When an elderly person falls and hits their head, immediate and informed action is crucial due to the heightened risk of serious complications such as a subdural hematoma. The aging process causes the brain to shrink, placing tension on the bridging veins that connect the brain’s surface to the outer membrane. This increased vulnerability means even a minor bump can lead to bleeding that accumulates slowly over hours or days. Understanding the correct protocol can prevent a minor injury from escalating into a life-threatening one.
Initial Response and First Aid
The immediate priority following a fall is to ensure the environment is safe before approaching the individual. Check for hazards like spilled liquids, sharp objects, or electrical cords that could cause further injury to either the fallen person or the helper. Once the area is secure, instruct the person to remain still, especially if they report any neck pain or if a spinal injury is suspected.
Avoid trying to move the person unless they are in immediate danger, as this could aggravate a potential fracture or spinal injury. Assess the individual’s level of responsiveness by speaking to them clearly and asking simple questions about what happened. If the person is conscious, encourage them to minimize any movement of their head or neck.
Any visible lacerations on the scalp may bleed profusely due to the rich blood supply in the area. Control this bleeding by applying gentle, direct pressure to the wound with a clean cloth or gauze. If the person is unconscious or their breathing is impaired, call emergency services immediately, and then monitor their airway, breathing, and circulation until professional help arrives.
Identifying Critical Warning Signs
The elderly are at a higher risk for delayed complications, which means a careful assessment of symptoms is imperative. Immediate emergency medical attention is required if the person exhibits a loss of consciousness, even if they quickly regain it. Any signs of a seizure, such as uncontrolled jerking movements, or repeated vomiting should also trigger an immediate emergency call.
Observe the person for signs of neurological decline, which can include increasing confusion, severe drowsiness, or difficulty staying awake. Look for clear fluid draining from the nose or ears, as this may indicate a skull fracture and leakage of cerebrospinal fluid. Unequal pupil size or the inability of the eyes to track normally are ominous signs that pressure is building inside the skull.
Symptoms of a developing subdural hematoma, a common and dangerous complication in older adults, can be subtle and delayed for hours or even days. These delayed signs include a persistent headache that worsens and does not improve with standard pain relief, or new weakness or numbness on one side of the body. Because brain atrophy provides more space for blood to accumulate before symptoms appear, a high degree of suspicion is warranted, especially if the person is taking blood-thinning medications.
Follow-Up Care and Observation at Home
After a medical evaluation determines the injury is minor and the person is cleared to return home, careful observation remains necessary for the next 48 to 72 hours. The primary caregiver should monitor the person’s neurological status by waking them periodically, perhaps every few hours during sleep, to ensure they can be easily roused and remain oriented. This monitoring helps catch any delayed onset of severe symptoms.
For managing minor pain, rest is encouraged, and it is important to discuss appropriate pain relievers with a medical professional. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often discouraged following a head injury because they can increase the risk of bleeding. Acetaminophen may be recommended as a safer alternative for headache relief, but this must be confirmed by a doctor.
Maintain adequate hydration and ensure the person rests, avoiding strenuous activity or any tasks that require concentration. Any return of the “red flag” symptoms—such as slurred speech, persistent nausea, worsening headache, or any change in behavior or walking ability—requires an immediate return to the emergency room.
Strategies for Fall Prevention
Addressing the underlying causes of the fall is the long-term step to ensuring safety. A comprehensive review of all current medications with a doctor can identify drugs that may cause side effects like dizziness, sedation, or balance issues. Adjusting dosages or switching medications can significantly lower the risk of future incidents.
Home safety modifications are also highly effective:
- Improve lighting in hallways, stairwells, and bathrooms, and use nightlights to navigate in the dark.
- Remove tripping hazards such as loose rugs, clutter from walkways, and unsecured electrical cords.
- Install grab bars in the bathroom, particularly near the toilet and in the shower or tub.
Maintaining physical health through regular activity also plays a part in prevention. Engaging in exercises like Tai Chi, walking, or strength training can improve balance, muscle strength, and coordination, which are protective factors against falls. Regular vision and hearing checks are also important, as impairments in these senses can directly affect balance and the ability to perceive hazards.