More and more spinal cord injuries (SCI) are occuring in older persons. An estimated 7-20% of those living with SCI are 60 years or older, and these rates have been increasing steadily over the past 20 years. Estimates in the United States indicate a five-fold increase in the incidence of SCI in the elderly over the past 30 years. Thus, understanding the lived experience of older persons with SCI – specific issues and needs – is very important for optimizing care.

By many measures Mr. Meier could be considered successful. After 25 productive years as the chief executive officer of his own auto parts firm, he retired three years ago. At 78, he is still married to his first wife and is an involved grandparent to his two grandchildren from two daughters.

Retirement has not meant slowing down for Mr. Meier and he certainly hasn’t ceased working. Since retiring, he has focused on managing and maintaining a number of properties that he owns throughout Switzerland. Not surprisingly, Mr. Meier has lived comfortably and in relative wealth together with his wife in a one-family chalet.

He has always engaged in life enthusiastically and since stepping down as chief executive officer, sailing, gardening and socialising have comprised his recreational time. At his age, Mr. Meier had certainly never anticipated living with a spinal cord injury (SCI). And despite his collected years and the existence of diverse diseases at the time of its occurance, physical fitness, mental clarity and independence were the norm.

His condition after the SCI left him in a drastically different state, taking him on a five-month rehabilitation whose challenges were as difficult as any that came before.

Aging is both an unavoidable fact of life and a complex process. Aging is intertwined with a spectrum of medical, social, environmental, physical and psychological processes, as well as other factors such as genetics, adaption to stresses, ethnicity and economic resources.4

Sorting out what might be considered the “normal” processes and effects of aging from those of spinal cord injuries is therefore next to impossible.

There is an additive effect to health problems with the intersection of spinal cord injury and increasing age.

However, it can be assumed that there is an additive effect to health problems with the intersection of spinal cord injury and increasing age.

Until recently, no longitudinal studies on SCI and aging had been undertaken. However, since 1990 studies have attempted to make correlations between complications and comorbidities, SCI and age.10 For example, some secondary conditions such as pressure sores, respiratory problems and decreasing physical independence have all been associated with increasing age.11

Box 1 | Etiology of Late Onset SCI in Older Patients

In general, the causes of late onset spinal cord injuries in older patients differs markedly from those of younger patients. The late onset group tend to have nontraumatic and incomplete SCIs.1 While persons under 50 have a higher probability of having a traumatic injury that results in an SCI, this is not the case in older and elderly individuals. In one study of 284 patients, car or motorcycle accidents were the cause of 40% of the SCI injuries in those under 50 years of age as compared to 3% in those over 50.1 Falls, on the other hand, were roughly equal in causing SCIs in both younger and older persons (10 and 11.5%, respectively).1 Only about 20% of traumatic SCIs occur in those over 65.1 The majority of spinal cord injuries in older patients are a result of inflammatory, vascular, neoplastic or degenerative causes.1 Thus, the mentioned study also indicated that 83% of the sample population over 50 suffered from non-traumatic SCIs.

Medical complications such as those arising from aorticaneurysm surgery (View page 9) also are a frequent cause of SCI in the elderly.1

This case study aims to illustrate the later phase of rehabilitation of one elderly patient suffering from SCI and reflect on the role that comorbidities and age can play in achieving optimal functional outcomes.