A nosebleed (epistaxis) is bleeding from the tissue lining the inside of the nose. The nose contains many tiny, superficial blood vessels that warm and moisten inhaled air, making them vulnerable to injury and bleeding. While common across all age groups, nosebleeds can be a particular concern in older adults. In the elderly, they may signal underlying health issues or be influenced by medications, making understanding their causes important.
Common Causes of Nosebleeds in Older Adults
Nosebleeds in older adults are often linked to age-related changes in nasal tissues. The nasal lining tends to become thinner and drier with age, making it more susceptible to damage. Low humidity, especially in heated indoor spaces during winter, can exacerbate this dryness, causing nasal membranes to dry out, crack, and bleed.
Physical irritation or trauma, such as nose picking, forceful nose blowing, or minor bumps, can easily rupture delicate nasal blood vessels. Respiratory infections, such as colds or sinusitis, can also lead to inflammation and irritation of the nasal lining, increasing the likelihood of bleeding.
Underlying Health Conditions and Nosebleeds
Nosebleeds in older adults can indicate broader systemic health issues. Uncontrolled high blood pressure, or hypertension, places increased stress on the delicate blood vessels within the nasal passages, making them more prone to rupture and bleeding. Bleeding associated with hypertension can be more difficult to control and may recur if blood pressure remains elevated.
Conditions affecting the body’s ability to form blood clots also increase bleeding risk, including inherited bleeding disorders like hemophilia or von Willebrand disease, and acquired clotting factor deficiencies. Liver disease, particularly advanced stages like cirrhosis, can impair the liver’s production of proteins essential for blood clotting, leading to easier bruising and frequent nosebleeds. Atherosclerosis, characterized by hardening and narrowing of blood vessels, can make nasal blood vessels more rigid and fragile, increasing their likelihood of rupture. Late-stage kidney disease can also affect blood clotting mechanisms, contributing to a higher tendency for bleeding, including nosebleeds.
Medications That Increase Bleeding Risk
Many older adults take medications that significantly increase nosebleed risk. Anticoagulants (blood thinners) like warfarin and direct oral anticoagulants (DOACs) such as rivaroxaban and apixaban prevent blood clots by reducing clotting ability. Nosebleeds are a known side effect and can be more difficult to stop.
Antiplatelet drugs, such as aspirin and clopidogrel, prevent platelets from clumping. Those on these medications, especially dual antiplatelet therapy, have an increased risk of frequent or more severe nosebleeds. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can also affect platelet function, contributing to bleeding tendencies.
Overuse or improper use of certain nasal sprays, particularly decongestant sprays, can dry out and irritate the nasal lining, making it more vulnerable to bleeding. Steroid nasal sprays, while effective for allergies, can also thin the nasal lining over time, potentially increasing nosebleed risk. If nosebleeds become frequent or severe while taking these medications, consult a healthcare provider to review the regimen.
When to Seek Medical Care
While many nosebleeds are minor and resolve with home care, certain signs warrant prompt medical evaluation, especially in older adults. Seek medical attention if bleeding does not stop after 20 to 30 minutes of continuous direct pressure. Heavy bleeding, indicated by a large volume of blood or difficulty breathing, also requires immediate care.
Frequent or recurrent nosebleeds, even if minor, should be discussed with a healthcare provider to identify any underlying causes. If nosebleeds are accompanied by symptoms like dizziness, weakness, pale skin, chest pain, or shortness of breath, these could indicate significant blood loss or a more serious systemic issue. Nosebleeds after a head injury or fall, or concerns about medication interactions, also necessitate professional medical evaluation.
First Aid and Prevention
When a nosebleed occurs, remain calm. Sit upright and lean slightly forward to prevent blood from flowing down the throat, which can cause nausea or vomiting. Gently pinch the soft part of the nose, just above the nostrils, with your thumb and index finger, maintaining continuous pressure for 15 to 20 minutes. Breathe through your mouth. Applying a cold compress or ice pack to the bridge of the nose can also constrict blood vessels.
To prevent future nosebleeds, particularly in older adults, keep nasal passages moist. Use a humidifier, especially during dry seasons, and apply saline nasal sprays or gels regularly. Avoid aggressive nose picking or forceful nose blowing to protect the delicate nasal lining. Discuss medication adjustments with a doctor if they contribute to bleeding, and effectively manage underlying health conditions like high blood pressure.