A traumatic brain injury (TBI) is a potentially life-changing event. It can affect your ability to do things we take for granted—like solving problems, focusing on a task, making decisions and even speaking and walking. People who suffer a TBI are also at greater risk for developing mental health disorders.

A TBI is a type of injury that occurs when a sudden, external force or trauma affects the brain’s functioning. This force can result from a blow or jolt to the head (closed brain injury) or penetration of the skull (penetrating brain injury).  

While TBIs can happen to anyone, older adults are especially vulnerable. In fact, people age 75 and older have the highest rates of TBI-related hospitalizations (32%) and deaths (28%).

TBIs are typically categorized as mild, moderate or severe, based on the degree of impact. A brain injury may or may not involve a loss of consciousness immediately after the traumatic event. Symptoms of a mild TBI include:

• Confusion
• Memory issues
• Trouble speaking clearly
• Headache
• Dizziness
• Nausea and vomiting
• Sensitivity to light and/or sound
• Ringing in the ears

WHY YOU’RE AT HIGH RISK

Falls are the leading cause of TBI, accounting for nearly half of all TBI-related hospitalizations. Older adults are at high risk, with more than 1 in 4 people age 65+ falling each year. 

“It can be just a trip or from medical issues such as cardiac problems or syncope (fainting or passing out),” said Michael Hall, PhD, LCP, an associate professor in the department of physical medicine and rehabilitation at Virginia Commonwealth University. “There are movement problems that can result in people falling as well as medication issues, things like benzodiazepines that can sedate and increase your fall risk.” 

Motor vehicle accidents are a frequent cause of TBI in older adults age 60 to 75. 

CHALLENGES AFTER TBI 

Older age is a known risk factor for poorer prognosis after a TBI. One reason for this, Hall explained, is normal age-related changes and decreased brain plasticity as we get older. Older adults tend to have:

• A higher risk for brain bleeds
• Slower recovery rates
• Higher level-of-care needs
• A greater likelihood of existing medical/mental health issues that worsen functioning
• A higher risk for mild cognitive impairment, dementia and other neurological disorders

While most TBIs are non-life-threatening, they can still have long-lasting physical, cognitive, behavioral and emotional effects. Roughly 1 in 5 people may experience TBI mental health symptoms up to six months. Major depression is the most common mental health diagnosis, followed by:

• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Irritability, anger, emotional lability
• Adjustment disorder
• Substance misuse or abuse
• Psychosis and mania
• Personality changes

People suffering a TBI also have higher-than-normal rates of self-harm and suicide.

Certain predisposing factors can make it more likely for an older adult to experience mental health troubles after a TBI. These include sleep problems, anxiety, alcohol and/or drug use, negative thinking and poor social functioning. A brain injury can also increase the symptoms of a pre-existing mental health disorder. 

INTERVENTION & TREATMENT

Hall said that since mental health issues typically arise within six months after a TBI, early intervention is critical. An in-depth neuropsychological assessment can identify TBI mental health symptoms and create a tailored treatment plan, which may include:

• Screenings (cognitive, mood, suicidality)
• Referrals to mental health resources (therapy, medication management, substance abuse counseling)
• Symptom management/ disease management
• Tracking (cognitive, mood, functioning)
• Assessment of barriers to care
• Crisis and safety planning
• Social/family/peer support
• Referrals to social workers and/or nurse case managers
• Practicing healthy behaviors , including regular exercise, a healthy diet and good sleep habits.

COPING STRATEGIES 

People with brain injuries tend to experience the world differently than they did before, and accommodations may be required to help them adapt. Strategies for managing TBI-related challenges include:

• Keep noise and light to a minimum whenever possible.
• Limit distractions and work on one task at a time.
• Provide written direction whenever possible.
• Break large amounts of information into smaller “chunks” or steps.
• Don’t mistake lack of emotion for lack of interest.
• Provide neutral, but direct, feedback.
• Be factual; avoid abstract concepts.
• Prioritize and organize tasks to be performed.

Brain injuries are considered a “silent epidemic,” meaning they aren’t always easily recognized. Someone with a TBI can appear perfectly normal on the outside. This is one of the reasons they so frequently go undiagnosed, misdiagnosed or mistreated. If you suspect you have a brain injury, don’t ignore it. Talk to your health care provider.

REDUCE YOUR RISK

• Reduce your TBI risk by taking steps to avoid falls:
• Get your vision and hearing checked. Annual exams can help you make sure you’re in tune with the environment around you.
• Use assistive devices like a walker to provide extra support if you have poor balance, muscle weakness or other mobility problems.
• Regularly review your medications and ask your doctor or pharmacist to identify any potential side effects that can increase your falls risk.
• Fall-proof your home by removing tripping hazards, installing grab bars in bathrooms and stairways, and making sure lighting is sufficient throughout. 
• Find a balance and exercise program.
• Check your risk for falling with our Falls Free CheckUp and share your score with your health care provider. Take the quiz here: NCOA.org/tools/falls-free-checkup 

This article provided courtesy of National Council on Aging.