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5 Things to Know About Concussions

Risks are higher for older adults, and sometimes the warning signs are easy to overlook

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Malte Mueller / Getty Images

Whether it’s caused by a slip on the ice, a spill off a bike or a tumble on uneven ground, taking a hit to the head is nothing to overlook.

You could have a concussion — a type of brain injury that experts say requires immediate medical attention, since a swift diagnosis and proper treatment is key to preventing further damage.

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Concussions are especially a concern for older adults. An estimated 36 million falls are reported each year among adults age 65-plus, according to the Centers for Disease Control and Prevention (CDC). “And we know about 80 percent of head traumas occur in older adults from falls,” says Richard Figler, M.D., a staff physician at the Cleveland Clinic’s Center for Sports Medicine and director of the Concussion Center.

Read on to learn more about concussions, including their warning signs and symptoms, plus a few steps you can take to help prevent them.

1. What is a concussion?

A concussion is a mild traumatic brain injury, or TBI, caused by a bump, blow or jolt to the head, according to the CDC. These types of impacts can cause the brain to bounce or twist around in the skull, triggering chemical changes in the brain, and possibly stretching and damaging brain cells.

2. Concussion symptoms are wide-ranging — and not always obvious

When it comes to concussions, the range of symptoms is quite broad, says Ray Chu, M.D., associate professor of neurosurgery at Cedars-Sinai in Los Angeles. Some people might experience a headache; others have trouble with thinking or memory.

“Sometimes people have some light sensitivity or sound sensitivity,” Chu says.

Other common symptoms include feeling anxious or irritable, feeling dizzy or unsteady, or having nausea or vomiting. Symptoms can develop right after the incident or creep up hours — even days — later, though Chu notes that people with a concussion are typically “a little bit dazed” immediately after the fall or hit. 

Because these symptoms can be similar to other health problems, it’s not uncommon for them to be overlooked by a patient or health care provider, the CDC notes. That is why it’s important to be evaluated right away if you or someone else notices that you are confused, unsteady or speaking funny, Chu says.


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If possible, ask someone who knows you well to accompany you to the emergency room. “Because any kind of change in behavior could be an indicator that they have had something like a stroke or traumatic brain injury,” Figler says.

Your doctor will likely check your vision and hearing and ask you a series of questions to observe how your brain responds. It’s possible you’ll also need brain imaging tests, most likely a CT scan, to rule out any complications.

3. Older adults are at increased risk for complications

Older adults who have a concussion are at greater risk for bleeding in the space between the skull and the brain tissue due to age-related changes that take place in the brain, Figler explains.

Adding to the risk is the use of blood thinners, a common type of medication among the older population. If you’re being evaluated for a fall, it’s important to tell your doctor about all of the medicines you are taking, including over-the-counter antiplatelet drugs like aspirin.

And because bleeding can be slow and, as Figler explains, “accumulate over the course of time,” don’t be surprised if your doctor keeps you overnight for observation. “The key is making sure that we’re monitoring people afterwards, because the biggest risk is missing that [bleeding] and somebody potentially dying from an intracranial bleed,” he adds.

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4. Rest is the key to recovery 

The good news: Most people with a concussion recover quickly and fully, the CDC says, though the process may be slower in older adults. Recovery typically involves a lot of rest — both physical and mental — in the first few days. Then, as symptoms improve, you can ease back into routine activities.

Not giving your brain enough time to recover could put you at risk for more long-term injuries if you take another hit to the head. “When your brain is already in a state where there’s a mild injury and it’s healing, sometimes that second injury becomes something more life-threatening,” Chu says.

5. You can reduce your risk for brain injuries

One message experts want to drive home is prevention. Always wear a helmet when you are biking or skiing, Chu advises. And don’t forget your seat belt in the car.

Older adults, in particular, can take a few extra steps to reduce their risk of falling, and therefore their risk of a concussion. At the top of the list: Exercise often and be sure to focus on exercises that help to improve your strength and balance.

“Exercise is one of the most important components that we think can help reduce the risk of falls,” Figler says. “And I can’t stress balance enough. Balance is a huge component, because balance is a neurological and a muscular function that, combined, keeps us upright. And when we lose that balance, for whatever reason, we are at a significant increased risk of falling.”

Ask your doctor to check your eyes and feet annually. And while you’re there, be sure to have your list of medications reviewed. Some drugs, or a combination of them, can make you feel dizzy or sleepy and put you at risk for a fall. “There are typically other medications we can potentially try that might make a difference,” Figler says.

Make sure you’re staying hydrated, since dehydration can cause falls. Finally, take stock of tripping hazards in your home and remove them. Clear clutter in high-traffic areas (especially on stairs) and remove small throw rugs or use double-sided tape to keep them from moving, the CDC recommends. Use nonslip mats in the bathtub and swap dim lights for brighter bulbs.


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