SCI in Older Persons

More and more spinal cord injuries (SCI) are occuring in older persons. With the effectiveness of SCI interventions, the increased utilisation of preventative care and specialised treatment centres and people living longer in general, the life expectancy of persons with SCI has increased dramatically over the past decades.

I felt relatively healthy before the aneurysm and the spinal cord injury. I didn’t have any sense of a problem that would require an operation, so I was quite surprised when it came up. There was no discomfort; I wasn’t disabled. I did get a little tired while working. Of course, I thought this was just my age.

Mr. Meier

The Rehab-Cycle^® of Mr. Meier began in July 2007 with an assessment of functioning from both a health professional perspective as well as Mr. Meier’s own perceptions and experiences.

Based on the assessment results an ICF Categorical Profile of Mr. Meier's functioning status was created. See table 2. An ICF Categorical Profile is a visual display of ICF categories that reflect these assessment results as well as the goals i.e. global goal, service-program goal and three cycle goals, that Mr. Meier and his rehabilitation team mutually agreed upon.

Mr. Meier’s rehabilitation team included his physician, a nurse, physical therapist, occupational therapist and social worker. Each team member was assigned to corresponding intervention targets that had been determined during the assessment phase.

I didn’t achieve as much as I wanted to. I still can’t walk!

Mr. Meier at the end of his Rehab-Cycle^®

Despite the complications that arose, Mr. Meier was able to make progress in his Rehab-Cycle^®, achieving two of his three cycle goals: mobility and general health status. This was clearly seen during the evaluation phase.

Spinal cord injury (SCI) has a devastating and traumatic impact on all those it affects. An older person with SCI can present unique challenges within a rehabilitation setting. These persons bring a variety of age-related problems as well as resources that can greatly influence the rehabilitation process. Mr. Meier’s case is a good illustration of rehabilitation in older persons with SCI.

1. Whiteneck G, Charlifue, SW, Frankel HL, Fraser MH, Gardne BP, Gerhart KA, Krishnan KR, Menter RR, Nuseibeh I, Short DJ, Silver JR. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia. 1992; 30:616-630.
2. Menter RR, Hudson LM. Effects of age at injury and the aging process. In: Spinal cord injury: Clinical outcomes from the model systems. Stover SL, DeLisa JA, Whiteneck GG (Eds.). 1995. Gaithersburg, MD: Aspen Publishers: pages. 272–288.
3. Krause JS. Aging after spinal cord injury: An exploratory study. Spinal Cord. 2000; 38: 77-83.
4. Capoor J, Stein A. Aging with spinal cord injury. Phys Med Rehabil Clin N Am. 2005; 16: 129-161.
5. Bickenbach J et al. A global picture of spinal cord injury. In: Bickenbach J, Officer A, Shakespeare T, von Groote P. Eds. International perspectives on spinal cord injury. Geneva, Switzerland: World Health Organization; 2013. p. 13-41.
6. Thomas Jefferson University. Elderly Spinal Cord Injuries increase five-fold in 30 years, Neurosurgeons find. ScienceDaily. March 2007., [Internet] Available from: http://www.sciencedaily.com/releases/2007/03/070319111256.htm. Accessed November 2014.
7. Gerhart KA, Charlifue S, Menter RR, Weitzen-kamp DA, Whiteneck G. Aging with spinal cord injury. Spinal Injury Network website. [Internet] Available from: http://www.spinal-injury.net/ageing-spinal-cord-injury.htm Accessed November 2014.
8. Rochon PA, Katz JN, Morrow LA, McGlinchey-Berroth R, Ahlquist, MM, Sarkarati M, Minaker KL. Comorbid illness is associated with survival and length of Hospital stay in patients with chronic disabilities. Med Care. 1996; 34(11): 1093-1101.
9. Barrett J, Putzke J, Richards J. Early versus late onset of spinal cord injury among the elderly. J Clin Psych Med Settings. Sept 2002; 9(3): 219-226.
10. Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M. Effects on age on spinal cord patients’ rehabilitation. Spinal Cord.2003; 41:457–464.
11. Putzke JD, Barrett J, Richards J, DeVivo M. Age and SCI: An emphasis on outcomes among the elderly J Spinal Cord Med. 2003; 26(1): 37-44.
12. DeVivo, M, Kartus P, Rutt R, Stover S, Fine P. The influence of age at time of spinal cord injury on rehabilitation outcome. Arch Neurol. 1990; 47: 687-691.
13. Ohsawa S, Tamaki M, Hirabayashi S. Medical rehabilitation of the patients with spinal cord injury caused by aortic aneurysm and its operation. Spinal Cord. 2008; 46: 150-153..
14. DeVivo MJ. Discharge disposition from model spinal cord injury care system rehabilitation programs. 1999; 80(7): 785-790.
15. Blanchard J. Epidemiology of abdominal aortic aneurysms. Epiodemiologic Reviews. 1999; 21(2): 207-221.
16. Rahimi S, Rowe VL. Abdominal aortic aneurysm: Practice essentials, background, anatomy, pathophysiology, etiology, epidemiology, prognosis, patient education. [Internet] 19 November 2014. Available from: http://emedicine.medscape.com/article/1979501-overview. Accessed November 2014.
17. Bhimji S, Davis CP. Aortic Aneurysm Definition and Overview. [Internet] 17 September 2014. Available from: http://www.emedicinehealth.com/aortic_aneurysm/article_em.htm#aortic_aneurysm_definition_and_overview. Accessed November 2014.
18. Yokoyama O, Sakuma F, Itoh R, Sashika. H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation. Arch Phys Med Rehabil. 2006; 87(9):1189-1194.
19. Miller W, Chan C. Spinal Cord Independence Measure (SCIM). [Internet] 1 February 2013. Available from: http://www.scireproject.com/outcome-measures-new/spinal-cord-independence-measure-scim. Accessed November 2014.
20. Holicky R, Charlifue S. Aging with spinal cord injury: the impact of spousal support. Disability and Rehabilitation. 1999; 21(5/6):250-257.