long-term cognitive changes, reduced ability to function, and changes in emotional health.  

According to the CDC, older adults who experience loss of consciousness after a TBI were 28% more likely to report subjective memory impairment than elderly patients who did not experience a TBI.  

TBI may affect a person’s cognitive abilities, including learning and thinking skills. Most TBI’s are caused by falls, being struck by an object, or by vehicle crashes.  

Doctors classify traumatic brain injury as either mild, moderate, or severe depending on whether the injury causes unconsciousness, how prolonged unconsciousness lasts, and the severity of the individual symptoms.  

Although most TBI’s are classified as mild because they are not life-threatening, a mild TBI can have severe and long-lasting effects. The extent of these effects is not fully understood and requires more research.  

Some of these injuries are considered primary, with immediate damage and symptoms. Other outcomes of TBI can be secondary, meaning they can occur gradually over hours or days or appear weeks later.  

These secondary brain injuries are the result of reactive processes that occur after the initial head trauma. TBI resulting from an impact to the head disrupts normal brain function and is a threat to cognitive health in two ways: 

1. A traumatic brain injury’s direct effects, which may be long-lasting or even permanent, can include unconsciousness, inability to recall the traumatic event, depression, confusion, difficulty learning and remembering information, trouble speaking coherently, unsteadiness, lack of coordination, and problems with vision or hearing. 
2. Certain types of TBI may increase the risk of developing Alzheimer’s or another type of dementia years after the injury takes place. 

Effective Ways to Prevent a Head Injury  

TBI can affect the brain even if an individual does not lose consciousness and their symptoms clear up quickly. Anyone who experiences an impact on the head and develops any symptoms of TBI should seek medical attention, even if symptoms seem mild.  

It is important to call emergency services for anyone who: 

• Is unconscious for more than a minute or two.  
• Experiences seizures, repeated vomiting, or symptoms that seem to worsen as time passes. 
• Was ejected from a vehicle and sustained a head injury. 
• Was struck by a vehicle while on foot. 
• Has fallen from a height of more than three feet. 
• Hits their head on a hard object. 

Measures to reduce the risk of falls include: 

• Using a walker or other assistive device to compensate for mobility problems muscle weakness or poor balance. 
• Having vision checked regularly and using glasses or contact lenses that correct for changes. 
• Working with the individual’s doctor to watch for medication side effects or interactions among drugs they are taking. 
• Avoiding hazards such as clutter, loose rugs, or bad lighting. 

Symptoms, Diagnosis, and Treatment of Traumatic Brain Injury 

The severity of symptoms depends on whether the injury is mild, moderate, or severe. In all forms of TBI, cognitive changes are amongst the most common, most disabling, and longest-lasting symptoms that can result from the injury.  

The ability to learn and remember new information is often affected. Other commonly affected cognitive skills include the capacity to pay attention, organize thoughts, plan effective strategies for completing tasks and activities, and make good judgments.  

More severe changes in thinking skills, a hallmark characteristic of dementia, may develop years after the injury took place and the person appears to have recovered from its immediate effects. 

Symptoms of Mild Traumatic Brain Injury

Mild TBI, also known as a concussion, does not necessarily cause loss of consciousness or causes consciousness that lasts for 30 minutes or less. Mild TBI symptoms may include: 

• Inability to remember the cause of the injury or events that occurred immediately before up to 24 hours after it happened 
• Confusion and disorientation 
• Difficulty remembering new information  
• Problems with finding words  
• Headache, dizziness, and blurred vision 
• Sensitivity to light and sound  
• Change in energy or motivation 
• Nausea and vomiting  

• Ringing in the ears  
• Trouble speaking clearly 
• Changes in emotions or sleep patterns  

Symptoms of Moderate and Severe Traumatic Brain Injury

Moderate TBI causes unconsciousness lasting more than 30 minutes but less than 24 hours, and severe TBI causes unconsciousness for more than 24 hours. Symptoms of moderate and severe TBI are like those of mild TBI, but more serious and longer lasting.  

The most severe injuries may also lead to hemorrhages or other brain injuries associated with neurologic symptoms such as localized weakness or sensory loss. 

Diagnosis of Traumatic Brain Injury

Evaluations by healthcare professionals typically include: 

• Questions about how the injury happened. 
• Assessment of the person’s level of consciousness and confusion 
• Assessment of memory and thinking, vision, hearing, touch, balance, gait, coordination, strength, sensation, reflexes, and other indicators of brain function. 

Individuals who are taking blood thinners such as Coumadin and aspirin should be closely monitored because these medications can increase the chance of complications. Depending on the cause of the TBI and the severity of symptoms, brain imaging, computed tomography, or magnetic resonance imaging may be needed to determine if there’s bleeding or swelling in the brain.  

If an individual experiences a TBI, it should be noted in their permanent medical record and mentioned whenever they see the doctor, especially new doctors.  

Treatment of Traumatic Brain Injury

The most serious traumatic brain injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic brain injuries are mild, however and can be managed with either an ER visit or short hospital stay for observation, or at home monitoring followed by outpatient rehabilitation if needed. 

Treatment of dementia and a person with a history of traumatic brain injuries varies, depending on the type of dementia diagnosis. Strategies for treating Alzheimer’s or another specific type of dementia are the same for individuals with and without a history of TBI.  

However, the contributions of TBI to cognition is a relatively new area of research for physicians. Formal clinical guidelines for diagnosing and managing this condition do not yet exist. 

The Bottom Line

In conclusion, older adults are at an increased risk of suffering from TBI due to several factors related to aging that increase their risk of falling and sustaining one of these injuries. TBI in the elderly is a frequently seen condition in the emergency department.  

TBI can have long-lasting and debilitating effects and it is essential that we take the prevention of TBI in the elderly seriously and do everything we can to mitigate the risks for serious head injuries.  

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