Aging with a Brain Injury

Sal lives alone, with supports from an in-home chore worker, a DSHS case manager, and a non-local family member. Sal is only 60 years old, but he’s unable to fully participate in his care planning. Sal is aging with an acquired brain injury.

Sal also receives support at ElderHealth Northwest’s Heads Up Program, a specialized adult day health program for adults (ages 18-59) with acquired brain injury. He is one of the original participants from the program’s inception six years ago, and he is transitioning into our senior adult day health program.

Sal — and others like him — sensitizes us to the issues facing individuals who are aging with a brain injury.

Some of these issues include:

Loss of skills gained in rehabilitation

Many brain injury survivors become homebound, and their skills may dissipate if they lack the opportunity to practice them in the community. They may experience declines in their communication skills, memory-compensation strategies, and overall physical and cognitive function.

Increased risk for injuries from falls and other impact injuries

Across the elder population, the risk for falls increases as balance becomes compromised. Indeed, falls are the leading cause of brain injury in the elderly.

A person with a brain injury may have weakness due to injury as well as additional fall-risk factors. They may exercise poor judgment in risky situations (e.g., crossing the street), increasing the likelihood of an accident.

Acuity of senses diminishes with age, and most elders will seek to compensate for losses by using greater caution or by obtaining hearing and vision aids. A person with a brain injury may not be able to identify or communicate about sensory changes they are experiencing or may have additional challenges of double vision or perceptual problems.

Increased risk for other injuries

An individual who has cognitive and judgment problems due to a traumatic brain injury is at higher risk for recurrent and more severe injuries. Likewise, those who acquired their injury due to stroke are at increased risk for another stroke and further brain injury.

Increase in medical needs

Cardiac, peripheral vascular and other systems are strained by aging, and medical conditions can become increasingly complex. Memory problems and diminished organizational skills compromise the patient’s ability to self-report medical symptoms and to independently take prescribed medications.

Increased risk for social isolation

This is a risk for elders in general, but brain injury survivors can be dependent upon friends and family systems for 30 years or more, during which time these care partners may pass away or burn out due to the strains of caregiving.

General decrease in endurance, strength and range of motion

Physical conditioning is difficult to maintain with advanced age and is further compromised in those who have trouble initiating and maintaining physical activity, even though such activity might have been habitual in the individual’s pre-injury past.

Decrease in independent living skills

There is often a proportionate decrease in independent living skills as declines are seen in flexibility, balance, endurance, strength range of motion. Concerns about lost function can create a cycle of fear that further contributes to a decline in independent functioning.

Most of the participants in our acquired brain injury day health program are in their 20s through their 50s, and we are continually striving to decrease the losses and risks noted above. Programs like ours can bolster social, behavioral and cognitive skills, allowing aging participants to transition into another community-based program for seniors.

In Sal’s case, having benefited from the structure and experiences provided in Heads Up, he is now poised to transition into an elder-focused adult day health program. There he can continue to maintain his health and function and enjoy social interaction and meaningful activity.