Odds are it has happened to you. You wake in the middle of the night and have to use the bathroom. It is dark, difficult to see and…bam…you trip and clunk your head. After you get your wits about you, you figure you must be okay and head on to the bathroom and back to bed.
But maybe you’re not okay—maybe you’ve just sustained a concussion and don’t know it.
Most of the headlines about concussion involve well-known athletes, but Senator Mitch McConnell’s fall and concussion back in March brought to light the significant differences when an older person experiences a head injury. Concussions are classified as a mild form of traumatic brain injury (TBI), but in older adults, they may be anything but mild…and while we’ve learned a lot about how to help young people and athletes after concussion, the needs of the older brain aren’t as well understood.
Why is there a difference? When an athlete suffers a concussion on the field, his/her brain is in a very specific and, in fact, optimal chemical state—primed for competition with the endorphins, or feel-good hormones, flowing.
He/she is not only young but also likely to be in good physical condition. Age is on his side, and with the proper treatment and time, his healing potential is phenomenal.
An older person, on the other hand, may already be managing chronic conditions, such as high blood pressure, high cholesterol or diabetes—factors that can impact the healing process. And in many situations, such as when an older person falls in the middle of the night, the brain is in a fatigued state, another factor that can make recovery more difficult.
Concussions in Seniors: A Silent Epidemic
About 12% of all hospitalizations nationwide are due to brain injuries such as TBIs, and the majority of those hospitalizations are adults 75 years and older who experienced a fall. That’s more than the number of people of all ages whose TBIs stemmed from two other common causes—motor vehicle accidents and violent assaults. This silent epidemic is a major public health concern that needs a targeted, age-appropriate approach for care and, in particular, more research to overcome the challenges that older people face.
Following a concussion, older adults are at higher risk for severe complications, including a brain bleed. Reason: Normal anatomical age-related changes in the brain cause it to shrink over time, leaving more room for it to shake and rattle during a head injury. More space between the brain and the inner wall of the skull gives even a slight bleed from a TBI space to grow or bleed more. Being on a blood thinner, as many older adults are, also increases bleeding risk.
Challenge to Diagnose
Identifying a concussion can be difficult even for health-care providers. The Glasgow Coma Scale (GCS) is a common assessment tool used to measure concussion effects, but it’s very vague when it comes to the fine points. Example: The GCS considers whether you can move your arms and legs and open your eyes. If you can, you’ll score pretty well…even if you have a concussion. In fact, older adults with a completely normal GCS score can show acute brain trauma on a CT scan.
Even brain scans have their limitations—they can’t tell how severe a concussion is or how well you’ll recover. There also are instances in which a CT scan looks normal at the time of the concussion, but the patient starts to experience symptoms in the days or weeks to come. In that situation, an MRI might be needed to identify problems.
When to Get Medical Attention
Senator McConnell was actually lucky to have fallen in public because people around him got him immediate attention. Many people who fall at home assume they’re okay if they can get back up. But even if you think you’re fine, a head trauma that shakes your brain causes chemical changes—the brain’s normal workings may be impacted—so it is always best to get checked out when your head is shaken or rattled from a fall, a motor vehicle accident or even a low-impact event. And certainly get checked out if you feel that your functioning and/or thinking is off.
Keep an eye out for these three categories of concussion symptoms…
Physical symptoms: Fatigue, dizziness, headaches, sensitivity to light and sound, nausea and/or vomiting, and problems with sleep. Note: People used to be discouraged from going to sleep in the hours after a suspected concussion. That’s no longer the case, but needing too much sleep or not being able to get restorative sleep are concerns.
Cognitive symptoms: Confusion, mental fog and difficulty concentrating or remembering.
Emotional symptoms: Anxiety, irritability and worsening of existing mental health issues such as depression.
If any of these occur immediately after you have a head injury, call 911 or get to an emergency room for a neurological evaluation.
Problem: You might not feel symptoms right away. They can occur one, two or even six months after a single fall, and people often fail to connect them to a head injury that occurred so much earlier. Signs that may occur later on include becoming fatigued faster than usual…needing to take daytime naps…yawning or feeling your eyes tiring after reading just three or four sentences…or feeling as though you’re tripping over your own feet when you used to be able to run down stairs without a problem.
After a Concussion
As time passes, you may feel some of the following symptoms—all are signs to see your doctor or a neurologist for a neurological evaluation and possible treatment…
From two weeks to three months after a concussion or any head trauma: You may feel depressed. That’s because certain brain chemicals are at an all-time low—the brain depletes them while healing, and that may cause depression or even aggressive behavior. You might have trouble finding the right words, have difficulty with tasks that used to be automatic such as how to turn on your car or forget recipes you’ve been preparing for years.
Between three months and two years: Post-concussion syndrome can set in with post-traumatic headaches, vertigo and/or ringing in the ears and/or dizziness. After this long, most people have forgotten about hitting their head, so their doctor might order all sorts of tests unrelated to concussion without rooting out the true cause. What’s needed is an evaluation by a neurologist of your balance and cognition and how you’re processing information.
Recovery Road map
There’s no one-size-fits-all time frame for concussion recovery. It depends on your overall health, your lifestyle habits and, of course, the extent of your injury. It’s not your age but the health of your brain that influences the healing process. Example: If you experienced brain injuries in your youth or you’ve already had one or more concussions as an adult, your brain will be slower to heal from any new trauma. Depending on the extent of the injury, you may need a hospital stay, possibly followed by inpatient rehabilitation at a special facility, as did Senator McConnell. Rehab programs are tailored to each person’s unique needs but typically focus on physical and mental therapies to help with movement and cognition and include a plan to gradually return to your everyday activities so that your brain has time to heal.
For a first-time concussion: Expect to feel extremely fatigued or wired for two to three weeks because of the chemical changes that took place in your brain. Your brain will use more than 300 calories a day to heal—that’s why you may feel drained or excessively hungry, so boost your diet with healthy foods.
Other important steps: Get enough sleep…make sure you’re getting needed vitamins…control any chronic conditions such as high blood pressure…and enlist loved ones to watch over you, drive you to follow-up appointments, help you prepare meals and take medications as directed…and monitor pills and bills because the chances of making cognitive errors are high while you’re healing from concussion.