A fall involving a head strike in an elderly person raises serious concerns because the aging brain is significantly more vulnerable to trauma. Age-related changes, such as brain atrophy, create a larger space between the brain and the skull, stretching the bridging veins. This makes the veins susceptible to tearing, even from a minor blow, potentially leading to a severe condition like a subdural hematoma. The heightened fragility of the vascular system and underlying health conditions compound the danger, necessitating an immediate and careful response.
Immediate Safety Assessment and Emergency Contact
The first action is to pause and quickly survey the area to ensure the environment is safe before approaching the person. Moving the person immediately is inadvisable, as this could worsen a potential spinal injury. Movement should only occur if the person is in immediate danger, such as being near a hazard. After securing the scene, check for responsiveness by speaking clearly and gently tapping their shoulder, and then observe their breathing pattern.
If the person is unconscious, confused, struggling to breathe, or bleeding profusely from the head, call emergency medical services without delay. A particularly urgent factor is whether the individual takes anticoagulant medications, commonly referred to as blood thinners. This drastically increases the risk of intracranial hemorrhage, or bleeding within the skull. Even a minor head strike in a person on blood thinners warrants immediate transport for imaging, as internal bleeding may not show external signs.
Clearly communicate the person’s age, known medical conditions, and whether they are taking blood thinners to the emergency operator. Providing these details allows the medical team to prepare for the increased possibility of a serious head injury. If the person is conscious, ask them what happened and if they have pain anywhere. Avoid pressuring them to move or sit up until medical professionals arrive.
Providing Care Until Help Arrives
While waiting for emergency services, focus on stabilizing the person and protecting them from further harm. If the person is conscious, instruct them to remain still on the floor in the position they landed, offering reassurance to keep them calm. If there is bleeding from the head, apply light, clean pressure using a sterile gauze pad or a clean cloth. Take care not to press directly into any visible skull indentation.
Maintaining the person’s normal body temperature is important, so gently cover them with a blanket, jacket, or towel to prevent hypothermia, especially if they are lying on a cold floor. If the person is unconscious but breathing normally, or if they begin to vomit, move them into the recovery position to prevent aspiration. To do this, carefully roll the person onto their side, extending their lower arm and positioning the upper leg to stabilize the body. Make every effort to support and keep the head, neck, and spine aligned during the roll.
Continue monitoring their level of consciousness by checking if they respond to your voice and noting any changes in speech or breathing. Observe the color and temperature of their skin, which provides clues about their circulation and overall condition. Write down the time of the fall and a description of the symptoms you have observed. This information will be valuable to the responding paramedics.
Monitoring for Delayed Symptoms of Head Injury
Even if the fall seemed minor or the person was discharged from the hospital, monitoring for delayed symptoms is necessary. Intracranial bleeding, such as a chronic subdural hematoma, may develop slowly over hours or days, with symptoms appearing subtly. Monitoring should continue for a minimum of 48 to 72 hours following the incident.
Look for persistent or worsening headache that does not improve with over-the-counter pain relievers, or any new onset of confusion or unusual behavior. Other concerning signs include difficulty waking the person from sleep, slurred speech, or problems with coordination and balance. Persistent vomiting, sensitivity to light or noise, or noticeable changes in the size of the pupils also demand immediate attention.
If the person is resting or sleeping, it is often recommended to wake them periodically, perhaps every few hours, to ensure they can be easily roused and are oriented to their surroundings. Any observation of these delayed symptoms warrants an immediate trip to the emergency department, regardless of the initial assessment. These changes suggest an evolving brain injury that requires urgent medical intervention.