Traumatic brain injury is responsible for over 80,000 emergency department visits annually in adults over age 65 and falls are the leading cause (51%) followed by motor vehicle crashes (9%). For those who have severe head injuries the mortality rate over age 55 is 80% compared with 29% for ages 26 to 35. Even with a diagnosis of mild head injury the mortality rate is 20% for older adults.
Risk Factors for Brain Trauma and Concussions
Shrinking brain mass, or atrophy, is a common condition in the aging brain. As a consequence the brain tissue pulls away from the brain lining that adheres more tightly to the skull than the brain. This drawing away has two effects increasing the liklihood of injury:
- The shrinking of the brain creates more space allowing for movement within the cranium
- The vessels that bridge between the lining and the brain are stretched
This combination of factors associated with decreased flexibility and pliability of vessels creates a perfect situation for damage. When these vessels are damaged by either direct trauma or indirect trauma resulting in excessive movement of the brain within the skull bleeding into the cavity occurs. In addition, many adults over the age of 65 take aspirin or other medications that inhibit clotting so that when bleeding occurs the amount of bleeding increases.
Some examples of injuries in older adults that may result in brain injuries when the same may not be true at a younger age are:
- A jarring fall without directly striking the head
- A motor vehicle collision resulting in shaking or sudden stopping even in the absence of direct blow to the head.
An injury that causes a minor concussion in a younger person may result in major bleeding into the brain of an older adult.
Prevention StrategiesAdmittedly there are many common occurances that are beyond our control but some common sense strategies may help reduce the incidence or severity of brain injuries.
- Avoid self-medicating. Make sure your health care provider knows and approves of your medication regime. Even many over-the-counter medications or herbal preparations increase the risks of bleeding.
- Wear protective head gear when indicated. Activities such as motorcycle riding, riding ATVs, Snowmobiling, skating, bicycle riding. The list goes on, wear protective head gear!
- Get evaluation or treatment early. Any time a significant jolt of the head occurs get it checked out before the problem progresses. Even if initially there seems to be no injury be aware that significant bleeding may occur until the empty space is filled with blood and symptoms develop.
Reference
"Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications". Journal of the American Geriatric Society. Oct 2006- Vol. 54, NO. 10.
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