When Laurie retired at age 69, she was in fairly good health. She controlled her mild heart condition with medication, though some memory difficulties had led her to move in with her daughter.

One morning as she entered the bathroom, Laurie tripped over the bathmat and fell, hitting her head on the granite vanity top. Hearing a noise, her daughter rushed to find Laurie on the bathroom floor. She helped her mother to her feet, then nursed her cuts and bruises from the fall. Since Laurie seemed otherwise fine, neither of them thought to seek medical attention.

The next morning when her daughter could barely rouse Laurie, she called 911. By the time the paramedics arrived, Laurie was clearly disoriented; by the time they arrived at the emergency room after the 20-mile drive to the nearest hospital, Laurie could no longer talk.

Falls are the leading cause of traumatic brain injury (TBI) in the U.S., and older people like Laurie—especially those who have physical or cognitive issues—are most at risk. In fact, in adults aged 65 or older, more than 81 percent of TBIs result from falls.

Laurie had experienced a subdural hematoma, when blood pools between the brain and the membrane between the brain and the skull caused by rupturing blood vessels. In older people like Laurie, subdural hematoma may occur more than in younger people because the aging brain tends to atrophy and shrink. The blood vessels that connect the brain to the skull also shrink and become thinner and more taut—and thus more susceptible to ruptures when a person falls and hits their head.

Why didn’t Laurie and her daughter recognize a problem sooner? With a subdural hematoma, blood slowly leaks from a bruise, and often no symptoms appear at first, leading caregivers, patients, and even health care providers to believe that the head injury is not serious enough to require treatment.

In fact, according to the U.S. Centers for Disease Control and Prevention, people age 65 and older account for half of all TBI-related deaths—a disproportionate number, considering people in this age group only experience 10 percent of all TBIs.

The atrophy of the older brain may contribute to the fact that seniors recover from aTBI less readily than younger people. Elderly patients have different physiological and psychological needs than younger TBI patients, and some research suggests that even mild TBIs may worsen cognitive decline, including an earlier onset of dementia, in the years following an injury.

Elderly patients also tend to have a number of health factors already in play when they fall, complicating the initial injury and ultimately their ability to recover. For example, many older adults take blood thinners, which make any leak to bridge blood vessels between the brain and the skull more severe. According to a report in the journal Current Translational Geriatrics and Experimental Gerontology Reports, numerous studies show that Laurie’s heart medication, the commonly prescribed blood thinner warfarin, increases elderly mortality by 50 percent or more.

Emergency surgery on the subdural hematoma saved Laurie’s life. While her recovery may have been improved, though still complex, had she and her daughter realized right away that they should go to the hospital, healing from this injury for an elderly person remains a long-term proposition.

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Thanks to these colleagues for the website photo opportunities:

Kam Gardner, MS, CCC-SLP, Speech-Language Pathologist
Raymond Samatovicz, MD, Physiatrist, Brain Injury Medicine Specialist
Kaiser Foundation Rehabilitation Center, Vallejo, California