Concussions

Concussions in the Nursing Home

elder abuseConcussions are typically associated with small children, athletes and young adults.

However, concussions can happen to elderly individuals in a variety of ways and this is especially true in the nursing home.

Concussions happen when the brain shifts back and forth within the skull during blunt force trauma or a fall (1). There may be no indication that trauma to the head has occurred, as there are often no visible wounds from a concussion.

This kind of injury can result from a sudden jolt to the body that provides enough force to snap the head around, a sudden jolt to the cranium or a sudden blow to the area of the head.

In many cases, the concussion is masked in the elderly because some of the symptoms of a concussion mimic those of dementia and other diseases of the aged. The following symptoms are the most common ones seen in a concussion (1):

  • Confusion, from mild to severe
  • A slowing of the thinking, reading and speaking
  • Concerns about neck pain or constant headaches
  • Mood swings
  • Difficulty understanding the directions of others

Many of these symptoms are misdiagnosed in the elderly as being related to dementia or attributed to other types of diseases.

Risk of Dementia Following A Concussion

When an elderly person sustains a concussion, this can increase their chances of developing dementia. The Journal of the American Medical Association Neurology (2) conducted a study that looked at adults who were 55 years of age and older. They found that even a single brain injury can increase the risk of developing dementia later in life.

The study looked at more than 160,000 Veterans Hospital patients who had experienced some sort of trauma to the head or body. About 60,000 of these participants had experienced a traumatic brain injury from their trauma.

A total of 8.4 percent developed dementia after a concussion. Only about 5.9 percent of patients developed dementia later in life if they never experienced a traumatic brain injury. Among traumatic brain injured patients, the onset of dementia was within less than 3.2 years following the injury.

Another study indicated that patients with Alzheimer’s disease that suffered a traumatic brain injury had more buildup of plaques in the brain when compared to Alzheimer’s disease patients that didn’t suffer from a traumatic brain injury.

Risk Factors for Sustaining a Concussion in the Elderly Population

Falls accounted for the greatest risk factor for a traumatic head injury among seniors who were living in a nursing home (3). According to studies, an elderly person aged 65 years of age or older that lives in a nursing facility is at an elevated risk of falling when compared to seniors in the same age group who lived in a community setting.

The risk of falling in a nursing home is about 2.6 times greater than the risk of falling in the community.

Falls are a completely preventable risk for elderly people living in an assisted living environment or in a nursing home facility. Yet — research indicates that these are places where the elderly person is at the greatest risk of falling. Preventing concussions and traumatic brain injury through management of falls is extremely important in nursing homes and other facilities for the elderly because even mild concussions can become a cause of death for an elderly person.

The risk of developing a blood clot on the brain (a subarachnoid hemorrhage, epidural hemorrhage or parenchymal hemorrhage) in an elderly person is increased whenever there is an injury to the brain. This can cause permanent neurological damage unless immediate emergency services are put into place to relieve the pressure caused by a blood clot on the brain.

Concussions and Nursing Home Neglect

Unfortunately, some nursing facilities do not act as quickly as is necessary when an elderly person becomes injured.

The nursing home staff may take the approach of “watchful waiting” because they do not want to have to complete an injury report or bring emergency services into the facility. This constitutes neglect on the part of the nursing home staff. This is considered a failing that could leave the elderly person with permanent damage to their brain.

How To Prevent Long-Term Damage

While it can be difficult to stand up to nursing home staff, you need to report any incident that might have led to a traumatic brain injury in your loved one. Things you can do to prevent long-term damage include the following:

  • Ask your loved one how they are feeling, what happened and what is currently going on in the world
  • Ask the staff about any incidents of falls
  • Don’t allow staff members to convince you that unusual behavior that suddenly occurs is a part of normal aging
  • Make contact with an attorney who may be able to help you

You should not be fearful to ask nursing home staff members what is happening to your loved one. You should also never hesitate to ask your loved one about incidents that might have happened in the nursing facility.

If you are suspicious that your elderly loved one sustained an injury in a nursing home facility, you should follow up on your suspicions. Talk to the loved one’s doctor or contact an attorney who can get you the help you need for your family member.

References:

  1. http://www.brainline.org/content/2012/06/what-you-need-to-know-symptoms-of-concussion.html. Accessed 3/18/2016.
  2. http://www.healthline.com/health-news/concussions-increase-dementia-risk-in-older-adults-102914. Accessed 3/18/16.
  3. http://health.usnews.com/health-news/news/articles/2013/12/26/concussions–linked-to-alzheimers-risk-in-study. Accessed 3/18/16.
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Dr. Christine Traxler

Christine Traxler, MD is a retired family practice physician, graduate of the University of Minnesota School of Medicine in 1986, and freelance writer, having worked with patients in rural Minnesota for two decades. She has written several books on medical topics and currently resides in Minneapolis, MN, where she works as a freelance writer on medical topics.

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