Maybe you collided with your doubles partner during a pickleball match. Got rear-ended at a stoplight. Smacked your head on the kitchen cabinet door that’s been left open for the thousandth time.
It didn’t seem like a big deal, but a day or two later you’re struggling with a pounding headache and nausea. You’re forgetting words, losing your train of thought, and snapping at your spouse.
If you didn’t immediately connect those symptoms to a concussion, it’s understandable. While typically associated with pro football players and teenage athletes, concussions are surprisingly common in everyday life and affect people of all ages. In a Centers for Disease Control and Prevention (CDC) study, 27 percent of adults reported experiencing at least one concussion during their lifetime. Yet only about half of them sought medical care for their most recent injury.
That matters, because a concussion is no mere bump on the head. It’s technically a type of traumatic brain injury (TBI) that occurs when the brain moves rapidly inside the skull, temporarily disrupting normal function.
And in fact, it doesn’t even take a direct hit to the head to cause one, explains Shae Datta, MD, a neurologist and co-director of the NYU Langone Concussion Center. “Any sudden blow to the body that pitches your head and neck forward can make the brain jolt inside the skull,” she says.
But not all concussions are created equal. The one you get in your 40s, 50s, or beyond can look very different—and carry greater risks—than the one you had at 21, because the brain’s ability to recover changes over time. Here’s what to know about how concussions affect older adults, and what to do if you suspect you’ve sustained one.
The Aging Brain Connection
To be clear, there’s no magic age at which concussions suddenly become dangerous. “I’ve seen people in their 70s who are healthy and get better relatively soon [after experiencing one],” Dr. Datta says. “I’ve also seen people in their 20s with a concussion who are completely debilitated.”
Still, research shows that the brain becomes less resilient with age. One study found that adults between ages 51 and 68 recovered more slowly and remained symptomatic longer than younger concussion patients. Part of that comes down to other common health factors in midlife, including migraines, sleep disorders, balance issues, and cardiovascular disease.
There are also subtler changes happening inside the skull. Brain volume naturally decreases over time, particularly after age 60, and that shift can have real consequences. “Brains can shrink a little as we get older,” Dr. Datta says. “That creates more space, so when you hit your head, the brain jolts around a lot more.”
The additional movement can make injuries more complex and may increase risk for brain bleeds, particularly among people taking blood thinners. Those age-related changes also help explain why repeat head injuries can become especially concerning over time.
The Real Risk: Multiple Hits
For most people, a single concussion isn’t what neurologists lose sleep over. “It’s not one and done,” Dr. Datta says. “What we worry about more is repetitive head hits.”
A study analyzed data from more than 15,000 adults ages 50 to 90. People who reported three or more concussions had significantly worse cognitive function than those who had never sustained one—with attention and the ability to complete complex tasks declining with each additional concussion.
Other research has linked TBIs, including mild ones, to an increased risk of neurodegenerative diseases such as dementia and Parkinson’s disease later in life. The cumulative effect is particularly concerning, as repeated injuries appear to chip away at the brain’s ability to bounce back, especially if you’re predisposed.
“If you have a family history of dementia, multiple concussions could up your risk faster,” Dr. Datta says.
The Not-So-Silent Signs
One of the reasons concussions frequently go undiagnosed is that symptoms don’t always show up immediately. Some people notice problems right away; for others, symptoms take a day or two to emerge.
“A lot of times people who are in an accident will say, ‘I feel fine,’ and refuse the ambulance,” Dr. Datta says. “Then a day or two later they’re at the ER because their head or neck hurts.”
Many people assume that concussions always involve passing out, or a loss of consciousness, but that’s not the case. The most common symptom is headache, yet concussions can also cause dizziness, nausea, fatigue, balance problems, vision changes, memory lapses, difficulty concentrating, irritability, mood changes, and neck pain. Because these symptoms overlap so neatly with stress, poor sleep, menopause, and garden-variety exhaustion, they’re easy to dismiss.
Not every concussion requires a 911 call or a trip to the emergency room. But seek medical attention immediately if you experience any of these red-flag symptoms:
- Worsening headaches
- Slurred speech
- One pupil appearing larger than the other
- Seizure-like activity
- Severe confusion
- Significant memory loss
- Difficulty moving the neck normally
How to Recover From a Concussion
If you ever sustain a concussion, don’t expect your recovery to involve lying in a dark room for days. “We don’t cocoon people anymore,” Dr. Datta says. While she and other experts still recommend taking it easy for the first 24 hours after a concussion, prolonged bed rest is no longer considered beneficial. “Cocooning actually has shown to worsen outcomes,” she adds.
Instead, Dr. Datta recommends avoiding rigorous exercise, contact sports, and excessive screen time while aiming for gentle movement that gets oxygen flowing to the brain. “You need to at least be able to walk down your hallway,” she says. Once initial symptoms improve, you can gradually reintroduce light physical activity and mental tasks.
Protecting Your Brain
You can’t prevent every fall or fender-bender, but you can shift the odds in your favor with some simple precautions.
Wear a helmet during activities with a higher fall risk, such as cycling, skiing, or horseback riding. “Helmets don’t prevent concussions,” Dr. Datta says, “but they can make the injury less severe.”
Maintaining overall health is crucial. “The better your baseline health, the better recovery you’ll have,” she says. Prioritize sleep, regular exercise, stress management, and social connection—all of which support long-term brain health.
Don’t skip strength training; building muscle with weight-bearing exercise improves balance and stability, which reduces your risk of falls in the first place.
Don’t push through your symptoms, urges Dr. Datta, who says many of her female patients try to do just that. “We’re responsible for so much—our families, our household, our work. We’re more likely to ignore symptoms just because we’re busy,” she says. “If you don’t feel like yourself after a head or neck injury or a fall, have someone check you out.”
Getting evaluated quickly, resting appropriately, and easing back into activity will give your brain the best shot at a full recovery.
Think you may have sustained a concussion? Use NYU Langone’s Find a Doctor tool to find a concussion specialist near you.
