Falling in elderly individuals significantly **increases the risk of subdural hemorrhage**, a type of bleeding that occurs between the brain surface and its outer covering (the dura mater). This risk is notably higher in older adults due to several physiological and anatomical changes associated with aging, as well as common comorbidities and medications that affect bleeding and clotting.
Subdural hemorrhage, often referred to as subdural hematoma, is a serious medical condition where blood collects beneath the dura mater, usually caused by trauma such as a fall. In elderly people, even minor head injuries can lead to this condition because of brain atrophy (shrinkage), which stretches and weakens the bridging veins that cross the subdural space. When these veins rupture, blood leaks and accumulates, causing pressure on the brain[2].
The incidence of subdural hemorrhage rises sharply with age. While the general population experiences an incidence of about 13.5 per 100,000 people annually, this rate increases to approximately 127.1 per 100,000 in those aged 80 and above, demonstrating a nearly tenfold increase in risk for the elderly[2]. This elevated risk is compounded by factors such as:
– **Brain atrophy**: Age-related shrinkage of brain tissue increases the space between the brain and skull, making veins more vulnerable to tearing during falls or minor trauma.
– **Increased fall risk**: Elderly individuals are more prone to falls due to balance issues, muscle weakness, vision problems, and medication side effects.
– **Coagulopathy and anticoagulant use**: Many elderly patients take blood thinners (e.g., warfarin, direct oral anticoagulants) for conditions like atrial fibrillation or venous thromboembolism, which increase bleeding risk. Additionally, undiagnosed bleeding disorders, such as mild hemophilia A or factor XIII deficiency, can exacerbate bleeding risk even after minor trauma[1].
– **Delayed symptom onset**: Subdural hemorrhages in elderly patients may develop slowly, sometimes days or weeks after the initial fall, making diagnosis challenging.
A case study of a 75-year-old man with recurrent acute subdural hematoma (ASDH) revealed that underlying mild congenital hemophilia A combined with factor XIII deficiency significantly increased his bleeding risk after trauma, despite no prior bleeding history[1]. This highlights that not only mechanical factors but also hidden blood clotting disorders can elevate the risk of subdural hemorrhage in the elderly.
Clinically, subdural hemorrhage in elderly patients often presents with symptoms such as headache, confusion, weakness, or decreased consciousness, but these can be subtle or mistaken for other age-related conditions. Prompt diagnosis typically requires neuroimaging, such as CT scans, especially after any head trauma or fall[2].
Management of subdural hemorrhage in the elderly is complex due to the high incidence of recurrence and the presence of comorbidities. Surgical evacuation may be necessary for large or symptomatic hematomas, but the risk of complications and recurrence remains significant[4]. Careful perioperative management, including correction of any coagulation abnormalities, is critical to improve outcomes[1].
In summary, falls in elderly individuals are a major risk factor for subdural hemorrhage due to anatomical vulnerability, increased fall frequency, and often impaired blood clotting. Awareness of this risk and early medical evaluation after falls are essential to prevent severe complications.
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**Sources:**
[1] Yamanishi S, Kim Y, Ashida N, et al. Recurrent Subdural Hematoma Revealing Undiagnosed Mild Hemophilia A and Factor XIII Deficiency in an Elderly Patient. Cureus. 2025;17(9):e92502.
[2] Kılıçkesmez Ö. Subdural Hemorrhage. 2025.
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