Head Injuries Secondary to Falls in the Elderly

The elderly are prone to falls. They can be cognitively impaired and do not have the reflexes to catch themselves in such a way as to protect the brain from injury. There are both minor and major head traumas an elderly person can get following a fall. There has been a study of those who are 70 years of age or older and their propensity to fall. A total of 588 people were studied.

Mild injuries to the brain in the elderly can affect brain function indefinitely. In fact, in the elderly, having a head injury puts one at the same level as one with Alzheimer’s dementia. In the study, the participants received a Mini Mental Status Exam or sMMSE along with other clinical variables of health and wellness. Any fall was recorded over a 2 1/2 year period of time. sMMSE testing was done after each fall. The chances of a fall causing a cognitive decline were examined and the elderly person was studied for an additional 21/2 year period of time.

The results of the study indicated that the occurrence of minor head traumas was not related to a decrease in sMMSE scores. Major head traumas, however, were associated with a decline in sMMSE scoring following the injury. The risk of decline in cognition increased linearly when higher cutoff points were used to measure changes in score. If the score was one, two or three points different from the pre-fall score, the high risk for falls remained high after the initial fall, leading to a risk for Alzheimer’s dementia.

During the second period of observation, the risk of falls were high, especially if psychotropic drug use (2 fold risk), the age was high (3.85 times higher risk), the use of anti-hypertensive drugs (1.8 fold risk) or if the sMMSE score declined by 5 points or more (2.41 times higher risk).

The summary proposed by the researchers was that the risk of major head injury increases the risk of further cognitive decline and risk of Alzheimer’s dementia. It is crucial for families to understand that the prevention of falls is important to the overall health of the elderly. It means pulling up rugs that the elderly might trip on and removing furniture that can get in the way of trips and falls.

The elderly person needs to be aware of the fact that just giving an elderly person a walker or cane does not mean they can use it right off. They need to be trained in their proper use by a qualified physical therapist. That way they can be skilled in getting around their house with these assistive devices.

It also means that special care and attention must be given to those who have to take psychotropic medication or anti hypertensive medications. They need close follow up of their blood pressure – including orthostatic blood pressures. These measurements can assure that the blood pressure is not going down too fast as the patient stands up.

If all measurements are assessed and the patient still falls, the fall should be treated in the emergency room and hospital so that the patient does not get progression of the injury nor too much brain swelling associated with the fall.

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