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.⁴  Estimates in the US indicate a five-fold increase in the incidence of SCIs in the elderly over the past 30 years.⁵ 

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.⁶ 

Therefore SCI in the elderly can be conceived of as occuring in two distinct populations:

1. those individuals whose SCI onset arrived at an older age, known as late onset and
2. those with a long SCI duration who then reach old age, known as early onset.⁷

While both types can be the result of either traumatic or non-traumatic events, the traumatic occur less frequently in older patients; those that do are often a result of falls.⁸  Given aging patterns in the general population, it is expected that the number of those with both early and late onset injuries will continue to increase.

Box 1: Etiology of Late Onset SCI in Elderly Patients

Older, late onset SCI patients differ somewhat from younger patients in fundamental ways. Most notably, older patients have more associated medical problems 9, 10, 11  and are more likely to develop secondary medical complications related to the SCI itself which can have a major impact on rehabilitative results for any patient, and may lead in the worst cases to a cycle of further complications.12, 13 Studies have demonstrated that above the age of 61, there is a greater risk of diabetes, heart disease, obesity and arthritis, poorer outcomes with respect to walking and more difficulties with bladder and bowel independence.14, 15, 16

Additionally, older patients are more likely to develop complications such as pneumonia, pulmonary emboli, renal stones and gastrointestinal hemorrhage.^{17, 18}  

Such complications are of general importance in recovering from a spinal cord injury in that it is not only the type of injury that determines functional outcomes, but also a patient’s general health status. For example, conditions such as aspiration pneumonia resulting from poorer states of health can initiate a cycle of declining health that lead to correspondingly poor prognoses. 

In general, patients with late onset SCIs tend not to be working and often report greater handicap in independence measures than those with early onset injuries.

Given the higher rates of complications such as these among elderly patients, what outcomes can be anticipated with elderly patients suffering from non-traumatic, late onset SCI?

One large study of over 6,000 SCI patients showed a correlation between age and a decrease in functional independence, overall life satisfaction, and perceived physical health, especially in the areas of physical independence, mobility, occupational functioning and social integration.²¹ 

Given these adverse outcomes, there is a significant chance among elderly SCI patients that they will be transferred to other hospitals or rehospitalized.^{22, 23, 24} Additionally, an individual’s age is a particularly strong predictor of whether he is discharged to his own home, a nursing home or another care facility.²⁵ 

Approaches to rehabilitation may differ between the early and late onset SCI persons and need to be specially tailored. Other health conditions will be of relevance in the late onset population and an awareness of these will do much to further the rehabilitation process.

A lower general health status leads to lower levels of physical (i.e. exercise) and mental tolerance, effectively limiting those processes that can work to promote better functional outcomes. As we shall see in Mr. Meiers’ case, memory loss and dementia can have significant effects impeding rehabilitive efforts.

In either case, as SCI has been associated with an acceleration of the aging process due to lower physiological reserves and increasing requirements of those body systems that are functioning, the treatment and prevention of conditions and complications associated with older SCI patients requires special attention on the part of health care teams.²⁶ 

Hence, it is essential that in the rehabilitation of elderly SCI patients, a staged process is undertaken that can deliver appropriate services at the right intensity, taking into account a given patient’s functional status, impairments and comorbidities. 

Such a process requires that the health care team determine the effects that age might have following an SCI, characterize the adjustment necessary among elderly patients and identify their unique rehabilitative needs. 

This case study will focus on one late onset patient and the age-related factors and issues that had an impact upon his rehabilitation and recovery.