According to the World Health Organization, Traumatic Brain Injury (TBI) will be ranked as a major cause of death and disability in the world. In the USA, 155,000 seniors will suffer TBIs and probably many more, unrecognized mild TBIs.
So why talk about seniors (or patients over 65)? Everybody gets into automobile accidents, everybody falls. Unfortunately, older patients fall more often. And, the elderly get involved in their share of auto accidents as many seniors continue to drive into their 80’s and 90’s. I should know, I see these patients with DMV forms everyday in my office.
Overall, the medical evidence suggests the elderly do not do as well long-term when it comes to TBI. Experimental evidence in animal studies demonstrates that older brains don’t recover as quickly or completely. Mild TBI often goes unrecognized as it can be attributed to other medical conditions such as early dementia or Alzheimer’s. It is very important to assess the elderly in careful comparison to their pre-injury performance on cognitive tasks- one cannot assume a given senior is just naturally slowed down after an accident.
Vision is the same as other cognitive functions. It easy to say to the senior, “Those cataracts have gotten a little worse” when, in fact, the cataracts are the same. Visual complaints and deficits can be magnified by head injuries in older patients since they may already have visual problems from such diseases as glaucoma and age-related Macular Degeneration. Brain impairment exaggerates the impact of internal eye disease. Also, the injured brain of a senior simply takes more time to heal- they do get better but often require more intensive rehabilitation services.
Seniors also justifiably fear loss of independence, especially the ability to drive, which is heavily tied to vision. The car accident is very scary to an older patient who wonders, “Am I beginning to lose it?” Some just need reassurance, but my personal office experience is that people over 65 are more vulnerable to vision problems after TBI and should be evaluated by an ophthalmologist or optometrist before they start to drive again.
After head injuries, seniors need to be checked for near-vision and reading. Reading is a precious gift and should routinely be checked after a brain injury. Other specialists may simply ignore visual symptoms. I see many 65+ TBI patients in my practice and it is often possible to tease out what is old disease, and which problems are new. Maybe they just need stronger reading glasses but age is never a reason to explain away real problems.
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Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as a Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.