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TBI Symptoms and Progression in Older Patients vs. Younger

Believe it or not, your parents and grandparents are at high risk for concussions and TBI, or traumatic brain injury. This is not because the elderly are playing tackle football in their free time. It is because they are more prone to falling. As we age our vision, balance, and coordination all become less reliable, and falls become more frequent. In fact, 36 million seniors fall per year.

Photo Sourced from Griswold Home Care

At advanced ages, even low energy falls that happen getting out of the shower or simply missing a step can result in serious health consequences. The worst of those are broken bones and TBI.

So what exactly is TBI, what are TBI symptoms, and how does this type of injury affect young versus older patients. Continue reading below for the answers.

What is TBI?

TBI stands for traumatic brain injury. This acronym is used to refer to any injury to the brain caused by external physical forces. An external physical force could be from a car accident, a sports-related impact, or, most common in the elderly, a fall.

External forces do not refer to strokes, tumors, or any other internal source of brain damage.

Not all head bumps are considered TBI. In addition to an external physical force, TBIs also involve a loss of consciousness, memory loss of the event, a skull fracture, seizures, or an abnormal brain scan.

Types of TBI

There are a few different types of TBI, depending on the level of head trauma. The brain is made up of soft tissue that is just floating inside the skull. The soft tissue of the brain can twist, stretch, rip, or become compressed depending on the type of force on the head.


In a closed head injury, damage occurs as the brain strikes the inside of the intact skull. This happens either from a blow to the head or the head stopping suddenly enough to jostle the brain around, such like might happen during a car accident. The impact of the brain on the skull causes bruising to the brain.

A closed head injury might also occur if the brain twists inside the skull. This results in the stretching and tearing of the nerves and blood vessels within the brain. This type of damage might be localized or spread throughout the brain.


In an open head injury, the skull itself is opened up. The brain tissue is damaged by the same force that broke the bone of the skull. This requires an extreme impact on the skull, such as a bullet wound. Open head injuries are usually localized.

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Primary Injury

The primary injury is whatever happens to the head. That could be the head hitting a windshield, another head, or the ground. This could also be the brain hitting the inside of the skull. Primary injuries are irreversible.

Secondary Injury

Secondary injuries occur as an indirect result of the primary injury, or the head trauma. For example, damage to the blood vessels may result in limited blood flow to the brain tissue which causes further damage. Secondary injuries also include damage caused by swelling in the brain tissue, increased pressure within the skull, or infection of the brain, also known as meningitis.

Photo Sourced from Trauma Victoria

The goal of treatment is to prevent or slow these secondary injuries through some sort of intervention. This could mean drilling a hole in the skull to relieve pressure or closely monitoring the brain with CT scans.

TBI Symptoms

It can be hard to know if a fall has resulted in a TBI. Keep a lookout for these symptoms:

  • Loss of consciousness

  • Balance problems

  • Dizziness

  • Headaches

  • Vomiting

  • Seizures

  • Blurred Vision

  • Light Sensitivity

  • Memory problems

  • Mood swings

  • Disrupted sleep patterns (either more or an inability to sleep)

One or more of these symptoms following head trauma is a good indication that the individual has sustained a TBI. In this case, you should seek treatment as soon as possible.

Progression of TBI Symptoms in the Elderly

The most common symptoms of a TBI in an elderly patient are confusion and memory loss. It can be especially difficult to diagnose a TBI in an elderly patient with pre-existing memory problems.

Memory loss and a general decline in mental acuity are part of the aging process. However, if symptoms occur suddenly or alongside other TBI symptoms like incontinence, seizures, or a lack of consciousness, this is probably a brain injury. It is essential to get a good history from a patient or the patient's family to determine if they did experience head trauma.

Where the symptoms of a TBI and secondary injuries may resolve or be easier to treat in younger patients, older patients may not progress as well. This is due to a number of factors.

Complications for Elderly Patients

Although primary injuries in the elderly are usually the result of a fall and may not be as severe as a child involved in a sports injury, underlying factors can lead to more severe secondary injuries.

Brain Shrinkage

As we age, the brain, like any other tissue in the body, shrinks. This shrinkage means there is more room for the brain to move around within the skull, resulting in closed head TBIs even from low-energy impacts, like a fall.


The brain also becomes less pliable with age. The veins of the brain become more fragile meaning they are more likely to tear if the head is jostled around. Secondary injuries in elderly TBI patients are often bleeding in the brain, also known as hematomas.


Older patients often have a whole host of comorbidities. In fact, about 50% of elderly adults have high blood pressure and many take some sort of blood thinner. Blood thinners will worsen bleeding anywhere in the body, including in the brain.

Brain Plasticity

Older brains have less plasticity. Plasticity is the brain's ability to adapt to changes. This means cognitive recovery takes longer.

Management Intensity

Management intensity refers to the amount of time spent with or on a patient. Research is clear in showing that as age increases management intensity decreases.

This means older TBI patients will wait longer for CT imaging than younger patients, will be seen by only the most junior doctors, and will be less likely to receive surgical intervention. This bias in care can have a real impact on patient recovery and outcome.

Outcomes for Elderly Patients

Despite brain trauma often being less severe in elderly TBI patients, their outcome is usually worse.

Unfortunately, TBI-related mortality is higher among seniors than among children. This likely has to do with the factors and complications described above.

TBI Symptoms in the Young

TBI symptoms are generally the same for the young, including dizziness, vomiting, seizures, and memory problems. However, children can have difficulty communicating changes they may experience in vision or sensitivity to light. Children with TBIs will likely suffer from behavioral changes such as mood swings, irritability, and sleep disruptions.

Children progress through a TBI more quickly than adults. Again this has to due with brain plasticity, fewer comorbidities, and fewer health issues in general.

Treatment for TBI

Patients with moderate to severe traumatic brain injuries will likely end up in a trauma center. CT head scans can determine the extent of the damage and of secondary injuries, such as a brain bleed.

Surgery may be necessary to relieve pressure in the brain caused by swelling and bleeding. A burr hole, or small hole, will be drilled in the skull to relieve pressure. In cases of extreme pressure, a surgeon may remove a larger piece of the skull.

The priority is to limit further damage to the brain. However, the treatment also involves airway, blood pressure, and seizure management.

Tracking TBI Symptoms

Traumatic Brain Injuries can alter a person's life forever. Even mild, TBI symptoms can interfere with a person's ability to think and function, from memory loss to sleep disruptions.

It can be helpful to track your or your loved ones' symptoms and triggers. The more information, the better the outcome from a TBI will be.

For older patients, it is especially important to keep close track of symptoms. This allows the patient to distinguish between pre-existing, normal, old-age amnesia and new or sudden onset symptoms that could point to a worsening or new TBI.

Older patients frequently experience worse outcomes when it comes to TBI even if the injury is less severe. Having a good handle on the symptoms can make a world of difference.

Create an Account with Sallie®

Power of Patients' Sallie® was designed to help patients dealing with traumatic brain injury symptoms and providers caring for them.

If you have a concussion or severe TBI or are caring for someone that does, tracking their symptoms can be overwhelming and impact both the injured and the caregiver's quality of life. Sallie® can help track TBI symptoms through an easy-to-use dashboard.

Even if you are unsure whether or not you or your loved one has sustained a TBI or concussion, it is a great idea to track your symptoms and triggers using Sallie®. Monitoring any symptom progression can help lead to the correct and personalized rehabilitation.

Engage with your medical provider through the use of Sallie® and start your journey to a truly personalized recovery now.

For more information about TBIs check out more of our blog posts!

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