How Is Traumatic Brain Injury Different in Older Adults?

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On a November afternoon in 2022, Scott Chatham and Tucker, a rambunctious golden retriever, set out for a walk around his North Carolina neighborhood. Just a few yards away from the house,

Tucker jerked the leash to pursue something. As the 73-year-old scrambled to recover control, he flipped over the dog, coming down hard and headfirst on the asphalt.

Chatham’s teenage grandson witnessed the scene from the house and ran outside to help. Tucker was quickly recaptured and Chatham, who enjoys five- to seven-mile hikes a couple of times a

week, judged himself to be fine despite a black eye and a cut on his eyebrow, both on the right side. “I didn’t even have a headache,” says the retired ob-gyn. The walk with Tucker resumed

without incident.

What is traumatic brain injury?

Older adults and TBI

TBI symptoms in older adults

The challenges of diagnosing a TBI

How is TBI treated?

Time for recovery from TBI

Five days later, Chatham got on his stationary bike and began cycling. He doesn’t remember finishing the workout or dismounting the bike. “The next thing I knew I was in the kitchen, and my

wife was saying, ‘Do you know what room you're in? Where are we?’ ” Chatham couldn’t answer her. He was alert but “disoriented and confused.”

After he made his way to a comfortable chair in the den, Chatham's daughter grew more concerned when he couldn’t recall his four grandchildren’s birthdays. She brought him to the ER, where

an EEG measuring electrical activity in his brain showed abnormalities in the left temporal lobe causing seizures and leading to Chatham’s occasional confusion. The doctor prescribed the

anticonvulsant drug Keppra.

Today, almost one year later, Chatham still takes the drug. He has had two more EEGs which show that the seizures persist, though they are becoming less frequent. Some of those periodic

episodes make him feel like he’s watching the world through “a fish-eye lens where things aren’t quite in focus.” It’s as if, he says, “there's a time delay on everything that happens and

nothing is connected to anything else.” But his symptoms are improving gradually, and he remains active, hiking about twice a week, kayaking twice a month, and using his indoor bicycle when

the weather is disagreeable.

Chatham experienced a non-penetrating, traumatic brain injury, or TBI. A TBI may occur with a blow or jolt to the head or a hit to the body that can move the head quickly back and forth,

sloshing the soft brain around inside the hard, bony “helmet” that is the skull. This movement can cause stretching or tearing of brain cells and blood vessels in the brain, leading to

bruising, bleeding, inflammation and brain swelling. These changes to the brain can affect how a person thinks, learns, feels, acts or sleeps. TBIs exist along a spectrum from mild to very

severe. A mild TBI is sometimes called a concussion.

In some cases, the signs of injury on the outside can obscure the full story of what’s happening inside. When Chatham fell, the impact on the right side of his head caused his brain to

rebound in the opposite direction, damaging his left temporal lobe. For some injuries, the damage is immediate. But in other cases, and especially in older adults, the effects of a TBI can

come on gradually — hours or even days later.

Traumatic brain injury used to be considered “very much an injury of the young, dumb male,” says Geoff Manley, M.D., professor of neurosurgery at University of California, San Francisco. It

was something that primarily happened to boys doing the “silly, stupid things that we all did when we were young.” But today, Manley says that more than half the patients he sees at UCSF’s

trauma center are over the age of 65.