Falls are a frequent occurrence within the elderly population, and when a head injury is sustained, the situation requires immediate and measured attention. The aging brain is more vulnerable to trauma, and certain medications, such as blood thinners, significantly increase the risk of internal bleeding following a blow to the head, even if the impact seems minor. Remaining composed and acting decisively can help prevent an acute situation from developing into a life-threatening emergency. The first moments after a fall are crucial for assessing the injury and determining the appropriate level of care.
Immediate Assessment and Stabilization
The first priority is to assess the person’s responsiveness and breathing. Speak to the individual calmly and ask simple questions to gauge their level of consciousness and orientation. If the person is unresponsive, not breathing, or only gasping, immediately begin cardiopulmonary resuscitation (CPR) and call emergency services.
If the person is conscious, they should not be moved unless they are in immediate peril, such as lying in a dangerous location or on a collapsing surface. Moving a person who has sustained a head injury risks exacerbating a potential spinal cord injury. Stabilize the head and neck by placing your hands gently on both sides of the head to keep it in line with the spine while awaiting help.
Inspect the head for any visible wounds or external bleeding. A scalp laceration can bleed profusely, so apply firm, direct pressure with a clean cloth or sterile gauze to any obvious bleeding site. If you suspect a skull fracture, which may be indicated by a soft spot or an obvious deformity, apply pressure only to the edges of the wound and avoid pressing directly on the injury. Continuously monitor the person’s breathing and alertness for any changes.
Recognizing Signs That Require Emergency Medical Services
A fall involving a head strike in an older adult always warrants medical evaluation, but several specific symptoms necessitate an immediate emergency call. Loss of consciousness, even if brief, is a serious sign. Any seizure activity or repeated vomiting—more than one or two episodes—also signals a potentially severe neurological event.
Call emergency services immediately if you observe any of the following signs:
- Loss of consciousness, even if brief.
- Seizure activity or repeated vomiting.
- Altered mental status, such as increasing confusion, agitation, slurred speech, or difficulty waking up.
- A worsening headache that becomes severe over time.
- Clear fluid or blood draining from the ears or nose, which may suggest a skull fracture.
- Pupils that differ in size or react differently to light.
- New weakness or numbness on one side of the body.
- Significant problems with balance and walking.
Practical Care While Awaiting Medical Assistance
Once emergency medical services have been contacted, keep the injured person as still and calm as possible, reassuring them while maintaining the stabilization of their head and neck. If there is external bleeding, continue to apply steady, direct pressure to the wound using a clean dressing.
If the person is conscious, a cold compress wrapped in a cloth may be gently applied to any bump or area of swelling on the head to help minimize inflammation. Avoid leaving the compress on for too long and never apply ice directly to the skin. If the individual feels nauseous or begins to vomit, gently roll their head, neck, and body as a single unit onto their side to prevent choking, taking care to maintain spinal alignment.
Use this waiting time to gather relevant medical information. This includes a list of all current medications, especially blood thinners like warfarin or aspirin, any known allergies, and pre-existing medical conditions.
Post-Injury Monitoring for Delayed Symptoms
Even if the individual appears to recover quickly and does not require immediate emergency transport, a risk of delayed complications remains, which can occur hours or even days later. This is particularly true for older adults, who are susceptible to delayed intracranial bleeds because the aging brain shrinks and stretches the bridging veins. The first 24 to 48 hours are a period of heightened surveillance, even for seemingly minor head bumps.
Monitoring should include checking for increased drowsiness, persistent vomiting, or a headache that continues to worsen instead of improving. Watch for subtle changes in behavior, such as increased irritability, confusion, or memory problems. An unsteady gait, slurred speech, or new difficulty with movement also warrants an immediate trip to the emergency department.
The person should not be left alone for the first night following the injury. They should be checked frequently, ideally every few hours, to ensure they can be easily roused from sleep and that their mental status remains clear. Any sign of deterioration or the emergence of new symptoms should prompt an immediate medical review, as symptoms can progress rapidly.