What is Geriatric Head Injury?
Trauma, or physical injury, is one of the main reasons older people experience serious health changes and death. Treating trauma in older people, particularly head injuries, can be quite complex and difficult. This is because older people usually have more ongoing health problems, which increases the likelihood of death from traumatic injuries. Studies have found that when compared to younger patients, older patients suffering from traumatic head injuries are much more likely to die or need ongoing care.
What Causes Geriatric Head Injury?
People over 60 are part of a growing population in developed countries and they’re more likely to get injured. What we define as “elderly” or “geriatric” can be a tricky subject. A lot of times, people consider 65 as the age when someone becomes geriatric, but there isn’t a lot of scientific evidence supporting this. In fact, a person’s existing health conditions might give us a better idea about their likelihood of long-term complications after an injury.
These existing health problems can make older people more prone to accidents like falls. For instance, someone who’s had a stroke could have weakness on one side that makes them unsteady. Older people often have to take a lot of medications, which can lead to falls, confusion and increased risk of bleeding. Drugs like aspirin, or stronger blood thinners like Coumadin, can make head injuries even more dangerous by increasing bleeding. The combination of chronic illnesses and multiple medications puts older people at a greater disadvantage when dealing with injuries.
Risk Factors and Frequency for Geriatric Head Injury
Falls are the leading cause of injuries among older adults. Studies show that people over the age of 65 have about a 27% chance of falling within a given year. Most of these falls occur at ground level, which might not injure younger people as much.
The second most common cause of injury is car accidents. Although they happen less often than falls, car accidents are more likely to be fatal in older people. In fact, older adults who are involved in high-energy accidents, like car crashes, are three times more likely to pass away compared to younger people.
- Falls are the main cause of injuries in older adults.
- People over 65 have a 27% chance of falling in a year.
- Most falls in this age group are from ground level.
- Car accidents are the second leading cause of injuries.
- Car accidents are more likely to be fatal in older people.
- Older adults in high-energy accidents are three times more likely to die than younger people.
Signs and Symptoms of Geriatric Head Injury
When doctors first assess an older patient after an accident, they focus on the essentials like airway, breathing, circulation and any disabilities. Sometimes, immediate steps like putting a tube in the airway (intubation) are needed to stabilize the patient before they can examine for potential head injuries. Figuring out if the person had hit their head is crucial, but it can be complicated, especially if the patient is unconscious, suffering from memory issues, or has confused thinking. In these cases, details are gathered from family, friends, onlookers, and emergency medical staff. If someone mentions that the patient fainted, it might suggest a potential injury due to an accident.
Along with a clear report of a head injury, other important clues can suggest a possible head injury. These can include headache, nausea/vomiting, changes in vision, decreased feeling, weakness, and reported confusion.
Examining older patients with injuries is very important because minor bruising may be the only sign of injury. This is especially true in patients with dementia who might not be able to express their symptoms clearly. However, physical exams can be less reliable in older patients, making it harder to separate new issues from long-standing ones. Despite this, it’s important to be alert for any changes in the patient’s response to light, unusual body posturing, seizures, and combination symptoms like high blood pressure, slowed heartbeat, and irregular breathing—all of which may suggest increased pressure inside the skull from a head injury.
- Initial assessment includes checking airway, breathing, and circulation
- Information from multiple sources may be needed if the patient is unable to communicate
- Signs of a head injury can include headache, nausea, vision changes, decreased sensation, weakness, and confusion
- Physical exams are crucial but can potentially be unreliable in older patients
- Specific symptoms that suggest increased pressure in the skull need careful assessment
Testing for Geriatric Head Injury
When a severe head injury occurs, especially in older people who might have other health issues, a CT scan of the head is usually the top choice for examination. This is because medical professionals can’t always rely on the person’s history or physical exam alone to determine the extent of the injury. Different professional guidelines agree that for people at or over age 60 to 65, a head injury can’t be accurately assessed without a CT scan.
Even though there’s no specific laboratory testing required to check for severe head injuries like brain bleeding, other tests may be needed. These other tests can uncover whether there are any medical conditions that could have caused the injury, like fainting (syncope). Also, if the person is taking a blood-thinning medication called coumadin and a brain bleed is confirmed, a test called PT/INR is necessary ahead of possible surgery. For those taking other types of blood thinners, a test known as a thromboelastogram may be useful. These tests can help doctors plan what steps to take if they need to reverse the effects of the blood thinners.
Treatment Options for Geriatric Head Injury
Certain types of brain bleeds, such as epidural hematoma, subdural hematoma, or intracerebral hemorrhage, may require surgery if they match specific criteria. A neurosurgeon should be consulted promptly to decide the next steps. The most common treatments for these conditions are creating burr holes or removing part of the skull (craniectomy).
It’s important to manage the patient’s blood pressure to avoid dropping too low. If the patient has sustained a traumatic brain injury, normal saline is usually used to maintain the right amount of fluid in the body, as it’s better at preventing brain swelling than alternatives like dextrose or balanced crystalloid solutions, like lactated Ringer’s solution.
Patients might need help with breathing, such as through intubation, to protect their airways and prevent low oxygen levels.
Patients with traumatic brain injuries often need help in managing or preventing seizures. Studies show that up to 20% of patients develop a seizure in the first week after receiving moderate to severe head injuries. Levetiracetam is typically the preferred medication for treating and preventing seizures related to traumatic brain injuries.
If a patient has high intracranial pressure, treatments can include raising the head of the bed to an angle of 30 degrees and keeping the neck in a neutral position. In consultation with a neurosurgeon, using IV hypertonic saline or mannitol to draw water out of tissues and into the blood can also be considered.
If a patient is taking a blood thinner called coumadin, it’s vital to bring their INR (a measure of how fast the blood clots) to a normal level as quickly as possible. This is typically done using a prothrombin complex concentrate and vitamin K. If a prothrombin complex concentrate isn’t available, fresh frozen plasma should be started to help reverse the effects of coumadin.
What else can Geriatric Head Injury be?
There are a number of conditions that can have the same symptoms as a traumatic brain injury in older people. These include non-traumatic brain bleeds, such as subdural hematomas (bleeds on the surface of the brain), intraparenchymal hemorrhages (bleeds within the brain tissue itself), and subarachnoid hemorrhages (bleeds in the space around the brain). These conditions can cause headaches, confusion, or specific issues with nerve function. Stroke is another condition that can show the same signs and symptoms as a traumatic brain injury.
What to expect with Geriatric Head Injury
Individuals aged between 60 and 99 who experience serious head injuries have more than 80% chance of either dying or suffering long-term disability. A severe head injury is defined as scoring less than 9 on the Glasgow Coma Scale.
Possible Complications When Diagnosed with Geriatric Head Injury
People who have survived a traumatic brain injury can sometimes experience long-term neurological issues. These can include things like seizures, which are common after this type of injury. Cognitive problems of different severities can also happen, as can specific areas of weakness or a loss of sensory perception.
Preventing Geriatric Head Injury
The most common causes of injuries in seniors are falls and car accidents. Hence, finding ways to prevent such occurrences is important to reduce the instances of head injuries in older individuals. Key preventative measures can be teaching seniors about the importance of fall prevention and providing tools to assist with walking, like canes, walkers, or wheelchairs. Making simple household changes, like removing rugs that lead to tripping, can also be effective.
To prevent car accidents, doctors have to be careful in evaluating whether existing medical conditions may hinder seniors from driving safely. Conditions like compromised vision, seizures, unpredictable fainting spells, and using multiple medications at once can significantly hinder safe driving for people of all ages, not just seniors.
For patients considering blood thinners, a comprehensive discussion on its pros and cons should occur. This discussion will help the patient and their family understand the implications and adjust their lifestyle as needed, allowing them to make informed decisions.
