Spinal cord injury has a devastating and traumatic impact on all those it affects. The elderly SCI patient can present unique challenges to health care professionals. These older patients bring a variety of age-related problems and resources for optimal rehabilitation. Mr. Meiers’ case helps to illustrate one possible example of SCI and its rehabilitation in the elderly.
With increasing age comes a higher risk of aortic aneurysm and as with Mr. Meiers’ story, it is clear that the corrective surgery required for this condition carries with it the unfortunate risk of SCI.13 In this case, it results in a non-traumatic and incomplete lesion, which tends to be more prevalent among older patients.7
Health care providers must be attuned to the fact that older patients are more frequently confronted by complications, both mental and physical, during the rehabilitative process.
As SCI survivors of older age recover, there are numerous factors that can affect rehabilitative processes and their outcomes. Mr. Meiers offers a descriptive case of the higher incidence of complications during hospitalization in patients over 50.7
Here, comorbidities, physical tolerance limits, age-related personal factors and psychological impacts all had a potentially significant effect on his rehabilitation and general health. In the assessment phase of the Rehab Cycle we found that while some aspects were common among many SCI patients and not necessarily related to age, there were a number of factors that could be considered age-dependent.
Included here are Mr. Meiers’ comorbidities that resulted in impaired cardiovascular and respiratory functions, as well as a weakened musculoskeletal system. Such limitations and complications have the potential of creating a negative feedback cycle leading to poorer outcomes.
For example, Mr. Meiers’ physical limitations adversely impacted the training and exercises required for his rehabilitation, slowing the process and maybe even leading to a less optimal outcome. This in turn resulted in a weaker health status that was further harmed through an unexpected complication: the suddent downturn of Mr. Meiers’ mental status late in the Rehab Cycle.
This may or may not have been correlated with his age. However, dementia in elderly patients can occur. Health care providers must be attuned to the fact that older patients are more frequently confronted by complications, both mental and physical, during the rehabilitative process.
Other factors that could also be correlated with Mr. Meiers’ age had facilitating effects. Such factors could be social or economic or include personal characteristics and geographic aspects. There were positive financial factors in Mr. Meiers’ case: he had significant capital resources such that there were no real financial concerns — less common among younger patients.
Furthermore, he was retired and had no occupation upon which he and others depended. The presence of a spouse can also have a significant impact. If elderly, is she able to sufficiently care for her partner or does she require care herself? Spousal support has been associated with less depression, greater life satisfaction, psychological well-being and better perceived quality of life among SCI patients.14
Fortunately in Mr. Meiers’ case, he had a wife and family that were willing and able to support him. Both of these factors were of great benefit to Mr. Meiers during the course of his recovery.
The presence of a spouse can also have a significant impact.
Furthermore, an older patient’s life perspective and outlook may differ to those of a younger persons affected by SCI and this outlook may have psychological impacts. Mr. Meier felt strongly that he had already lived a long and successful life. Overall, he felt he had a “good life” and these perspectives offered him a degree of comfort and strength. While this was a facilitating aspect of Mr. Meier and perhaps of many older patients, it did not preempt other psychological challenges.
Feelings of being “lost” and “helpless” or of crying, followed by feelings of diminished masculinity, were issues that continued throughout the rehabilitation. While such feelings may not be specifically age-dependent, powerlessness and dependence among older men who have always maintained traditional gender roles may be prevalent.
Another mental obstacle that arose was the challenge posed by poor memory. Mr. Meiers’ limitations in committing his transferring steps to memory would continue to keep him dependent upon others. In this case, the memory limitation could be considered largely age-related.
Feelings of being "lost" and "helpless" or of crying, followed by feelings of diminished masculinity, were issues that continued throughout the rehabilitation.
Older and elderly SCI patients can present a special set of challenges, issues and factors to the rehabilitation process. Within the Rehab Cycle, many of the factors can be assessed at the beginning and constructively used to inform the process of rehabilitation and hopefully achieve better outcomes.
Awareness of comorbidities and the possibility of complications associated with the older patient is the first step in their prevention and management. Facilitating aspects of the patient’s personal characteristics, social network and environment can also be taken into consideration in order to support the process and prepare a patient for returning home or, if needed, to a nursing home or other care facility.
For older SCI patients, the Rehab Cycle’s holistic approach to rehabilitation will support them and their health care team’s decision making along the way, allowing for the best possible recovery and outcomes.