What older adults need to know about concussions

As you age, your risk of this type of brain injury goes up. That’s why it’s important to know the signs and the best ways to protect your body and mind.

Older adult thinking about concussions

The word “concussion” may bring to mind football players and other athletes. Or maybe someone who’s been in a bad car wreck. But the truth is that a concussion isn’t always the result of a severe impact. In fact, the most common cause of concussion is a fall. Which means older adults are more vulnerable. 

Why? Because people ages 65 and older have an increased risk of falling, according to the Centers for Disease Control and Prevention. About 36 million falls are reported among older adults in the United States every year.   

Many people who have had a fall don’t want to go to the doctor or a hospital. So, some older adults may not know that they’ve suffered a concussion at all.  

“After sustaining a head injury, you can feel out of it, and a concussion is hard to self-diagnose,” says Jonathan Rasouli, M.D. He’s a neurosurgeon at Northwell Health’s Staten Island University Hospital and an assistant professor of neurosurgery at the Zucker School of Medicine at Hofstra University in Hempstead, New York. 

Concussion symptoms can also look like age-related issues. If you don’t get checked out, a doctor may not be able to pinpoint the real reason you’re having cognitive difficulties. 

To stay safe, it’s good to know a few things about concussions. Understanding the signs and how best to recover can help you — and your brain — bounce back. 

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What are the signs of a concussion? 

A concussion is a mild form of traumatic brain injury, or TBI. It occurs when the skull and brain are rapidly jolted back and forth. This is usually the result of a bump, bang, or blow to the head, face, or neck. Or it can be a hit to the body that jostles the brain. According to the Brain Trauma Foundation, a person with a concussion is awake upon impact, but they may become unconscious for a few seconds or minutes afterward. 

The impact of a concussion prompts a sudden flow of brain chemicals called neurotransmitters. This can cause temporary problems with cognition, explains Dr. Rasouli. “A concussion can affect your speech, judgment, the way you interpret things around you, and your level of alertness and awareness,” he says. “You can also feel confused.”  

Other signs of a concussion include problems with short- or long-term memory, attentiveness, concentration, and overall slowness in thinking. A person who has a concussion may also experience emotional side effects. They may feel anxious, irritable, sad, or angry.  

Additionally, concussion can bring on: 

  • Balance problems 
  • Dizziness 
  • Being bothered by light or noise 
  • Headaches 
  • Nausea or vomiting 
  • “Pressure” in the head 
  • Sleep issues, such as insomnia or sleeping too much  
  • Tiredness 

You may have symptoms immediately, or you may not. Some can occur minutes, hours, days, or even weeks after the injury.  

What to do after a fall where you hit your head 

It can be easy to brush off a fall, particularly if you are able to get up easily and feel fine afterward. But remember: The symptoms of a concussion aren’t always easy to pick up on.  

Dr. Rasouli recommends erring on the side of caution and going to the emergency room (ER) anytime you fall. You may need tests that require certain machines. And those machines may not be available in a traditional doctor’s office or an urgent care clinic. 

In the ER, a doctor will perform an initial exam. They’ll do basic cognitive testing, such as asking your name, what year you were born, and where you are. They might order imaging tests such as X-rays to check for any broken bones. 

An ER physician may also order a computerized tomography scan or magnetic resonance imaging if you have a severe headache, seizures, or repeated vomiting. These tests can’t diagnose a concussion. But they can detect any bleeding or swelling in the brain.  

If you’re treated in the ER for a concussion, let your primary care doctor know. That will help ensure that they don’t miss symptoms or misdiagnose them as general aging issues. That’s because there’s quite a bit of overlap between concussion signs and age-related symptoms such as memory blips, hearing loss, vision problems, depression, and dementia.  

A long-lasting concussion can also lead to a decrease in social and physical activity. If your doctor doesn’t know that you’ve experienced a fall or head trauma, they may attribute those changes to loneliness, social isolation, arthritis, mobility issues, or a sedentary lifestyle.   

How your brain recovers from a concussion 

The brain is pretty good at bouncing back when it comes to concussions. “The vast majority of people who have one will get better and recover fully in a couple of weeks,” says Dr. Rasouli. However, multiple concussions can increase the risk that a person won’t recover as quickly. 

And being older can add to the risk of poor recovery as well, even from a single concussion. “It can take a while to recover from a concussion, due to post-concussion syndrome,” Dr. Rasouli says. That’s just a way of saying that symptoms can persist after the concussion. Long-term side effects can include cognitive symptoms like problems with attention, thinking, memory, and speed; as well as tiredness and headaches; difficulty concentrating and falling asleep or staying asleep; and appetite changes.  

These issues can last up to a year. “But generally, post-concussion syndrome improves in a month or two,” Dr. Rasouli adds. 

The first step in recovering is rest. Just like any physical injury, you need some time to let your body focus on recovery. Current guidelines recommend resting for 1-2 days after a concussion. So save your mental energy for healing, and minimize overstimulation. Limit screen time, multitasking, driving, loud noise, and bright lights. Try to get some bed rest. “And if there’s a lingering headache, take some over-the-counter pain relievers,” says Dr. Rasouli.  

After those few days of rest, it’s important to get back to ordinary life if you are up to it. In general, studies show that resuming normal activities can help accelerate a full recovery.  

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What to do if your symptoms don’t get better 

While many people make a full recovery from a single concussion over a few days or weeks, some people don’t. They might continue experience cognitive problems, headaches, poor sleep, or irritability for months or even years after the injury — a constellation of symptoms doctors typically call post-concussive disorder. And the risk factors that make you more likely to experience post-concussive disorder — and less likely to have a quick, full recovery — are risk factors that any older person might have that relate to overall brain resilience, like having had a previous concussion, or having had an episode of depression or anxiety. Or even just ordinary age-related cognitive changes. 

If you find that you’re not getting better, you should see a head injury specialist who can help develop a personalized rehabilitation program designed specifically for you and your pattern of post-concussive symptoms. That could include:  

  • Cognitive rehabilitation therapy (to improve speed, attention, and memory) 
  • Vestibular therapy (to treat balance problems) 
  • Vision therapy (to treat issues like double-vision) 

At a leading clinic, you’ll likely be offered an evidence-based brain training program to help with your recovery, as well as expert coaching from a trained clinician.  

Getting over a concussion when you’re older may take a little longer than it would otherwise. But because the brain is plastic — and can be rewired at any age — there’s no reason to believe you won’t make a full recovery and be back enjoying life soon enough. 

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Additional sources: 
Concussions as traumatic brain injury: Centers for Disease Control and Prevention 
Causes and signs of concussions: Centers for Disease Control and Prevention 
Concussions and consciousness: Brain Trauma Foundation 
Concussion rehabilitation options: The Concussion Alliance 
How to prevent falls: Centers for Disease Control and Prevention 
Head injury and risk of dementia: Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association