A Silent Threat: Brain Injuries in Older Adults. Quality Long-Term Care Improves Well-Being

As life expectancy increases, so does the number of older adults facing the challenges of aging. One often overlooked concern is the vulnerability of older adults to brain injuries. These injuries, both traumatic and non-traumatic, can have a devastating impact on an individual's cognitive function, mobility, and overall well-being. 

Every year, nearly 5 million Americans are evaluated for traumatic brain injury in emergency departments across the nation. However,  Frederick Korley, M.D., Ph.D., associate professor of emergency medicine at Michigan Medicine, says that changes need to be made to provide better care for patients who often go through a prolonged recovery process.

We as physicians are frustrated that there are significant limitations to what we can do for our patients for an injury that has real-life, debilitating consequences.

Understanding the types of brain injuries commonly affecting older adults, their causes, treatment options, and long-term care considerations is crucial for families, caregivers, and health professionals alike. The number of older adults with these types of injuries is resulting in more of them needing long-term care services.

Types of Brain Injuries in Older Adults

Older adults are susceptible to two main categories of brain injuries:

• Traumatic Brain Injury (TBI):  A blow to the head or a jolt to the head that disrupts the normal function of the brain falls under this category. Falls are the leading culprit for TBI in older adults, accounting for over half of all TBI-related hospitalizations and deaths in this age group, according to a study in the journal Emergency Medicine. Other causes of TBI in older adults include motor vehicle accidents and assaults.
• Non-traumatic Brain Injury (NTBI):  This category encompasses various conditions that can damage the brain without a direct blow to the head. Common NTBIs impacting older adults include:

• Stroke: A sudden blockage or rupture of a blood vessel in the brain, depriving brain tissue of oxygen and nutrients. Strokes can cause significant brain damage and lead to cognitive decline, mobility issues, and other long-term complications.

• Cerebral Amyloid Angiopathy (CAA): A buildup of abnormal protein deposits in the blood vessels of the brain, leading to weakened blood vessels and an increased risk of bleeding in the brain (hemorrhagic stroke). This condition is more common in older adults and can contribute to cognitive decline and dementia.

• Normal Pressure Hydrocephalus (NPH): A buildup of cerebrospinal fluid (CSF) within the brain's ventricles without a significant increase in intracranial pressure. Symptoms of NPH can include memory problems, difficulty walking, and urinary incontinence.

Falls are Dangerous for Older Adults and Can Lead to TBI

Falls are the leading culprit behind Traumatic Brain Injury (TBI) in older adults, posing a significant public health threat.

Several factors contribute to falls in older adults:

• Weakened Bones and Muscles: Osteoporosis, a condition that weakens bones, and decreased muscle mass and strength make falls more likely in older adults. Even a minor fall can cause a serious head injury if the bones are brittle and there's less muscle to absorb the impact.
• Balance and Gait Issues: Age-related changes in the inner ear and nervous system can affect balance and coordination, increasing the risk of falls. Vision problems can further impair depth perception and contribute to stumbling.
• Medications: Certain medications can cause dizziness or drowsiness, which can increase the risk of falls.
• Environmental Hazards: Cluttered homes, loose rugs, poor lighting, and uneven surfaces can all create tripping hazards and increase the likelihood of falls.

Frequency of Falls Leading to TBI

A study in the Journal of Emergency Medicine suggests nearly half of all trauma patients aged 65 and over who are admitted with trauma meeting specific criteria have TBI. This trauma often stems from falls. A UCLA study points out that falls are responsible for over 80% of all TBI-related emergency department visits, hospitalizations, and deaths in older adults. 

Even falls that don't cause immediate TBI can have long-term consequences. The fear of falling can lead older adults to become more sedentary, further weakening muscles and increasing fall risk.

Anita Lamar, Managing Attorney at Lamar Law Office, LLC in Atlanta, says that TBIs are not just medical emergencies; they are life-altering events that can leave individuals struggling with long-term disabilities and profound changes in their daily lives.

With TBIs accounting for approximately 30% of all injury deaths, the need for specialized legal assistance cannot overemphasized. As a personal injury lawyer, I understand the complexities of TBI cases, from the nuances of primary and secondary injuries to the devastating impacts of hematomas, hemorrhages, and concussions. These injuries can stem from seemingly simple incidents—a fall, an accident, or a sudden blow to the head—yet their repercussions can span a lifetime, increasing risks for dementia and other neurological disorders.

Lamar says that personal injury attorneys become essential to helping the injured individual and their family when a brain injury occurs. These cases can be difficult as attorneys must obtain expert medical testimony and secure the compensation necessary for the ongoing care and support the individual requires.

Strokes and TBIs

While falls are the leading cause of TBI in older adults, strokes can also be a culprit. Strokes interrupt blood flow to the brain, causing brain tissue damage in the affected area. This damage can have a wide range of consequences, including cognitive decline, paralysis, and even loss of consciousness. In some cases, the force of the blood vessel rupturing during a hemorrhagic stroke or the impact of a blood clot dislodging in an ischemic stroke can cause a secondary traumatic brain injury, further complicating the recovery process.

Every 40 seconds, someone in the United States experiences a stroke, making it one of the top causes of long-term care. There are advances in care for stroke victims. 

In response, a study by the Cleveland Clinic is investigating deep brain stimulation as a potential recovery aid for stroke survivors. Andre Machado, MD, PhD, and chair of the Cleveland Clinic's Neurological Institute, describes deep brain stimulation as akin to having a pacemaker for the brain.

The pacemaker in the heart sends pulses to control the heartbeat. Deep brain stimulation sends electrical pulses into the brain to manage some of the brain activity to help treat a disease or a problem.

Risk Factors for Brain Injury in Older Adults

Several factors contribute to the increased risk and severity of brain injuries in older adults:

• Weakened bones and muscles: Osteoporosis, a condition that weakens bones and decreases muscle strength, makes falls more likely in older adults. Even a minor fall can cause a serious head injury.
• Reduced cognitive function: Some older adults may experience cognitive decline that affects their balance, coordination, and judgment, further increasing their fall risk.
• Pre-existing medical conditions: Older adults are more likely to have pre-existing medical conditions like cardiovascular disease or diabetes, which can complicate recovery from a brain injury [6].
• Medications: Certain medications can increase the risk of falls or dizziness, potentially leading to head injuries.

Symptoms and Early Detection

Early recognition and diagnosis of a brain injury are crucial for optimizing recovery. Here are some potential signs and symptoms of brain injury in older adults:

• Headache
• Confusion
• Dizziness
• Loss of consciousness
• Memory problems
• Changes in behavior
• Slurred speech
• Seizures
• Weakness or difficulty coordinating movements

Family members and caregivers should be vigilant in observing these signs and symptoms, particularly after a fall or other head injury. Seeking prompt medical attention after a suspected brain injury is essential.

Treatment and Rehabilitation

The treatment for brain injury in older adults depends on the severity and type of injury. For TBI, treatment may involve medications to manage symptoms like headaches and nausea, surgery to remove blood clots or repair skull fractures in severe cases, and rehabilitation to address cognitive, physical, and emotional impairments. Treatment for NTBIs like stroke may involve medications to dissolve blood clots, surgery to remove a blockage, or rehabilitation therapies.

Long-Term Care Considerations

Brain injuries can significantly impact an older adult's ability to live independently. Depending on the severity of the injury, long-term care options may be necessary. These options can range from in-home care services to assisted living and skilled nursing facilities. 

Occupational and physical therapy can play a crucial role in helping individuals regain lost skills and maximize their independence. Emotional support and counseling can also be essential for individuals coping with the cognitive and emotional consequences of a brain injury.

The cost of care depends primarily on the care recipient's savings and income, as traditional health insurance and Medicare will only pay for short-term skilled care. Money from a legal settlement could help pay for care if the brain injury from an injury was proven to be someone else's fault. Long-Term Care Insurance will also pay for this type of care in any setting. Medicaid will only pay for long-term care if the care recipient has little or no income and assets. 

Living a Fulfilling Life After Brain Injury

While a brain injury can pose significant challenges, it's important to remember that many older adults can experience a good quality of life after a brain injury. With the right support system, access to appropriate care, and a positive attitude, individuals can regain lost skills, adapt to their circumstances, and continue to live fulfilling lives.

Quality caregivers can improve the quality of life of those needing ongoing long-term care. Finding caregivers and facilities that meet your loved one's needs can be challenging. The LTC News Caregiver Directory has over 80,000 listings of caregivers and facilities nationwide and is free to use. 

By promoting awareness, taking preventative measures, and seeking support when needed, families and communities can empower older adults to age safely and with a reduced risk of brain injury.