Falls can happen to anyone, but as we age, they become a much more serious threat to our health. One of the most severe consequences of a fall is a traumatic brain injury (TBI), a condition that can significantly alter your life, or worse, end it. So, how do you protect yourself or your loved ones from a fall that could result in this devastating injury? In this comprehensive article, we’re going to dive deep into the relationship between falling and TBI, the risks involved, and, most importantly, what you can do to prevent them.

What Is a Traumatic Brain Injury (TBI)?

Before we jump into the connection with falls, let’s start by understanding what a TBI is. A TBI occurs when an external force, often a violent blow to the head, causes the brain to move within the skull and collide with the bone. (1) The sudden impact of the brain against the skull leads to brain damage. TBIs can range from mild (like concussions) to severe, causing long-term cognitive, emotional, and physical impairments.

Types of TBI

There are three primary categories of TBI that look at severity (2):

• Mild TBI (Concussion): This is the most common type of TBI and is often caused by a quick jolt or bump to the head. Symptoms can include headaches, confusion, dizziness, and nausea. Even though these symptoms might resolve in days or weeks, repeated concussions can have lasting effects on brain health and can result in pathologies such as chronic traumatic encephalopathy (CTE).

• Moderate TBI: This involves a longer period of unconsciousness or confusion post-injury, often accompanied by more pronounced neurological issues including speech and movement dysfunctions. Recovery may take months, and long-term impairments are more common.

• Severe TBI: This involves serious brain damage, potentially leading to permanent disability or death. Severe TBIs usually result from more traumatic incidents, like a major fall, car accident, or assault.

Additionally, we can further distinguish TBI in two ways depending on the mechanism (1):

• Closed brain injuries (Non-penetrating brain injury): This form of TBI results when there is impact trauma to the brain without any external penetration or broken skull bones. In this case the brain is simply injured from movement within the skull.

• Penetrating brain injury: This form of TBI occurs when the skull is fractured and penetrated leading to an opening into the skull. There may or may not be an object penetrating the skull into the brain.

Primary vs. Secondary Brain Injury

Although the initial impact and injury of a fall is termed a primary brain injury, the injury can develop overtime. (3) This development leads to what is called a secondary brain injury. Secondary brain injury is due to the body’s reaction to the primary TBI and can lead to swelling, reduced oxygen, reduced blood flow, in addition to other difficulties that can be life threatening if not treated immediately.

Symptoms of TBI

Whether mild or severe, TBIs come with a range of symptoms, including (4):

• Memory problems

• Dizziness

• Loss of balance

• Persistent headaches

• Cognitive difficulties, like trouble concentrating

• Emotional changes, such as irritability or depression

• Sensitivity to light or noise

These symptoms can appear immediately after the injury or develop over time. But, as we’ll explore, not all falls result in these injuries. So why are falls such a significant cause of TBIs?

How Falls Contribute to Traumatic Brain Injuries

Falls are actually the leading cause of TBI in the United States, particularly among older adults. (5) According to the Centers for Disease Control and Prevention (CDC), about 32,000 people die each year from fall-related injuries, and a large portion of those deaths are linked to traumatic brain injuries. (6) But it’s not just older adults who are at risk; children, athletes, and even healthy, active adults can suffer a TBI from a fall.

Why Are Falls So Dangerous for the Brain?

When you fall, the brain can collide with the inside of your skull, which causes damage. (7) The impact can rupture blood vessels, bruise brain tissue, and cause swelling. It’s important to note, it doesn’t take a long fall or a high-impact event to cause damage. Even a simple trip on the stairs or a slip in the bathroom can result in significant head trauma if you hit your head just right.

Statistics on Fall-Related TBIs

• Falls are responsible for nearly 48% of all TBI-related hospitalizations, according to the CDC. (8)

• 1 in 5 falls causes a serious injury, such as a head injury or broken bones. (9)

• Older adults are at the greatest risk. In fact, those aged 75 and older have the highest rates of fall-related TBIs, as aging decreases strength, balance, and coordination, all of which play a role in fall prevention. (10)

But what types of falls are most likely to lead to a TBI?

Types of Falls That Commonly Lead to TBIs

Not all falls are created equal. Certain types of falls are more likely to cause a TBI, depending on how you land and what part of your body absorbs the impact.

1. Slips and Trips

Have you ever slipped on an icy ground in the winter or tripped over an uneven surface? These falls can happen quickly, often without warning, and are one of the most common causes of head injuries due to the sudden occurrence of the fall. (11) When your feet fly out from under you, the back of your head is often the first thing to hit the ground, especially as you age and your next muscles weaken. This creates the perfect scenario for a TBI.

2. Falls from Heights

Falling from a height, whether from a ladder, stairs, or even standing on a chair, can increase the force of impact, making it more likely to result in a serious injury. (12) Even short falls, like tripping down the stairs, can lead to dangerous head impacts.

3. Falls During Physical Activity

While we typically think of falls happening to older adults or children, athletes are also at risk for TBI. Contact sports, cycling, and running can all lead to falls where head impact is possible. (13, 14) Even a tumble during everyday exercise like jogging can result in a TBI if you hit your head in just the right way.

4. Falls in the Home

Believe it or not, the most common place for older adults to fall is in the home, with the most likely places being the bedroom, bathroom, or the stairs. (15) Due to the confined nature of theses areas, older adults are more likely to hit their head on hard or cornered objects that can result in TBI.

Severity of TBIs After a Fall

How bad can a fall-related TBI be? It all depends on several key factors.

Factors Affecting the Severity of a Fall-Related TBI

• Height of the fall: The higher the fall, the more force your body and head will absorb upon impact. This is due to the increased velocity (increased speed) of the fall the higher up you are. (16)

• Surface: Landing on a hard surface (like concrete or tile) greatly increases the risk of TBI compared to softer surfaces due to less force absorption. (17)

• Direct Impact: Whether the head hits directly on a surface or is jolted by the force of impact will also affect injury severity and impact absorption. (18)

• Age and Health: Older adults are more prone to serious injury due to frailty (general weakness) and lower bone density. (19)

Common Injuries Associated with Fall-Related TBIs (20)

• Skull fractures: A severe fall can cause the skull to crack, a penetrating brain injury, leading to further damage to the brain.

• Contusions and hematomas: Bruising of the brain tissue and pooling of blood inside the skull are both common in TBI.

• Brain swelling: The body’s natural response to injury can lead to swelling inside the brain, which may increase pressure on the brain tissue and cause more damage. This is termed a secondary brain injury.

It’s crucial to seek medical attention after a fall, even if you feel fine, as symptoms can worsen over time without you realizing.

Early Detection and Treatment of TBI

Recognizing the signs of a TBI early can make all the difference in your recovery. Unfortunately, many people dismiss their symptoms after a fall, assuming they’ll “shake it off” over time, or hide the symptoms due to cultural pressures.

Early Symptoms to Watch Out For (21)

• Persistent headache

• Confusion or feeling "foggy"

• Difficulty remembering recent events

• Dizziness or balance problems

• Sensitivity to light or noise

If you experience any of these symptoms after a fall, it’s important to seek medical attention immediately. A healthcare professional will likely conduct imaging tests, such as a CT scan or MRI, to determine the extent of the injury.

Treatment Options

Treatment varies depending on the severity of the TBI (22):

• Rest and Observation: For mild TBIs, doctors often recommend physical and cognitive rest. You may also need to limit activities that could lead to a second injury while your brain heals.

• Surgery: In severe cases, surgery may be required to relieve pressure on the brain or stop bleeding.

• Rehabilitation: Physical, occupational, and speech therapy are common components of TBI recovery. Long-term rehabilitation may be necessary for those with significant cognitive or physical impairments.

The Emotional and Psychological Impact of TBIs

Traumatic brain injuries don’t just affect you physically, they can also have a profound impact on your emotional and psychological well-being. (23) Many people with TBIs experience emotional instability, which can manifest as irritability, mood swings, or even depression. In fact, research shows that individuals who suffer from a TBI are at a higher risk of developing anxiety and depression, which can significantly impact their quality of life.

Common Emotional and Psychological Symptoms of TBI:

• Depression and Anxiety: It’s not uncommon for individuals recovering from a TBI to feel isolated or overwhelmed by their symptoms, leading to feelings of depression or anxiety. (24)

• Personality Changes: Some individuals may experience shifts in their personality, becoming more easily frustrated or short-fused. (25)

• Cognitive Difficulties: Struggling to focus or remember things can lead to frustration, increased emotional issues, and harder time engaging socially. (26)

For many people, the emotional toll from a TBI can be just as challenging as the physical recovery. It's essential to recognize these symptoms and seek professional help if needed, whether through psychotherapy, physically focused therapy, or support groups. Addressing the emotional impact early can improve long-term recovery outcomes.

Long-Term Consequences of TBIs

Unfortunately, the effects of a TBI can linger long after the initial event, especially in moderate to severe cases. Long-term consequences of a TBI can be both physical and cognitive, affecting daily life for years, or even permanently. (27)

Potential Long-Term Effects:

• Cognitive Decline: Many individuals experience ongoing issues with memory, concentration, and processing information. In some cases, a TBI can even increase the risk of developing dementia or Alzheimer's disease later in life, with moderate to severe TBIs increasing the risk by 200-400% (28, 29) This has been seen consistently in boxers and football players, with notably Sugar Ray Robinson suffering from Alzheimer’s disease. (30, 31)

• Physical Disabilities: Severe TBIs can result in long-term or permanent disabilities, including difficulties with mobility, coordination, and balance. (32) This can further increase the risk of future falls.

• Chronic Health Problems: Individuals with TBIs may also experience chronic headaches, fatigue, and problems with sensory processing, such as increased sensitivity to light or sound. (32)

• Behavioral Changes: Behavioral issues like impulsiveness or difficulty controlling emotions can persist for years, affecting relationships and overall quality of life.(33, 34) A recent historical look at how this brain trauma can lead to abnormal behavior can be seen in famous football player Aaron Hernandez who was found to have chronic traumatic encephalopathy (CTE), a known consequence of multiple TBIs. (35)

Because the long-term effects of TBI can be so varied, early and consistent medical intervention is crucial. Regular check-ins with healthcare professionals, cognitive therapy, and rehabilitation exercises can help mitigate some of the more severe consequences.

Fall Prevention Strategies to Reduce TBI Risk

The best way to reduce the risk of a TBI from a fall is simply to avoid the fall in the first place. While it’s impossible to eliminate every risk, there are several steps you can take to protect yourself and your loved ones.

1. Home Modifications (36)

• Install grab bars in the bathroom, especially around the toilet and shower.

• Remove tripping hazards like loose rugs or cluttered walkways.

• Add non-slip mats in areas prone to water spills, such as the kitchen or bathroom.

• Improve lighting in hallways, stairs, and dark corners. Learn more about lighting here.

2. Strength and Balance Training

Focusing on strength and balance can reduce your risk of falls. Exercises like Tai Chi, yoga, and resistance training improve coordination, muscle strength, and flexibility, all of which are key to maintaining balance as you age. If you're not sure where to start, consider joining a fall prevention class or working with a wellness coach (like me!) to build a custom exercise plan.

3. Assistive Devices

If you have mobility and walking issues, using a cane or walker can provide the extra support you need to prevent falls. Make sure any assistive device is fitted correctly and used properly.

4. Medication Management

Certain medications, especially those that affect blood pressure or cause dizziness, can increase your fall risk. Learning about the BEERs criteria, and working with your doctor to review your medications regularly, can help avoid common causes of falling.

5. Vision Care

Your eyesight plays a critical role in avoiding falls as it is a key aspect of the three bodily balance systems. Regular eye exams are essential, and wearing the right prescription glasses or contacts can help you avoid hazards.

Protective Gear to Reduce the Severity of TBI

In some cases, falls are inevitable, but there are ways to reduce the damage to your brain.

1. Helmets

If you’re engaging in high-risk activities like biking, skiing, or construction work, wearing a helmet can significantly reduce your risk of TBI. (37) Helmets are designed to absorb the impact of a fall and protect your skull.

2. Hip Protectors

For older adults at high risk of falls, hip protectors can help minimize injury during a fall. (38) While they won’t prevent a head injury directly, they can reduce the severity of a fall by protecting vulnerable areas of the body. Additionally, they will allow you to direct forces away from the head and onto other areas of the body without as much risk of further injury.

3. Human Airbags

Although quite new, these airbags are worn and blow up when sensing a fall. They will expand to protect your head and hips. These are great for frail older adults who have a high risk of falling but never have, or fall very infrequently. Again, this technology is new but rapidly becoming more available and hopefully will have more research soon. (39, 40, 41)

Final Thoughts: Protect Your Brain, it’s Worth It!

Falls are a leading cause of traumatic brain injury, but they don’t have to be inevitable. By taking proactive steps like modifying your home, improving your balance, and using protective gear, you can significantly reduce your risk of both falls and TBIs. And remember, it’s never too early, or too late, to start taking your brain health seriously.

If you're concerned about your risk of falling, or want to build a fall prevention plan that works for your lifestyle, I’m here to help! Book a wellness coaching session today, or if you prefer to be more independent, build your balance with my Beginner to Intermediate Balance Program. Don’t wait until it’s too late, take action now to protect your brain and your future.

References

1. Traumatic Brain Injury (TBI). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi

2. Facts About TBI. Traumatic Brain Injury & Concussion. Published April 29, 2024. https://www.cdc.gov/traumatic-brain-injury/data-research/facts-stats/index.html

3. Types of Traumatic Brain Injury | BrainLine. BrainLine. Published March 15, 2022. https://www.brainline.org/article/types-traumatic-brain-injury

4. Traumatic brain injury - Symptoms & causes - Mayo Clinic. Mayo Clinic. Published February 4, 2021. https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

5. Older Adult Falls Data. Older Adult Fall Prevention. Published May 9, 2024. https://www.cdc.gov/falls/data-research/index.html

6. Facts About Falls. Older Adult Fall Prevention. Published May 9, 2024. https://www.cdc.gov/falls/data-research/facts-stats/index.html

7. Rauchman SH, Zubair A, Jacob B, et al. Traumatic brain injury: Mechanisms, manifestations, and visual sequelae. Frontiers in Neuroscience. 2023;17. doi:10.3389/fnins.2023.1090672

8. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. MMWR Surveillance Summaries. 2017;66(9):1-16. doi:10.15585/mmwr.ss6609a1

9. National Center for Injury Prevention and Control. Stopping Elderly Accidents, Deaths & Injuries.; 2017. https://www.cdc.gov/steadi/media/pdfs/STEADI-FactSheet-MajorThreat-508.pdf

10. Older adult falls data. Older Adult Fall Prevention. Published May 9, 2024. https://www.cdc.gov/falls/data-research/index.html#:~:text=Falls%20are%20the%20leading%20cause%20of%20injury%2Drelated%20death%20among,.cdc.gov/STEADI.

11. Slips, Trips, and Falls: Understanding, Preventing, and Mitigating Risks | Environmental Health and Safety. Weill Cornell Medicine. https://ehs.weill.cornell.edu/slips-trips-and-falls-understanding-preventing-and-mitigating-risks

12. Alizo G, Sciarretta JD, Gibson S, et al. Fall from heights: does height really matter? European Journal of Trauma and Emergency Surgery. 2017;44(3):411-416. doi:10.1007/s00068-017-0799-1

13. Baker CE, Yu X, Patel S, Ghajari M. A review of cyclist head injury, impact characteristics and the implications for helmet assessment methods. Annals of Biomedical Engineering. 2023;51(5):875-904. doi:10.1007/s10439-023-03148-7

14. McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and clinical findings in young contact sport athletes exposed to repetitive head impacts. JAMA Neurology. 2023;80(10):1037. doi:10.1001/jamaneurol.2023.2907

15. Moreland BL, Kakara R, Haddad YK, Shakya I, Bergen G. A descriptive analysis of location of older adult falls that resulted in emergency department visits in the United States, 2015. American Journal of Lifestyle Medicine. 2020;15(6):590-597. doi:10.1177/1559827620942187

16. Alizo G, Sciarretta JD, Gibson S, et al. Fall from heights: does height really matter? European Journal of Trauma and Emergency Surgery. 2017;44(3):411-416. doi:10.1007/s00068-017-0799-1

17. Drahota A, Felix LM, Raftery J, et al. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technology Assessment. 2022;26(5):1-196. doi:10.3310/zowl2323

18. Young L, Rule GT, Bocchieri RT, Walilko TJ, Burns JM, Ling G. When physics meets biology: Low and High-Velocity penetration, blunt impact, and blast injuries to the brain. Frontiers in Neurology. 2015;6. doi:10.3389/fneur.2015.00089

19. Appeadu MK, Bordoni B. Falls and fall prevention in older adults. StatPearls - NCBI Bookshelf. Published June 4, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560761/#:~:text=The%20risk%20of%20falling%20is%20increased%20in%20older,gait%20velocity%2C%20step%20length%2C%20and%20lower%20limb%20strength.

20. Head injury. Johns Hopkins Medicine. Published August 8, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/head-injury#:~:text=The%20following%20are%20some%20of%20the%20different%20types,blood%20clots%2C%20in%20or%20around%20the%20brain.%20

21. What are common symptoms of traumatic brain injury (TBI)? https://www.nichd.nih.gov/. Published November 24, 2020. https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/symptoms

22. What are the treatments for traumatic brain injury (TBI)? https://www.nichd.nih.gov/. Published November 24, 2020. https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/treatment

23. Behavioral and emotional effects after TBI | BrainLine. BrainLine. Published April 27, 2020. https://www.brainline.org/article/behavioral-and-emotional-effects-after-tbi#:~:text=People%20with%20a%20TBI%20may%20have%20many%20emotional,TBI%20also%20affect%20how%20people%20act%20and%20feel.

24. Emotional changes after Traumatic Brain Injury (TBI) | MSKTC. https://msktc.org/tbi/factsheets/changes-emotion-after-traumatic-brain-injury

25. Brain Injury Association of America. Understanding behavior changes after moderate to severe traumatic brain injury - Brain Injury Association of America. Brain Injury Association of America. Published March 20, 2023. https://www.biausa.org/public-affairs/media/understanding-behavior-changes

26. Wilson L, Horton L, Kunzmann K, et al. Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury. Journal of Neurology Neurosurgery & Psychiatry. 2020;92(4):407-417. doi:10.1136/jnnp-2020-324492

27. Centers for Disease Control and Prevention. Moderate to Severe Traumatic Brain Injury Is a Lifelong Condition. https://www.cdc.gov/traumaticbraininjury/pdf/moderate_to_severe_tbi_lifelong-a.pdf

28. Traumatic Brain Injury (TBI). Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/traumatic-brain-injury#:~:text=There%27s%20no%20evidence%20that%20a%20single%20mild,TBI%20increases%20cognitive%20decline%20and%20dementia%20risk.

29. Shively S, Scher AI, Perl DP, Diaz-Arrastia R. Dementia resulting from traumatic brain injury. Archives of Neurology. 2012;69(10). doi:10.1001/archneurol.2011.3747

30. Former boxing great Sugar Ray Robinson is suffering from... - UPI Archives. UPI. https://www.upi.com/Archives/1987/07/09/Former-boxing-great-Sugar-Ray-Robinson-is-suffering-from/5962552801600/. Published July 9, 1987.

31. The connection between boxing and brain injury. Published April 1, 2006. https://www.brainandlife.org/articles/head-blows-from-boxing-can-cause-dementia-and-alzheimers-can

32. Traumatic Brain Injury (TBI). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi#:~:text=Chronic%20traumatic%20encephalopathy%20(CTE)%20is,lack%20of%20coordination%2C%20and%20dementia.

33. Weis CN, Webb EK, deRoon-Cassini TA, Larson CL. Emotion dysregulation following trauma: shared neurocircuitry of traumatic brain injury and Trauma-Related psychiatric disorders. Biological Psychiatry. 2021;91(5):470-477. doi:10.1016/j.biopsych.2021.07.023

34. Robert S. Traumatic brain injury and mood disorders. Mental Health Clinician. 2020;10(6):335-345. doi:10.9740/mhc.2020.11.335

35. Gonzales R. Researcher says Aaron Hernandez’s brain showed signs of severe CTE. NPR. https://www.npr.org/sections/thetwo-way/2017/11/09/563194252/researcher-says-aaron-hernandez-s-brain-showed-signs-of-severe-cte. Published November 10, 2017.

36. Preventing falls at home: room by room. National Institute on Aging. Published September 12, 2022. https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room

37. Lee LK, Flaherty MR, Blanchard AM, Agarwal M. Helmet use in preventing head injuries in bicycling, snow sports, and other recreational activities and sports. PEDIATRICS. 2022;150(3). doi:10.1542/peds.2022-058878

38. Korall AMB, Feldman F, Yang Y, et al. Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care. Journal of the American Medical Directors Association. 2019;20(11):1397-1403.e1. doi:10.1016/j.jamda.2019.07.010

39. Tamura T, Yoshimura T, Sekine M, Uchida M, Tanaka O. A wearable airbag to prevent fall injuries. IEEE Transactions on Information Technology in Biomedicine. 2009;13(6):910-914. doi:10.1109/titb.2009.2033673

40. Mirco. Future Age Elderly Fall Prevention Devices- D-Air Lab  D-Air Lab. Published October 14, 2024. https://dairlab.com/en/future-age/

41. SKYVEST: patentierte Airbag-Weste gg. Verletzungen bei Stürzen. Skylotec. Published May 15, 2023. https://www.skylotec.com/eu_en/skyvest/