Undetected Post Concussion Symptoms in Older Adults
Over the years, I have treated many older patients following a fall or fracture, and one recent case is the inspiration for this article. The importance of treating the whole person – and advocating for yourself and your loved ones – cannot be overstated.
My story is about an 84-year-old woman who lived alone. She fell while changing a light bulb, fractured her hip, and needed surgery. Afterward, she experienced some post-anesthesia fogginess – very common, very normal, and not necessarily a sign of dementia – and was placed in a skilled nursing facility.
Her hip healed well, but she didn’t bounce back as expected. She continued to struggle with dizziness, headaches, balance problems, and an overall feeling of “not being herself.” She disliked the food, lost weight, and because she was unsteady, used a wheelchair more than she walked. This once-vibrant woman – who had cared for her home, yard, grandchildren, and drove everywhere – was on a downward spiral.
The Untreated and Undetected Complications
She returned home with 24-hour care about a month later. A friend of a friend who noticed her decline asked me to see her. As she described her fall and how different she felt, something didn’t add up. After a full head-to-toe assessment, I discovered two significant undetected complications – both likely tied to a blow to the head and a concussion.
First, her neck showed alignment issues, severe muscle spasms, and restricted movement. She had clear signs of cervicogenic dizziness, which is often overlooked as just a “stiff, older neck.” With two manual physical therapy sessions, she was already feeling about 75% better, with noticeably higher energy.
Second, she was experiencing intermittent dizziness. This is not a normal part of aging. Dizziness is one of the top five chronic complaints among older adults, with many possible causes: medication, low blood pressure, or inner ear issues, to name a few. In this case, because she had fallen and hit the side of her head (without losing consciousness), I suspected she had benign paroxysmal positional vertigo (BPPV).
Testing took only 5-10 minutes, and sure enough, it was positive. BPPV happens when tiny crystals in the inner ear’s semicircular canals shift into the wrong canal. The brain then receives conflicting signals about balance, leaving a person feeling dizzy or woozy, sometimes just for a few seconds at a time.
In my patient’s case, she had lived with this for six weeks. It upset her stomach, affected her appetite, limited her activity, and left her fearful of falling again. But BPPV can often be treated in just one session by moving the head in certain positions to guide the crystals (otoliths) back where they belong. For her, it was a complete game changer.
Within a week –after only two treatments and some simple homework – this wonderful woman turned a corner. Instead of declining, she was regaining strength and independence. At 10 weeks post-fracture, she was nearly done with her walker, using only a cane for long walks, and feeling hopeful again. She committed to ongoing strengthening, balance training, breathing, and eye exercises. I have no doubt I’ll soon see her holding her new great-grandchild, swinging a golf club, and enjoying the full, active life she loves.
My message? Don’t accept feeling unwell as a “normal” part of aging. Keep asking questions. Seek help. And never give up.
This story is just one example of how easily post-concussion symptoms can go undetected in older adults. To help you or a loved one navigate this issue, here’s what to know about symptoms, risks, diagnosis, and recovery.
Recognizing the Full Spectrum of Concussion Symptoms in Older Adults
This story is just one example of how easily concussion symptoms in older adults can go undetected. Concussions may look different than in younger people and are often mistaken for side effects of medications or normal aging. Recognizing the range of possible symptoms is critical.
Physical, Cognitive, and Emotional Symptoms
- Physical Symptoms: Headache, nausea or vomiting, blurred vision, muscle weakness, fatigue, sensitivity to light or noise.
- Cognitive Symptoms: Memory lapses, confusion, trouble concentrating, slowed thinking, difficulty finding words.
- Emotional Symptoms: Irritability, depression, anxiety, mood swings, emotional lability.
- Sleep Disturbances: Difficulty falling asleep, sleeping more or less than usual, unrefreshing rest.
If these symptoms appear or worsen after a head injury, don’t brush them off. Seek medical guidance immediately.
Risk Factors and Prevention Tips for Senior Concussions
Older adults are more vulnerable to concussions because of natural changes in balance, vision, and reaction time. Medications, chronic health conditions, and a history of falls can add to that risk.
The good news? Many risks can be reduced with small changes at home and in daily routines. For example, proactive fall prevention strategies can make a significant difference in reducing head injury risk.
Prevention Steps at Home and in Daily Life
- Reduce Fall Hazards: Remove loose rugs, add grab bars in bathrooms, and use night lights.
- Monitor Medications: Talk with a healthcare provider about side effects that may increase fall risk.
- Stay Active: Regular exercise and balance training build confidence and stability.
- Use Protective Gear: Wear helmets and supportive footwear for higher-risk activities.
Proactively addressing risk factors can help prevent a concussion before it happens.
What to Do After a Concussion: Step-by-Step Guidance
Knowing what to do immediately after a concussion is critical for safe recovery. Taking the right steps—especially in the first 48 hours—can reduce complications, guide caregivers, and give the brain the best chance to heal.
Essential Steps to Take
- Rest First: Limit both physical and mental activity. Avoid screens, reading, and strenuous movement in the initial 24–48 hours.
- Monitor Closely: Watch for worsening symptoms, such as repeated vomiting, severe headache, confusion, slurred speech, or trouble waking up.
- When to Seek Emergency Care: If severe symptoms appear—like inability to recognize people, seizures, or repeated loss of consciousness—call 911 immediately.
- Gradual Return: Only resume normal activities with medical approval and after symptoms resolve.
Giving clear, actionable instructions supports better outcomes and empowers caregivers.
Recognizing Complications and When to Seek Immediate Help
Most concussions improve with time, but some can develop into serious complications if left untreated. Recognizing the warning signs that require immediate medical care is one of the most important steps in keeping older adults safe.
Emergency “Red Flag” Symptoms
- Severe or worsening headache
- Repeated vomiting
- Fainting, trouble waking up
- Slurred speech, weakness, or numbness
- Sudden behavioral changes or seizures
These symptoms require prompt emergency medical attention and should never be ignored.
Concussion Care and Balance Support at Ivy Rehab
If you or a loved one is experiencing symptoms after a fall or head injury, don’t ignore the signs. At Ivy Rehab, we understand how concussions and balance issues affect older adults, and we’re here to help you recover safely.
Maintain Independence and Mobility
Specialized programs focusing on balance, strength, and fall prevention.
Article Reviewed by Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA is the Regional Director for Ivy Rehab Network Partner clinic, Generation Care located in West Michigan. Holly is a Board-Certified Geriatric Physical Therapist and a Certified Exercise Expert for Aging Adults. Holly is an award-winning writer, having earned a Best Medical Feature writing award for this article through the National Mature Media Awards. This article was originally published in Senior Perspectives.
