The long-term impact of a head injury when you’re over 60

Where you hit your head will impact different parts of the brain - Getty

When Princess Anne was admitted to hospital this week after being kicked in the head by a horse, she was reportedly suffering from memory problems.

“Horse riding is one of the most dangerous sports for sports injuries. It’s not just being thrown off. It’s being kicked, being fallen on and trampled,” says Natalie Mackenzie, a cognitive rehabilitation therapist and brain injury trainer. Height and speed of course also play a part if you are actually riding. “The bigger the horse, the higher the fall,” says Mackenzie.

A concussion is always a worrying situation and while we often hear about the impact of young sports people, the concerns become greater after 60.

What is concussion?

A concussion is a type of traumatic brain injury (TBI) that results from a blow to the head, a fall, or any other injury that jars or shakes the brain inside the skull. “This impact can cause the brain to move rapidly back and forth, leading to chemical changes and sometimes stretching and damaging brain cells,” says Dr Steven Allder, a consultant neurologist at Re:Cognition Health.

Symptoms of concussion

In some cases, an individual may lose consciousness as a result of the head injury. “But it is important to note that only around 10 per cent of reported concussions involve a loss of consciousness,” says Luke Griggs, the chief executive of brain injury charity Headway. So it’s imperative that you don’t solely rely on this as an indicator.

Memory loss, as reportedly suffered by Princess Anne, is a common symptom. “It’s not necessarily a marker of severity,” explains Mckenzie. “But if you had a period of being knocked unconscious you may or may not remember the event. It’s not uncommon at all. It tends to resolve, or else you might have a blank couple of hours.”

Other symptoms include headaches, nausea, blurred vision, drowsiness and loss of balance, but they may not appear immediately after the injury.

Generally, where you hit your head will impact different parts of the brain. “Being hit to the back of the head you may have problems with your vision,” says Mckenzie. Conversely, hitting the frontal part of the brain can often result in problems with personality and behaviour, as this part of the brain is responsible for these ‘higher functions’.

However, with concussion, it is less about what part of the head that is hit: “Because it is about how the brain has moved and how the neural connections have been sheared and bruised,” explains Mckenzie.

While bleeds on the brain will show up on a CT scan, the neural damage at a cellular level caused by a concussion will not.

Princess Anne will be being monitored closely by medical professionals. For most people, after falling and hitting your head, it is a case of waiting and watching for any changes. “Problems finding words or ringing in the ears, sensitivity to light or sound, they are the markers that people should seek medical attention,” she says. “While you should always seek help to rule out bleeds, it may be a sign of a significant concussion that will require rehabilitative therapy.”

Why concussion is riskier in older people

Concussions are more dangerous for older adults due to brain atrophy, which creates more space for the brain to move within the skull upon impact. “Increased fragility of blood vessels, raising the risk of brain bleeds or haemorrhages; slower recovery rates from injuries (including brain injuries) and the presence of pre-existing conditions, such as blood thinning from medications or other underlying health issues that can complicate recovery,” says Dr Allder.

How concussion can cause memory loss and dementia

Repeated knocks to the head can increase the risk of developing degenerative neurological conditions, including dementia or chronic traumatic encephalopathy (CTE), later in life.

“CTE is a progressive condition of the brain, with symptoms similar to other neurodegenerative conditions, such as memory problems, confusion, mood swings and behavioural changes,” explains Griggs.

People with a history of recurring head injuries, for example through sports such as boxing, may be most at risk of developing CTE.

“This is because concussions can cause brain cell damage directly from the impact, and might also initiate an inflammatory response resulting in secondary injury from swelling and bleeding,” Dr Allder continues. “Persistent inflammation causes further cell damage, and disrupts neural connections critical for cognitive function, increasing the risk of repeated falls.”

There is no set number of falls that determine an increased risk of dementia, as it depends on the severity of each fall and individual health factors. “However, repeated head injuries, even if mild, can accumulate damage and increase the risk of developing dementia.”

What you should do if you get a knock to the head

  • Always consult a healthcare professional if you or someone else experiences a head injury, even if symptoms seem mild.

  • “Rest is crucial for recovery – avoid physical and cognitive activities that can exacerbate symptoms,” says Dr Allder.

  • Avoid bright screens, as these can worsen concussion symptoms: “So it’s important to limit screen time, including computer, phone, and television use.”

  • Keep track of any symptoms and seek immediate medical attention if they worsen. Avoid alcohol and drugs: “These substances can interfere with the healing process and exacerbate symptoms,” Dr Allder continues.

  • Once cleared by a doctor, gradually return to normal activities, be cautious not to overexert yourself.

  • Stay hydrated; research suggests there may be a link between dehydration and an exacerbation of concussion symptoms.

  • Should any symptoms of concussion present themselves either immediately or over the course of the following few days, medical advice should be sought without delay.

  • “It’s essential to take head injuries seriously, especially in older adults, due to the increased risk of complications and longer recovery times,” says Dr Allder.