Why seniors are at risk of acquiring brain injury

BY: RICHARD HASKELL

It’s often been said that in life there are two things that are inevitable – death and taxes. Well, to that short list, I’d like to add “aging.” We can’t avoid getting older, and with any luck, old age will be a period in our lives (if it isn’t already) when we enjoy reasonably good health, discover new pleasures and continue to find contentment in the company of family and friends.

Nevertheless, aging can also bring new challenges. Energy levels drop, flexibility, strength and endurance aren’t what they use to be and some may experience issues with hearing and eyesight. As a result, seniors may find themselves more susceptible to head injuries.

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photo credit: 10040059 via photopin (license)

Feminist author Alix Kates Shulman describes in  her novelTo Love What Is: A Marriage Transformed how her husband acquired his traumatic brain injury at the age of 75:

On a moonless summer night my husband fell nine feet from a sleeping loft to the floor and did not die. … He did not die, though X-rays taken several hours later showed that he had broken most of his ribs and both feet; punctured both lungs, causing perilous internal bleeding; and suffered so many blood clots in his brain that each CAT scan of that precious organ resembled an elaborate filigree.

In the U.S., the Centers for Disease Control and Prevention (CDC) reports that more than 1.7 million people suffer brain injuries every year (statistics are not available for Canada, but correlating the differences between the U.S. population and Canada, and including rates of concussion, it is estimated that 587,025 acquire a brain injury each year here.)

People over the age of 75 tend to have the highest rates of ABI-related hospitalization. They are also slower to recover and their ensuing injuries are ultimately more serious and life-threatening. Falls are the leading cause of TBI, and rates are highest for children aged zero to four years and for adults aged 75 years and older.

Close to half-a-million Ontarians currently live with an ABI, with 18,000 new cases added every year, at an estimated cost of $1 billion annually. The Canadian demographic itself is aging, and as a result, medical practitioners are not only witnessing a greying of the population, but also a greying of the ABI-survivor population

photo credit: as if time stops.. and stay via photopin (license)
photo credit: as if time stops.. and stay via photopin (license)

Seniors with newly acquired brain injuries – how does it affect them?

Evidence is not entirely conclusive, but medical practitioners have come to feel that ABIs may accelerate the aging process. Those living with an ABI may suffer from increased losses in strength, greater fatigue, difficulties with problem solving and memory, and may also experience an increased loss of hearing and vision. In addition, any psychological and behavioural problems which follow an ABI will undoubtedly persist into older age and will increase as an individual ages.

But what about people who suffer an ABI as an older adult? Does the trauma affect them any differently than it would a younger person?

A 2008 study by the CDC found that in 2005, acquired brain injuries resulted in nearly 8,000 deaths and 56,000 hospitalizations for those aged 65 and older. That was ten years ago, and the numbers have risen since.

Dr. Ileana Arias, the Director of the National Center for Injury Prevention and Control (NCIPC) in Atlanta, Ga., agrees the incidents of seniors acquiring brain injury is rising.

“As more baby boomers reach retirement age, these types of injuries will increase demands on the health care system unless action is taken to prevent the injuries,” Dr. Arias said.

Most of the injuries are caused by falls, with traffic accidents a distant second.

Elderly people with an ABI may also have a higher risk of serious complications such as a blood clot on the brain and because they lack the physical strength and stamina of a younger person, the process of rehabilitation may take considerably longer.

photo credit: No Photos, Please via photopin (license)
photo credit: No Photos, Please via photopin (license)

Symptoms of an ABI in an elderly person may include the following:

  • Headaches that get progressively worse
  • Increased confusion
  • Listlessness, tiring easily
  • Crankiness
  • Sad or depressed mood
  • Change in eating habits
  • Change in sleeping patterns
  • Lack of interest in routine activities
  • New vision problems
  • Loss of balance or unsteady walking
  • Failure to identify brain injuries is a common problem: a mild traumatic brain injury diagnosis is often missed when other serious injuries are present.

Another problem is that many seniors tend to ignore the warning signals, relegating them to another sign of getting older. In older adults, brain injury symptoms may take days or weeks to appear. Over that time, the signs indicating a decline in mental facility may appear only gradually. But symptoms which interfere with the basic tasks of day-to–day living such as bathing, dressing, routine chores or taking care of financial matters should be taken seriously and should be dealt with by a specialist.

Older adult ABI survivors are also at risk a greater degree of social isolation. If they happen to be living on their own they may be dependent upon others for help but what happens when the caregivers become sick themselves and are unable to provide the help needed?

Living with ABI as an older adult

An ABI is life altering and even more so for older adults. Physical recovery is only half the battle, and the survivor must be ready to deal with the possibility of cognitive or behavioural changes down the road. But there are an enormous number of resources available in Ontario, all of them geared to helping those affected regain a degree of independence.

Elderly people with an ABI should be treated in a manner that allows them as much independence as possible and there are a number of ways to make life easier. For example, the contents of drawers or supplies in a medicine cabinet might be labelled to help with memory issues. Simple steps for tasks or a written schedule could be created thereby providing the ABI survivor some degree of flexibility while helping them to remain as active as possible. The schedule might include activities such as therapy, visits to medical practitioners or socializing with family and friends. As with many ABI survivors, there will likely be days when a senior with an ABI may not feel like doing anything, so it is important that they be kept engaged as much as possible.

How seniors can reduce the risk of falls and improve safety in the home

There are certain steps seniors can take to reduce the risk of falls, which in turn may lead to brain trauma. Here are some tips via Brainline:

  • Encourage Exercise. Exercise is one of the best ways to reduce older adults’ chances of falling. Exercises that improve balance and coordination are especially important, but check with the older adult’s doctor about which exercises are safest and best for them
  • Remove items from stairs and floors that might cause tripping
  • Remove small throw rugs or use double-sided tape to keep the rugs from slipping
  • Place items used often within easy reach, so that a step stool is not needed
  • Install grab bars next to the toilet and in the tub or shower
  • Place non-stick mats in the bathtub and on shower floors
  • Add brighter lighting and reduce glare by using lampshades and frosted bulb
  • Be sure there are handrails and lights on all staircases
  • Be sure the older adult wears shoes that give good support and have thin, non-slip soles.
  • Remind loved ones to avoid wearing slippers and socks or going shoeless

 

Sources: BrainlineCenters for Disease Control

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