Sports-related brain injury and concussion among young people have finally begun to receive the awareness they deserve. Indeed, we feature a story on the subject in this issue, so that more parents, players, and coaches will pay proper attention to head injuries as schools reopen this fall.
But few people realize how common the problem of traumatic brain injury (TBI) is for the elderly, especially for those who have a neurologic condition—such as Parkinson's disease, epilepsy, stroke, dementia, neuropathy, and multiple sclerosis—that puts them at risk for falls. Remarkably, falls are responsible for more than one-third of all TBIs, and represent the majority of all TBIs in people over the age of 65, according to a report from the US Centers for Disease Control and Prevention (CDC).
The CDC estimates that at least 1.7 million Americans sustain a TBI each year. Of those, 1.4 million are treated and released from an emergency department, 275,000 are hospitalized, and 52,000 die. Sadly, adults aged 75 and older have the highest rates of hospitalization and death from TBI. Older age is also associated with more disability and poorer outcomes after a TBI.
These figures are likely underestimates, according to experts, who characterize TBI as a "silent epidemic" because of its potential for devastating outcomes. It is also conceivable that this underreporting is worse in people who are impaired by cognitive disorders like Alzheimer's disease, and in those who already experience neurologic symptoms such as dizziness and balance problems, headache, or drowsiness, which may not be recognized as signs of a TBI after head trauma. Another group at risk for having masked symptoms are geriatric patients, who tend to take more medications, some of which can be sedating.
The anatomy of the older brain can also make a bump to the head riskier for the elderly. Advanced age causes the brain to atrophy, creating more space for blood to accumulate between the brain and the skull before symptoms occur. And people taking anticoagulants for stroke prevention are even more vulnerable. These concerns are why the American College of Emergency Physicians recommends that a non-contrast computed tomography (CT) scan be performed in all head trauma patients over the age of 65. A CT scan can rule out skull fracture, bleeding in or outside the brain, and contusions (bruised brain tissue).
In my own experience, it is the mild TBI, or concussion, that often goes unrecognized, mainly because it cannot be diagnosed with an imaging test. I see patients of all ages who come in with concussion symptoms but have no idea that a concussion is the cause of their complaints.
Whether you're a parent of a young athlete, the caregiver of an older person at risk for falls, or are at risk yourself, you can learn more about the signs and symptoms of mild TBI by visiting the American Academy of Neurology's Sports Concussion Resources and downloading the AAN's Concussion Quick Check app on your smartphone or tablet. If you have your own TBI story, please share it with us.
Orly Avitzur, MD, MBA, FAAN
Editor-in-Chief