Aging with SCI

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.

Read more: General Introduction

Spinal cord injuries (SCI) are occuring with increasing incidence in elderly patients. An estimated 7-20% of those suffering from SCI are 60 years or older and these rates have been increasing steadily over the past 20 years.Estimates in the US indicate a five-fold increase in the incidence of SCIs in the elderly over the past 30 years.

With the effectiveness of SCI interventions, the increased utilization of preventative care and specialized treatment centers and people living longer in general, the life expectancy of SCI patients has increased dramatically over the past decades.

Read more: Spinal cord injury in the elderly patient

Mr. Meier’s medical history extended back quite a number of years, covering a range of health problems, some of which would have implications for his recovery and rehabilitation from his SCI.

...previous aneurysms, heart disease and thromboembolytic incidents placed him at even greater risk for SCI-associated thromboses.

In 1998, he had suffered from thoracic and abdominal aortic aneurysms which were successfully treated.His history also included ischemic coronory heart disease and repeated thromboembolic incidents (1942, 1963 and 1998), renal cysts, cox arthrosis (leading to a hip joint prosthesis in 1998) and wrist and shoulder arthrosis.

Read more: Mr. Meier's story

The Rehab Cycle began in July 2007 with an assessment that included both a health professional perspective as well as Mr. Meiers’ own perceptions and experiences. This assessment was based on the description of ICF components (body structures and functions, activities and participation and environmental/personal factors).It helped identify what he and his health professionals saw to be outstanding needs and individual problems — some of which were age-related (see Figure 1).

Read more: Assessment

Mr. Meiers’ health care team included his physician, a nurse, physical therapist, occupational therapist and social worker. Each team member was assigned to corresponding intervention targets.

His physician, for instance, was responsible for cardiovascular, elimination and muscle tone functions, providing interventions primarily through pharmaceutical management. The nurses supported Mr. Meier in nearly all activities of self-care.

Read more: Assignment and Intervention

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 final Rehab Cycle, reaching two of his three cycle goals: mobility and general health status.

Read more: Evaluation

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

Read more: Discussion