Are You at Risk for an Injury to the Head?

Older women face a higher likelihood, but misconceptions are high

Marah Stets

Reviewed by

Rachel Lazarus, Ph.D.

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En español

Published July 02, 2024

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The risk of traumatic brain injury (TBI) is more prevalent among older adults than previously understood, according to a new analysis of over 9,200 people aged 65 and over, based on Medicare claims from 2000 to 2018.

Almost 13 percent of people in the study had visited an ER, urgent care or outpatient clinic and received a traumatic brain injury diagnosis. TBI can result from a blow or jolt to the head or body that causes bruising, bleeding, inflammation and swelling in the brain. These changes can impact a person’s thinking, emotions, behavior and sleep. TBIs range from mild, often called a concussion, to very severe.

“We expected a high number of TBIs,” says Erica Kornblith, assistant professor of psychiatry at the University of California, San Francisco, and lead author of the study, reported in JAMA Network Open on May 31. “But we did not expect a number quite this high.” The research is especially striking, she says, because it covers only those people who received medical care. “Most folks who have a TBI, particularly those who are older and have a fall at home, do not seek care.”

The new study also challenges the assumption that TBI is mainly a problem for men, especially young ones engaging in risky activities. In this 65 and older age group, the risk of TBI was higher among healthier, wealthier white women.

Video: Why TBIs Can Be More Dangerous in Older Adults

The study adds important nuance to the existing understanding of TBI risk factors. For example, while older women are more likely to be diagnosed with TBI, older men have much higher rates of hospitalization and death associated with TBI. When asked about these differences, Kornblith suggests that men might have more severe injuries that lead to hospitalizations and death, while women’s injuries are less likely to lead to hospitalization. It’s also “possible that women are more likely to seek care for a TBI than men,” so their injuries are more likely to be documented.

Kornblith adds that “since women tend to live longer than men, it follows logically that there are more women in the older age brackets being treated for TBI.” Matthew Peters, M.D., associate professor of psychiatry and behavioral services at Johns Hopkins University School of Medicine, who was not involved with the study, adds that “having wealth, being of white race and female, and having a higher education, in general, increases your chances of research participation.” The results reflect the people studied, “but may not be reflective of the population as a whole.”

“TBI is a major and poorly understood public health issue for all older adults,” Kornblith says, and a survey conducted by AARP in 2023 supports the need for consumer education. Among more than 3,000 people 18 and older, misperceptions around TBI causes and diagnoses were common. For example, many more respondents were concerned about having a TBI from being in a car wreck — 45 percent — than from falling — 18 percent. Yet, at least among older adults, most TBIs are caused by falls, says Kornblith, especially ground-level falls that happen at home during everyday activities.

Also striking is how many survey respondents were unaware that they had experienced a traumatic brain injury. While 2 percent of respondents reported they’d been diagnosed with TBI, almost 20 percent reported having experienced one or more concussions. Concussion is a type of TBI and the terms “mild TBI” and “concussion” are often used interchangeably, even in medical settings.

The worry is that such confusion might cause people to ignore their TBI risk and remain unaware of important information about recovery from TBI. Kornblith suggests that “for older adults, because of the increased risk of brain bleeds and other complications, it is a good idea to get medical attention after any head strike.”

The bottom line, says Kornblith: “TBIs are extremely common in older adults, and they tend to happen to folks who are healthier and more active.” Preventive strategies (helmets while bike riding; fall prevention) are important for all older adults (and their families and caregivers). “Physician-approved exercise, regular vision and cognitive screening, and close management of cardiovascular and other health conditions are great places to start!”

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Marah Stets is a freelance health, lifestyle and food writer based in the Washington, D.C., area.

Rachel Lazarus, Ph.D. is a neuroscientist at AARP who specializes in cognitive aging and brain injury.