Traumatic Brain Injury Among Older Adults

Traumatic Brain Injuries in Older Adults

A traumatic brain injury (TBI) is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury (1).

Utahns age 65+ years had the highest rates of TBI, primarily as a result of a fall. In 2011,

  • 818 Utahns aged 65 years and older received a TBI.
  • TBI hospitalizations and deaths were most common among older adults, especially those aged 75 and older.
  • Utahns aged 85 and older had the highest rate of TBI hospitalizations and deaths among all age groups.

TBIs can have a dramatic impact on a person’s ability to lead an active, fulfilling life. TBIs can affect an individual’s ability to work, as well as his or her short- and long-term memory, vision, sleep, mood, and movement.

Causes of Older Adult TBI in Utah

The vast majority of TBIs among older adults are due to a fall. Often factors associated with old age (such as vision problems, slower reflexes, decreased bone density, comorbid conditions, etc.) also greatly increase the risk of a TBI for older adults (2). TBIs are often missed or misdiagnosed in older adults (1).

Signs and Symptoms of a TBI

Some signs of a TBI may include:

  • Headache or neck pain that won’t go away
  • Blurred vision
  • Lack of energy/tired
  • Ringing in the ears
  • Trouble sleeping or sleeping too much
  • Loss of balance
  • "Hurt" by loud noises or bright lights

Some changes in behavior from a TBI may include:

  • Easily irritated; aggressive
  • Mood changes: feeling sad, anxious
  • Not interested in things that used to be enjoyed
  • Confused, get lost easily
  • Slow in thinking, speaking, or reading
  • Hard time getting organized
  • Hard time making decisions and solving problems
  • Hard time paying attention
  • Forgetting things that happened a few minutes or days ago

Outcomes of TBI Among Older Adults

Older adults with TBI have longer and more expensive hospital and inpatient rehabilitation facility stays, compared to younger individuals with a TBI (3). As age increases, the percentage of Utahns hospitalized with a TBI who are able to return home after leav¬ing the hospital (i.e., self-care, home health services, or outpatient reha¬bilitation) slowly drops, with less than half (47.9%) of the patients ages 65+ able to return home.

Research shows that older age negatively influences outcomes after a TBI (4). Comorbid dementia can increase the risk for TBI and cognitive impairment is underdiagnosed in older patients, making it difficult to distinguish between a TBI and dementia (2). The more chronic illnesses a person has, the more likely they will be hospitalized. These comorbid conditions can also place the older adult with TBI at an increased risk for secondary complications during recovery. Dementia and mild cognitive impairment prior to the TBI also increases the risk for TBI and for a slower, more complicated recovery. It is often difficult for providers to separate the effects of the brain injury versus cognitive impairment, confounding diagnosis and complicating management thereafter.

The incidence of TBI in older adults poses special diagnostic, management and treatment challenges, however; limited awareness of TBI in older adults and a paucity of research makes predicting outcomes and providing care among older adults with TBI difficult and problematic.

References

  1. CDC Traumatic Brain Injury
  2. National Institutes of Health
  3. Coronado VG, et al.
  4. Thompson, et al., 2006