After transmitting the email message which is the subject of this post, I realized it reveals a critical insight which may explain the severity of mTBI in older victims.
If it is accepted that “life” represents the accumulation of acquired wisdom (with “wisdom” representing an accumulation of both tacit and explicit knowledge) then it is clear that the older the individual, the greater their store of intellectual capital. Intellectual capital also translates into social capital. As the individual obtains insight into social processes and their surrounding social reality, they have an opportunity to refine their goals and identify improved strategies for achieving those goals.
Framed in another way, we all started out in life wanting to be a nurse, or a fireman, or the lead singer in a band. Increased KSA acquisition results in the development of more realistic occupational objectives. It also results in increased sensitivity to social milieu as an opportunity factor in achieving personal goals. The cumulative effect is like that of a snowball rolling downhill. Even without any conscious attempt, the more senior members of society will arrive at the bottom of the hill with larger accumulations of KSAs. These accumulations will be significantly greater than those of persons situated at an earlier point in their life trajectory.
In short, the more senior the victim, the greater the impact of an injury which impairs personal access to the personal store of intellectual capital.
This loss of intellectual capital will have knock on effects on social relationships. Once you realize your intellectually profound neighbour is withering away into a bowl of less than lucid ectoplasm, there will follow an aversive reaction. You will be less likely to interact with the impacted individual. This is similar to the magical thinking present in high risk occupations. If you do not discuss the risk of death and injury, you act to deny the high risk of death and injury, and therefore manage your psychological exposure to significant hazard.
Even if the mTBI victim is not consciously aware of the totality of their loss of intellectual capital (my first experience of this was in the form of a mental fog. There was limited understanding of the degree of loss until I made repeated attempts to duplicate tasks which I was previously able to perform and discovered to my great frustration that I was incapable of duplicating my prior competency), they will likely have some degree of awareness of their loss. I suspect that my feeling of being “unsafe” may have derived from the unconscious awareness of this loss of intellectual capital.
The fact of the senior victim being exposed to greater loss, and obtaining either conscious or unconscious awareness of this loss, will contribute to a psychological response which may exacerbate and compound the effects of the original injury. The onset of depression is one example of such a psychological response. A higher incidence rate of suicide is another. A higher incidence of substance abuse is a third.
The implications of these observations suggests that the information and counselling needs of the more senior victim population will be greater than, and somewhat different from, the needs of a more junior victim population.