Aging with a Brain Injury

Marti Spicer, M.S., OTR/L, the University of Washington TBI Model System and the University of Washington Medical Center
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.

Posted on BrainLine June 18, 2009.

From the University of Washington TBI Model System and the University of Washington Medical Center. Used with permission. www.uwmedicine.washington.edu.

Comments (4)

My first brain injury was when I was a year old I fell from the second story and hit my front lobe on concrete and also bounced and hit the back it was undetected for years I’ve always suffered with my reading spelling and math my second brain injury was severe I was in a car accident I was in a coma for 3 1/2 weeks my brain also swelled so they had to shave part of my hair to drill holes to drain the fluid . I did not have any rehabilitation after I left a ranch in los amigos my stupid family didn’t really help what they say is that it’s not all about me the world doesn’t revolve around me which is hurtful and my . My second brain injury was when I was 30 years old last year when I was 47 they diagnosed me with PTSD which made a lot of sense to me but I have lived my life with Trumatic brain injury and PTSD and had no support have none now I am all alone only when someone needs something from me Doctor say considering my injuries when I was 30 that I am a walking miracle most people that have my type of injuries don’t do what I do I drive a car manage my own money but I am still all alone by myself no one gives a damn about me and that is very hurtful no one understands me or they don’t want to take the time to understand or to get to know me they only want to say this they know me when they really don’t know me don’t know nothing about me people are very ignorant and not kind at all and no there is no help for me . And my family isn’t there they only think about is because I almost died how I feel why am I here I should’ve just stayed it hurts more to be by yourself and not matter if I was dead I would not feel anything .

I have a very similar story to your own, with my first brain injury around 1 year of age from a bad fall, further injuries as a child and young woman from physical abuse, and then an unexplained event that caused a backwards fall onto a kitchen tiled floor. I was 53 years of age when this last brain injury occurred, which caused skull fractures and bleeding inside my brain. It has left me with a multitude of problems and I continue to cope with them and learn to find better ways to survive .. almost 7 years later. My own family were unwilling to accept me in this new way with these new problems and refused to make any allowances for me in any respect. They have also called me nasty, weird and avoided me. After years of helping my sister (who I thought was very close to me) in a variety of ways and even helping in her businesses for very little or no return - to be treated like this at the greatest time of need in my life - was intolerable, and eventually I ceased all contact with her and her family. This made me feel better and I continue to have contact only with people who will accept me as I am. This is a very tiny circle of people but it is much better than tolerating the neglect and ignorance of people who should know better.

I AGREE!! I certainly hoped for more detailed information on the special issues facing individuals with TBI as they age. My brother is now 55, suffered severe TBI at age 17, and we need information on new problems he's facing, specifically with increased seizure activity.

I am very disappointed with the limited and somewhat obsolete information you have available on the renewed and additional effects of TBI's acquired decades ago as one ages.  I am suffering from this very scenario at the age of fifty-eight after acquiring a severe brain injury years ago when I was twenty. 

There are a good many current medical studies, journal articles, research, etc. available.  I have found a good deal of information on my own, but I truly thought your resources on the effects of Aging with TB would be the ultimate resource.  I encourage you to correct your lack of updated information on this subject.  Survivors of TBI are survivors and we are all getting older every day.  Personal the second round of TBI symptoms are more severe and limiting than the initial symptoms.