Aging with spinal cord injury

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Traumatic spinal cord injury (SCI) was long ago thought of as ‘‘an ailment not to be treated.’’1 Since World War II, this once always fatal condition has reaped the benefits from advances in emergency and acute management, to the extent that people with SCI are surviving the early years posttrauma. Further advances in rehabilitative interventions, assistive technology to enhance independence, and early identification of secondary conditions enables those with SCI to live many years, often into their seventh and eighth decades. Several studies suggest that survival is influenced by the level and severity of injury,2–4 age at injury,5–8 and decade of injury.9–12 Individuals with higher level, more neurologically complete lesions (ie, no or limited motor or sensory preservation below the level of lesion), and those injured at older ages have higher mortality rates in general. Those that live into their middle and older years with relatively stable health and functional abilities, however, experience the physical deterioration that naturally occurs with aging. Of note, the recent pattern of individuals incurring SCI is shifting with the mean age at onset increasing.13–15 With this trend, the effects of aging may appear more quickly post-SCI. In addition, there may be numerous psychosocial changes associated with functional decline, alterations in family and social support structures, and potential depletion of economic resources. It is useful for individuals with SCI and their health care team to know what changes may be expected as the individual ages, to identify possible preventive strategies to minimize the effects of aging.

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