Caring for Seniors With Traumatic Brain Injuries

Traumatic brain injuries (TBIs) are far more common among senior adults than any other age group and result in significantly higher mortality rates as well. Adults aged 75 and older have the highest rates of TBI-related hospitalization and death.

What Is a Traumatic Brain Injury?

A TBI is an injury to the brain that occurs as a result of a bump or blow to the head or from blunt or penetrating trauma. During the impact, the brain crashes back and forth within the skull–resulting in bruising, bleeding, and the shearing of nerve fibers.

What are the major types of head injuries?

Contusion. This is a bruise of the brain tissue, producing a mild form of bleeding. If a contusion does not heal on its own, it can turn into a hematoma, which doctors can remove through surgery.

Concussions. These are the most common type of traumatic brain injury. When a strong force strikes your head, your brain moves in the direction of the force until it collides with your skull, causing damage.

Subdural hematomas. A hematoma is defined as a collection of blood outside of a blood vessel. This specific hematoma is  the result of a buildup of blood leaking out of a torn vessel into a space within a protective membrane of the brain called the dura. The bleed occurs within the skull but outside the brain tissues.

As we age, our brains shrink, causing the space between the skull and brain to widen. Then, tiny membranes between the skull and brain begin to stretch. These thinned, stretched veins are more likely to tear in the event of even a minor head injury.

Intracranial hematomas. This type of hematoma is commonly caused by the rupture of a blood vessel within the brain as a result of the trauma that occurs during an accident or fall. This can lead to the collection of blood in the brain tissues or the empty spaces underneath the skull, pressing on the brain.

Penetrating TBI. This is an injury in which the dura, a protective membrane within the skull surrounding the brain, is penetrated.

Brain hemorrhage. This is caused by an artery in the brain bursting, resulting in localized bleeding in surrounding tissues.

Skull fractures. These are a serious concern because a fracture in the skull can cause injury to the brain or provide an open avenue for infection–or both.

Facts About TBIs & Seniors

Falls are the number one cause of traumatic brain injuries in seniors.

Older adults suffering a concussion are more likely to be admitted to the hospital for observation due to their increased risk factors.

A delay in seeking medical help due to confusion about whether the senior’s symptoms are a result of striking the head, dementia or other illnesses contributes to the increased TBI mortality rate in seniors.

The use of blood thinners like Warfarin can increase the likelihood of bleeding in the brain.

Survivors of traumatic brain injuries may suffer from chronic neurological complications, such as seizures, and varying degrees of cognitive impairment.

Senior Care for TBI Victims

Family members should maintain frequent contact with their senior and observe him or her closely if they have suffered a head injury. This is because the consequences of a TBI may not occur until weeks afterward the incident in a senior.

Some concussion symptoms such as dizziness, balance problems, memory issues, and anxiety can be mistakenly assumed as being normal for a senior, when in reality they are due to a brain injury. Immediate medical attention should be pursued if there is a sudden change in cognitive or physical abilities.

It’s important for family members to know what conditions and medications their loved one is taking to share this information with medical staff if a TBI is suspected.

Other symptoms that may be caused by a TBI:

• Confusion
• Difficulty remembering new information
• Headaches
• Dizziness
• Blurred vision
• Nausea and/or vomiting
• Ringing in the ears
• Emotional and/or sleep disturbances
• Increased risk of seizures.
• Depression
• Apathy
• Feelings of worthlessness
• Withdrawal

It is possible for a senior to recover from a brain injury, but the recovery process will probably be slow. Continue to stay in touch with the senior’s physician. He or she may recommend therapy for balance problems, vision changes, dizziness, headaches or worsening cognitive issues. The physician will probably also want to see the senior on a regular basis to follow up with their care.

A person with a brain injury may be more susceptible to Parkinson’s disease and early-onset dementia. Though a TBI is not a cause of these other diseases, there is some association in their increased likelihood in a senior who has sustained a TBI.

It is natural to focus on the cognitive challenges resulting from traumatic brain injuries, but if a senior is less physically active and does not follow a healthy diet, they are more likely to develop other health problems. It is particularly important for seniors–even if they haven’t sustained a TBI–to control high blood pressure, as it is a major contributor to cerebral hemorrhage.

Encourage your senior to participate in physician-recommended therapies and exercise. (TBI survivors with a frontal lobe injury often struggle with planning ahead and staying on task. Taking the initiative and completing therapy or exercising on their own initiative may be impossible for them.)

As a family member or caregiver, the goal is for your senior loved one to live as independently as possible while still receiving the care and supervision needed.

Other Ways to Help TBI Victims

Let them do what they can. If your senior is capable of completing tasks, encourage them to do so. This will boost their self-esteem and confidence.

Learn as much as you can about the TBI your loved one has suffered. Talk to their physician, go online, or find resources at a local senior center.

The more you learn about traumatic brain injuries, the more you will understand the effects of fatigue, depression, anxiety, and cognitive deficits your senior may be experiencing. For example, your loved one might come across as inconsiderate, when in fact they are simply confused or tired.

Create a calm home. For some seniors with a TBI, the world is an especially confusing place. Noise from TVs, radios, and multiple simultaneous conversations can be unnerving, making it harder for your senior to communicate and to cope.

Fall prevention. A senior with a TBI may be more susceptible to falling, so eliminating tripping hazards in the home like exposed electrical cords and cables, upturned rugs, uneven surfaces, and blocked pathways is a must!

Be patient. A TBI often results in short-term memory loss. This means you may have to repeat yourself several times. If comprehension isn’t possible, move on to another topic. When you speak, do so slowly and clearly.

Expect personality changes. After a traumatic brain injury, the senior may be a different person than they were before their injury. His or her emotions may be heightened and uncontrolled, and communication can be more difficult.

If your loved one becomes irritable or suddenly unreasonable, stay calm and don’t react. They might be in pain or exhausted and just need to be left alone for a few minutes.

Write things down. When caring for someone with a brain injury, write important information somewhere they can easily see.

Example: Keep a whiteboard and record every appointment and activity for the day on it. You can also place sticky notes on the microwave or coffee pot with precise instructions on how to use them.

All this will help the senior become more independent and take some responsibility off your shoulders.

Record progress. Progress may be slow and discouraging. However, keep a journal documenting all the progress the senior has made, no matter how small and seemingly insignificant it may seem (buttoning a shirt, making toast, etc.). This will encourage them – and you.

Take a “time out.” Caring for someone with a brain injury can take an extreme physical, mental and emotional toll on a caregiver. Be good to yourself. Ask for someone to step in and take over for a while to allow you to rest and do something you enjoy. You and your senior will reap the benefits when you come back with renewed physical and emotional energy.

Take a look at our blog for more resources on senior health concerns.