Emergency medicine

Bumps on head more serious for elderly

A neighbor and I were walking my dogs at the park recently when we saw an older couple slowly rollerblading, side by side, on the bike path.

My neighbor commented, "Isn't that neat? There they are in their 70s and having the time of their life."

As usual, my career prevented me from seeing just the splendor. Instead, I had to fight off the urge to flag them down and plead with them to put on helmets.

It's a public-health issue I can't help espousing, and especially to the elderly. Going without a helmet is a recipe for disaster.

Two days earlier, I had cared for a 74-year-old man whose daughter brought him in because he hadn't answered his phone, and when he finally did, he seemed a bit confused and slow in his responses.

When the man's daughter went to his home, she noticed he had a bump on the side of his head and that an armchair had been overturned. He told her that he didn't think that he had fallen but couldn't be sure.

When he came in, a nurse placed him in a cervical collar just in case.

We completed a detailed neurological exam and found no obvious neurologic deficits. But he did have some mild to moderate cognitive impairment. We agreed that he was acting "slow."

This, coupled with the goose egg on the back of his head, made trauma a good possibility. We also learned that he was taking an anti-platelet agent for his coronary-artery disease, which put him in a high-risk category for a traumatic brain injury and bleeding in the brain.

A CT-scan found signs of acute bleeding around his brain and a chronic subdural hematoma, a collection of blood between the brain and the tough fibrous capsule that surrounds it.

As we age, our brains inevitably shrink, putting increased tension on the veins that bridge the outside of our brains to the inner surface of the skull. These veins can snap or break during even relatively minor trauma.

Although my patient could not recall another fall, the scan indicated one had occurred at least a month earlier.

All things considered, this man was lucky. A surgeon cleared away his hematoma, and he is doing well. Time will tell what kind of neurologic recovery he will make.

The case illustrates the challenges emergency physicians face in treating an aging population. As the baby boomers age, we anticipate there will be 71 million people older than 65 by 2030, representing 20 percent of the U.S. population.

Falls represent a significant source of injury and death in this patient population. Thirty percent to 60 percent of older people will fall each year, and as many as 25 percent of those falls can result in serious injury.

Among older people, falls cause two-thirds of the deaths from unintentional injury and are the sixth-leading cause of death in patients older than 65.

The Falls Free Coalition was formed in response to these concerns. The coalition represents more than 55 state and national groups, including the Centers for Disease Control and Prevention and the National Council on Aging.

For more information, go to healthyagingpro-



As for the happy couple on the bike path, if a blonde woman with two dogs stops you and begs you to wear helmets, please forgive her. She doesn't want to see you as patients, but rather as a happy couple with miles of rollerblading ahead of them.
