Senator Mitch McConnell, the 81-year-old Senate minority leader, received treatment for a concussion at a Washington hospital on Wednesday night. According to a spokesman, he was injured when he fell at the Waldorf Astoria hotel.
Concussion is the most common form of traumatic brain injury, and, while attention often focuses more on effects in young athletes, older adults are at higher risk for severe outcomes following one, neurologists and health experts said.
Rates of concussions are increasing rapidly among older adults, said Dr. Geoffrey Manley, a professor of neurological surgery at the University of California, San Francisco. He partly attributed the increase to advances in cardiac and oncologic care, as well as the growing number of procedures like joint replacements, which enable older people to stay active for longer periods of time, but can also raise their risk of falling. Falls are the most common cause of concussion among any age group, said Dr. Monica S. Vavilala, director of the Harborview Injury Prevention and Research Center at the University of Washington School of Medicine.
Experts said that the outcomes and longer-term effects of concussions can vary greatly from patient to patient. Here’s what we know about the prognosis, risk factors and potential impact of concussions in older adults.
What is a concussion?
The specifics of what happens in the brain during a concussion are still largely a mystery. What researchers do know is that concussions result in brain dysfunction: When someone suffers a head trauma or is subject to violent shaking, brain cells may be injured and the networks in the brain don’t function the way they normally would, said Dr. Amaal Starling, director of the Mayo Clinic Sports Concussion Program.
Doctors typically classify concussions as a mild form of traumatic brain injury — “but mild is often a misnomer, especially when it comes to older adults,” said Dr. Angela Lumba-Brown, an associate professor of emergency medicine at Stanford University.
While most people recover from a concussion, no matter their age, even a seemingly innocuous head injury in an older adult can trigger bleeding in the brain, which requires a physician to properly diagnose.
What are the symptoms of a concussion?
Symptoms can vary from person to person, but in general, those who suffer a concussion may experience confusion, dizziness, fatigue, sensitivity to light, memory loss, headache and vision changes, said Dr. Joel Salinas, a clinical assistant professor of neurology at NYU Langone Health. Some people with concussions also vomit, feel sluggish or groggy or just “don’t feel right,” according to the Centers for Disease Control and Prevention.
Many symptoms are commonly overlooked in older adults, Dr. Lumba-Brown said, because they can have a different “baseline” from younger people; they may already have issues with balance, mood disruptions or memory, all of which could indicate a concussion. Sometimes, providers or caregivers confuse concussion symptoms with those of dementia, Dr. Vavilala said, which may result in patients delaying care.
Are concussions different in older adults?
Much of the research into concussions focuses on younger people, particularly athletes, said Benjamin Emanuel, a neurologist at Keck Medicine at the University of Southern California. But doctors have identified a cluster of unique factors that put older adults at a higher risk of severe complications following a concussion.
The anatomy of the aging brain can predispose it to more serious brain injury: For instance, older adults are at a higher risk of tearing blood vessels in their brains, Dr. Salinas said. And taking anticoagulation medications, like blood thinners, which is more prevalent in an older population, can elevate the risk of bleeding in the brain.
Dr. Vavilala added that older adults may also have mood disorders like depression, which can worsen in the wake of a concussion, for reasons that experts don’t fully understand.
How do you treat a concussion?
There is no one drug to cure a concussion, Dr. Manley said. Instead, patients can manage symptoms with rest, physical therapy and medication as needed. But, he added, most older patients can, and usually do, make a full recovery.
People should consult their doctor about which over-the-counter medications they should take to manage headache symptoms, Dr. Lumba-Brown said.
Treatment for mild cases mainly involves rest, avoiding mental and physical exertion. “It’s like nursing a sprain,” Dr. Emanuel said. The basic building blocks of good health — restful sleep, ample hydration, regular check-ins with a primary care physician, as well as social support from friends and family — can all help.
Most older adults will recover from a concussion in about a month, Dr. Lumba-Brown said, but around a third will take longer than that. Patients who have bleeding in the brain may have a more prolonged recovery time, she added, which is why it is important to seek treatment right away.