Key points

• Concussions in seniors are common, and are often underestimated and overlooked due to misconceptions about ageing symptoms.
• Falls and head trauma stand out as significant contributors to concussions in the elderly demographic, emphasising the need for preventative measures.
• A concussion, a mild traumatic brain injury (mTBI), results in temporary mental alterations, making accurate diagnosis challenging due to symptoms often attributed to normal ageing.
• Physical therapists, as movement experts, play a pivotal role in preventing, diagnosing, and treating concussions in seniors through personalised fall prevention strategies and post-concussion care.
• Physical therapists address common complaints of dizziness in older adults, conducting thorough assessments and employing manoeuvres like those for benign paroxysmal positional vertigo to enhance overall balance.
• Concussions in seniors require nuanced understanding; physical therapy emerges as a valuable ally, contributing significantly to overall well-being and quality of life through awareness and proactive measures.

Introduction

Concussions in seniors are a growing concern, often overlooked due to misconceptions about ageing symptoms. Falls and head trauma are significant contributors to concussions in this demographic. Understanding the impact and the role of physical therapy in preventing and treating concussions is crucial for the overall well-being of the elderly population.

What is a concussion?

A concussion, a mild form of traumatic brain injury, can result in temporary alterations to mental status, with or without loss of consciousness. The symptoms vary widely and may include memory problems, a slowed rate of thinking, difficulty concentrating, anxiety, and mood swings. Elderly individuals may attribute such symptoms to normal ageing, making accurate diagnosis challenging. Recognising the unique ways that concussions can manifest is vital for effective, timely intervention.

Causes of concussion in seniors

Concussions can stem from various causes, with falls being the most prevalent. In New Zealand, approximately one-third of individuals aged 65 and above experience a fall annually. The higher susceptibility of older individuals to falls can be attributed to factors such as diminished leg strength, impaired balance, vision issues, nutritional deficiencies, environmental hazards, and medication side effects. 

Falls among the elderly can lead to severe injuries and, in certain instances, prove fatal. Prioritising falls prevention measures can enhance safety and boost confidence among older individuals.  

It's also crucial to dispel the misconception that losing consciousness or a direct blow to the head is necessary for a concussion. A concussion can sometimes occur without a direct blow to the head does not occur but there does need to be significant movement of the brain within the skull to cause a concussion. Understanding these subtleties is key to implementing preventive measures and promoting awareness.

Can physical therapy help with concussion in seniors?

As movement experts, physical therapists play a pivotal role in preventing and treating concussions in seniors. Through comprehensive assessments, they can identify fall risks, develop personalised fall prevention strategies, and enhance balance, strength, and mobility. 

Post-concussion care is equally important, with physical therapists addressing persistent symptoms. These professionals use techniques like manual therapy, balance exercises, and mental challenges to facilitate recovery and ensure a safe return to daily activities. As well as physical therapists, there is often involvement of rehabilitation nurses, occupational therapists, medical specialists, clinical psychologists and /or neuropsychologists depending on the persona’s presenting problems. 

Managing dizziness in seniors

Dizziness, a common complaint among older adults, can result from various causes. Physical therapists, equipped with extensive knowledge, conduct thorough assessments to determine the root cause. 

For conditions like benign paroxysmal positional vertigo (BPPV), a leading cause of dizziness, physical therapists employ specific manoeuvres to reposition dislodged crystals in the inner ear. 

By resolving such issues, they enhance the overall sense of balance and reduce the risk of falls.

Tips to help elderly people maintain balance

To safeguard against the risk of losing balance, several precautionary measures can be adopted, including:

• Ensuring access to a call bell or button within close proximity.
• Taking ample time when getting up from a sitting or lying position.
• Seeking assistance when experiencing feelings of dizziness, weakness, or light-headedness.
• Exercising caution on wet or slippery floors.
• Opting for well-fitting shoes for enhanced stability.
• Utilising handrails strategically in hallways and bathrooms.
• Using walking aids in a proper and effective manner.
• Having a night light or easily accessible lighting for nocturnal movements.
• Avoiding reliance on an IV pole, tray table, or easily movable object for support.

Risk mitigation for seniors at home

To prevent falls within the home environment, it is crucial to minimise potential hazards. Key strategies to reduce risks at home include:

• Limiting the use of rugs, especially those with frayed edges or that slide easily.
• Incorporating non-slip bath or shower mats.
• Installing handrails in critical areas such as bathrooms and hallways.
• Ensuring a telephone is within reach from your chair or bed.
• Safeguarding against tripping hazards, such as electrical cords crossing walkways.
• Maintaining adequate lighting throughout the living space.

What to do if an elderly person has a fall

Despite proactive measures, the possibility of a fall still exists. In the event of a fall at home, it is imperative to remain composed. If capable of getting up, one should bend the knees, roll onto the side, and gradually assume an all-fours position. Crawling towards a sturdy chair can provide additional support for getting back into a seated position. Rest as needed during this process and attempt again if necessary.

If unable to rise, efforts should be directed towards rolling or crawling to reach a phone or calling out for assistance from a neighbour. Consideration may be given to a personal medical alarm system for individuals at risk of falls.

Following a fall, promptly consulting with a healthcare professional is essential for assessing injuries, strength, and balance. This proactive approach aids in preventing future falls and maintaining overall well-being.

Summary

Concussions in elderly individuals, often underestimated, require a nuanced understanding of symptoms and causes. Falls and head trauma, seemingly innocuous, can have severe consequences. Physical therapy emerges as a valuable ally in preventing falls and the integrated rehabilitation team in helping elderly people in recovering from concussive injuries. 

By addressing fall risks, managing post-concussion symptoms, and tackling issues like dizziness, physical therapists contribute significantly to the overall well-being and quality of life for the elderly population. Investing in awareness and proactive measures is the key to safeguarding the health of our seniors.