The older adult with a spinal cord injury

Abstract

Sixty-two consecutive acute spinal cord injury (SCI) patients who were aged 55 years or older were studied and compared to 296 SCI patients of age less than 55 years. Compared to younger patients, the older group had significantly more females (29%), preexisting medical conditions (87%), associated injuries (55%), incomplete quadriplegic patients (63%), and persons whose injuries resulted from falls (53%). There were no differences between groups in frequency of ventilator use, occurrence of medical complications, or acute length of stay, but older patients tended to have fewer surgical spinal fusions (40%), shorter rehabilitation stays (66.5 days), more indwelling urethral cathteters (31%), and more nursing home discharges (19%). With other factors being controlled, advancing age was predictive only of nursing home discharge, and not of acute or rehabilitation lengths of stay. Among older SCI patients, those with complete injuries were nearly 3 times as likely to have been discharged to nursing homes in our series compared to older patients with incomplete lesions. Although many aspects of the presentation, course, and care of older SCI individuals are similar to those of younger patients, there are several unique features of older adults with a SCI.

Effects on age on spinal cord lesion patients' rehabilitation

“…With regard to LOS in our series, older patients had a significantly shorter LOS, a finding similar to Roth et al, 13 but opposite to Cifu's data 7 on paraplegic subjects. LOS could be influenced by a series of factors: the completeness of lesion (a high number of patients with incomplete tetraplegia in older group could justify the shorter LOS of this group); the higher frequency of comorbidities in older patients could interfere with the rehabilitation process, which could in turn affect the length of stay; 1 the discharge disposition and the increase likelihood of institutionalisation of older patients, which could affect the length of stay for awaiting placement.…”

“…The choice of age 50 years, although arbitrary, was made on the basis of previous reports. [12][13][14] Only patients who had the cognitive ability to participate in the rehabilitation programme were included. Whenever a patient was discharged or transferred for more than 3 weeks, the readmission was considered a second admission and the patient was excluded.…”

Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury

“…15 The same age criterion has been used previously in other studies. 9,15,16 Forty (20.8%) subjects were aged 55 ± 85, the mean age of this group was 66.3 years (SD=7.4). One hundred and ®fty-two (79.2%) subjects were aged 16 ± 54, the mean age of this group was 34.0 years (SD=10.6).…”

“…However, the evidence is equivocal. Roth, Lovell, Heinemann, Lee and Yarkony 9 report no di erences in the frequency of complications following SCI or the requirement for mechanical ventilation between older and younger adult age groups. Furthermore, Krause,10 in a study to investigate ageing after SCI, found that acquiring a SCI at an older age was associated with the reduced risk of developing several conditions.…”

“…5,9,15 Therefore, the same level of physical functioning post-injury should not be anticipated ± as they are with population focused scales when comparing rehabilitation gain or rehabilitation outcome in older and younger adults with SCI. Secondly, injury characteristics di er between younger and older adults with older adults being more likely to sustain an incomplete cervical lesion than younger individuals 4,5,9 and injury characteristics seriously a ect the degree of physical independence following injury. Due to the heterogeneous nature of SCI's there is great diversity in what would constitute a successful outcome within the spinal cord injured population.…”