Fatigue, confusion, forgetfulness, irritability, headache – these are among the many symptoms you may notice in an aging loved one with a traumatic brain injury (TBI). According to the Centers for Disease Control and Prevention, the rate of traumatic brain injury in people 65 and older is 603.3 per 100,000. Older adults are at risk of TBIs when they hit their heads in falls, car wrecks, and assaults.
Because TBI symptoms can be wide-ranging, it may be challenging to help your aging loved one stay safe and comfortable.
“You want to set people up for success in their environment,” explains Nancy Hodgson, PhD, RN, associate professor of nursing at the University of Pennsylvania. Hodgson and colleagues have found that a structured approach to helping people with TBI live well at home also helps caregivers feel less stressed and in a better mood as a result.
“Many caregivers don’t know how to help their loved ones, so they are happy to be able to feel like there is something they can do,” she says.
With that in mind, what follows are 11 key recommendations for caring for an aging loved one with TBI.
1. Be proactive
You might have to step in immediately after a fall to insist that your loved one gets a head scan to see whether a brain injury has occurred. Then you will need to continue to advocate for speech language services, in-home care and more.
2. Learn about TBI
Gaining a better understanding of how TBI impacts the brain, and what that means for daily function, can help caregivers and aging patients work better together, says Melissa Wolack, a speech language pathologist in private practice in Denver, Colorado.
3. Take care of yourself, too
“Many caregivers neglect their own emotional, medical and psychological needs,” says Brian Lebowitz, Ph.D, a neuropsychologist with Stony Brook University School of Medicine in New York. You’ll be better equipped to care for your aging loved one if you’re ensuring your own wellbeing, too.
4. Improve safety
After a TBI, your aging loved one could still have another fall or accident. Work with them and others in the home to make sure it’s a safe environment. Some safety measures you can take include:
- Find out about fall risks linked to any medications your loved one is taking.
- Get your aging loved one’s vision checked.
- Pick up clutter and secure any throw rugs and wires.
- Add grab bars in bathrooms, and make sure all rails are securely fastened.
- Help your loved one increase their fitness and flexibility, ensure they undergo physical therapy if needed.
5. Adjust to changing speech patterns
“A traumatic brain injury can cause a variety of symptoms including word finding issues, difficulty swallowing and conversations with multiple partners,” says Wolack. Try these approaches to improving communication:
- Make sure you have your loved one’s attention before speaking.
- Speak clearly and concisely to avoid overwhelm and allow them to process the information.
- Decrease any background noise. For example, turn off the radio or TV.
- Be aware that a restaurant can be very overwhelming and over-stimulating.
- Do not provide too many options, especially if the adult seems tired: if your loved one appears fatigued, provide two options or ask yes-or-no questions.
- Avoid speaking with your back turned to them. Some people have hearing loss or may simply have difficulty understanding you if they can’t see your face.
6. Keep paid caregivers consistent
Tom Kessler, owner of senior home care company Always Best Care of Denver South Metro, explains that people with TBI may fare better if the same people provide their care over time. This is comforting to the person with TBI, and also means that your aging loved one’s caregivers will learn how best to understand them and their needs through repeated exposure to them.
7. Have a schedule
People with TBI may experience confusion and memory loss. Create a schedule and post it where your aging loved one can refer to it often. You can also make this interactive. “Set alarms for reminders to take meds or perform other tasks,” recommends Gwen Alexander, a senior occupational therapist at the University of Maryland's Rehabilitation & Orthopaedic Institute.
8. Prepare for emotional rollercoasters
Your loved one with TBI may experience emotional instability due to the injury, or because of frustrations related to TBI, such as being unable to express exactly what they want to say. Alexander recommends the following steps to help cope with these emotional changes.
- Remain calm, try not to take things personally and offer support and encouragement.
- Provide structure, consistency and repetition.
- Seek supportive services and groups
- Acknowledge your own feelings and talk to trusted family or friends, clergy members, or seek professional help.
9. Create a “control center”
Forgetfulness and confusion can be frustrating. Hodgson reports that it might help to create a centrally located space, such as on a small desk or table, that can act as your aging loved one’s control center. This is a place to keep all of the items they may want and need throughout the day.
10. Ask for help
Kessler explains that he and his team have seen families struggle to adapt to having an aging loved one with TBI. “This is their new normal,” he says. As a result, his caregiving team looks for ways to help not just the client, but the family as well. But that doesn’t mean you should wait and hope someone will notice your need – if you’re having difficulties individually or as a family, speak up.
Also important to remember is that some people with a mild TBI recover quickly, while others are on a longer timeline.
“Symptoms of moderate or severe brain injuries may take much longer to improve, and some individuals may never return to their cognitive baseline” says Lebowitz. “Because each individual and each injury is unique, determining the best course of treatment for any patient, regardless of age, requires assistance from brain injury experts.”
Caring for someone with TBI may mean you’ll need to enlist the help of an enhanced care team. This can include neuropsychology assessment and treatment, or additional therapy. Occupational, physical and speech therapies can all integral in a TBI care plan.
The right care team should assess your loved one’s current level of function and provide additional recommendations for services such as respite care, medical or adult day care for recreational activities, and personal care attendants to assist with self-care, home and community activities.