Aging & brain injury

The process of aging can potentially have accelerated impacts on people with an existing brain injury. It can also lead to increased chances of brain injury for older adults.

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Aging after a brain injury

While aging affects everyone, it can have more noticeable effects on someone living with a brain injury.

Ongoing cognitive challenges
It is normal for brain injury survivors to have lasting changes to their cognitive abilities. This includes memory loss, difficulty with concentration, and difficulty making decisions. For seniors, there may be a decline in cognitive abilities associated with aging. A senior with a previous brain injury may experience accelerated aging that affects cognition. This includes speed of processing information, decision-making, slower reaction times and memory. These effects can even lead to difficulty managing existing cognitive and behavioural challenges.

Multiple conditions
A person may develop comorbid medical conditions. Comorbid means conditions present at the same time. As we age, we are more prone to developing additional health conditions. This includes diabetes, hearing and vision problems, heart disease, osteoporosis, and high blood pressure. Co-morbid conditions can impact existing cognitive problems[1].

Any additional health challenges can impact a person’s mental, emotional and physical health. If your friend or family member does experience additional health challenges, doctors will provide you both with the appropriate information for treatments from different rehabilitations and medical professionals.

Increased risk of social isolation
While having a brain injury can increase the risk of social isolation, so can aging. Statistics Canada reported that several factors contributed to less socialization in older individuals. This includes hearing loss, emotional challenges, cognitive challenges, pain, and a fear of falling[2].

Humans are social creatures by nature, and this doesn’t change with age. A lack of socialization can lead to loneliness, depression, and additional mental health struggles. Since health problems, brain injury, and aging can all contribute to social isolation, it becomes a difficult cycle to break.

It’s important for your friend/family member with a brain injury to stay in touch with your family, friends, and the community they have created over the years. Look for community activities that are tailored for seniors or for individuals with brain injury to increase socialization. This includes clubs, community programs and fitness classes. If they are able, volunteering is also an excellent way to be social, stay busy, and help others.

Increased risk of Alzheimer’s and dementia
Studies have shown that moderate to severe traumatic brain injury is a risk factor for the development of Alzheimer disease and other dementias[3] . There is also an increased risk for Alzheimer’s and dementia with stroke and additional conditions such as epilepsy[4]. However, it’s important to note that many neurodegenerative diseases have genetic, lifestyle and environmental factors. Having a brain injury does not mean a person will develop Alzheimer’s or dementia as a senior.

If you notice any cognitive declines that seem to fall outside the scope of the person’s brain injury symptoms, check in with a doctor.

Increased risk of falls
A person with an acquired brain injury may be at risk for falls as they age due to balance, mobility, and cognitive impairments. Falls could also occur because of the environment: for example, unsteady terrain or inaccessible buildings. All of these factors can increase a person’s risk of  fall, which increases their risk for another brain injury[5].

You can reduce the risk of falling by getting the person with a brain injury to use assistive devices such as canes, walkers, and wheelchairs. Walking poles can provide an extra level of support, especially if walking is a main source of exercise. They should also make sure to wear supportive, secure footwear, remove obstacles from traffic paths in the home, and ask for help if necessary.

Acquiring a brain injury as a senior

Whether a person has an existing brain injury or not, the risk of acquiring a brain injury goes up with age. According to data from the Canadian Institute for Health Information, older adults (60 years or older) account for 29% of all head injury hospitalizations in Canada[6]. A population study showed that the rate of traumatic and non-traumatic brain injury increases in older age groups, with the highest rates being in the 85 years and older range[7]. These numbers are the same for both males and females.

Some of the leading causes of brain injury in seniors include:

Falls
As people get older, they are more at risk of falls. It is estimated that 1 in 5 Canadians aged 65 or older fall[8] and North American studies show that falls are the leading cause of traumatic brain injury in older patients[9]. Factors that can increase the risk of falls include substance use, medications, decreased balance, reduced attention and age-related neurological conditions such as dementia[10] .

Falls generally occur due to uneven or slippery surfaces and a loss of balance. People can fall in doorways, ramps, on the stairs, and in areas with heavy traffic. There is also a relationship between falls and strokes. Unexplained falls sometimes turn out to be signs of ‘silent’ strokes, and a history of strokes further increases the risk of falling.

Increase in instances of non-traumatic brain injury
As a person ages, they are at a greater risk of experiencing a medical event that can cause a non-traumatic brain injury. This includes stroke, brain tumours, and encephalitis.

More information on causes of non-traumatic brain injury

In a study completed in Ontario, hospitalization rates for non-traumatic brain injury increased with age; rates of 365 persons per 100,000 were reported for those 65-74 years old, compared to 561 persons per 100,000 for those above 85 years old (these rates did not include individuals with a primary diagnosis of stroke)[11] .

Motor vehicle accidents
While not as prevalent as other causes of injury, motor vehicle accidents still impact seniors. This is in part due to the fact that a large portion of the driving population is 55 years or older. As individuals age, it is possible to experience vision problems, slower reaction times, and cognitive changes that can impact a person’s driving[12].

Impact of age on acquired brain injury recovery

Age is a significant factor when it comes to recovery after acquired brain injury. Multiple studies have shown that there are greater long-term effects and poorer prognosis after a brain injury (with most studies focusing on traumatic brain injury) in older populations. These studies report older patients have higher mortality rates and worse functional outcomes than younger patients that have more severe injuries. They also have evidence that older survivors need more rehabilitation, pay more for rehabilitation and experience greater levels of disability[13] .

Mental health and behavioural changes

It is common for anyone with an acquired brain injury to experience a mix of mental health and behavioural changes such as depression, irritability, sleep problems, and mood swings. Mental health and behaviour have a direct effect on willingness and ability to perform rehabilitation. It is important to always speak with a medical professional or psychologist about symptoms, emotions and behaviours to receive an accurate diagnosis and develop a treatment plan.

Lack of rehabilitation

Many individuals with acquired brain injury, including seniors, may not be using rehabilitation services due to lack of availability, long wait lists, a lack of knowledge about cognitive and behavioural needs, and poor coordination of services[14]. More immediate access to rehabilitation, either in person or virtually, and more consistency could lead to better outcomes.

Age doesn’t have to be a barrier to recovery. By taking proactive steps and developing a continuing care plan with your friend/family member and healthcare professionals, rehabilitation and recovery can move forward. Some of the ways you can support them in their recovery include:

  • Offering help. You love them and want to support them, and they need to know that. They may not feel comfortable coming to you (especially if they are used to being able to do everything on their own), so it can be helpful for you to make the first move. Let them know you want to talk about their questions, concerns and ideas
  • Becoming an advocate. Advocating for the services and supports your friend and family member needs is an important part of making people aware of brain injury. Learn more about becoming an advocate
  • Learning more about brain injury. The more you know about the injury and its effects, the more informed you will be. This will also help you ask better, more thoughtful questions
  • Work with multiple healthcare providers. There is no one size fits all for brain injury rehabilitation. When a person experiences multiple effects of brain injury, they need multiple therapists and professionals to help them learn adaptive techniques and coping methods

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