The Cutting Edge Management of Concussion

More than a third of all adults over 65 fall every year. Their physical injuries are treated but they may not be evaluated for concussion. Student athletes often collide on the field, are struck by a ball, or take a backward fall. If they just get up and rejoin the team, possible concussion risks may not be considered.

Concussions happen. It’s what happens AFTER a concussion that matters. Read the article below by Dr. Jeffrery Ketchersid. Then attend The Cutting-Edge Management of Concussion with Dr. Paulomi Kadakia Bhalla on Thursday, September 12 — the first in our new ValleyCare Speaker Series. These two experts bring extensive background from their work at Stanford HealthCare/ValleyCare and as faculty at Stanford University to this important topic.  What you know about treatment and prevention of concussions can make a difference!


Concussion and Seniors: What Patients and Providers Need to Know


It is a scenario that I see far too often: a senior falls at home and hits the side of their head on a piece of furniture. Immediately after, they have some pain along the side of their head but otherwise feel “fine.” They may decide to try to go about their day as normal, but due to the urging of a spouse or child they reluctantly proceed to their local Emergency Department to be assessed. In cases where there appears to be no visible head injury and there are no immediate symptoms, a concussion may have quietly been sustained. Most commonly thought of as an ailment of young athletes, concussions are regularly underappreciated or completely missed amongst the senior population. Concussions can and often do affect seniors; nearly one million seniors suffer a concussion after a fall every year.

On arrival to the Emergency Department, one may expect to be examined by a physician and undergo various imaging studies to rule out more serious injury, such as a skull fracture or brain bleed. But the signs of a concussion can be quite subtle and are not visible on diagnostic imaging. Luckily, the immediate effects of a concussion are generally mild, and do not require hospitalization. Seniors who have suffered a concussion may display headache, incoordination, confused facial expressions, changes in speech, changes in vision, altered sleep patterns (more sleep than usual or difficulty falling or staying asleep), dizziness, disorientation, memory deficits, or may display extreme swings of emotion. Symptoms may begin immediately or may develop hours to days after the fall. Most concussion symptoms resolve within two weeks, but in certain cases, symptoms do not resolve, and seniors may even develop post-traumatic vertigo, characterized by persistent dizziness and imbalance, which may cause another fall.

Though the immediate side effects of a concussion can be mild, recent studies now suggest worrisome long-term outcomes for people with concussions. Most insidiously, there is increasing evidence that concussions may increase the risk of a senior developing dementia. A recent UCSF study published in JAMA Neurology found that veterans who had sustained a concussion had a more-than-doubled risk of developing dementia. Concussions have also been found to increase the long-term risk of developing Parkinson’s.

When it comes to immediate treatment options, prolonged rest was previously thought to lessen the symptoms of a concussion, but more recent research has shown this recommendation to be ineffective overall. Current research indicates that mental and physical rest for one to two days followed by “appropriate rest” — resuming daily activities while managing symptoms — is more effective. In addition, new tools and assessments allow evaluation and treatment of many systems that may be affected by concussion; for example, visual function and balance. In order to guard against long-term side effects of concussion such as dementia and Parkinson’s disease, prevention is the only reliable remedy. It is vital that seniors undergo regular assessments by their primary care physician with an eye toward balance problems that may predispose them to falls. If a problem is identified, targeted physical therapy can be used to help improve strength and proprioception in an effort to maintain overall balance. Another option may involve physical therapists, who can recommend and train seniors in the use of assist devices, such as a cane or walker, that help with ambulation and fall prevention. By being proactive about your own health, you may prevent not only a concussion but also the myriad of other injuries that can be caused by just one fall.

Dr. Jeffrey Ketchersid is a Hospitalist at Stanford Health Care – ValleyCare and a Clinical Assistant Professor, Medicine, at Stanford University. He has a special interest in working with seniors in the hospital setting.