SCI Forum Reports

Aging and SCI

February 4, 1997

Most of us don't look forward to the body and lifestyle changes that will occur as we age, said Stephen Burns, MD, a physiatrist at the Seattle Veterans Affairs Medical Center. "I don't want to be the bearer of bad news, but these things will come whether you have a spinal cord injury or not."

Aging with SCI is still an evolving research area, since long survival after injury is a relatively recent development, especially for those with higher-level injuries. However, it is an issue of growing concern. About 20% of the population with SCI is now over age 60, and the average age among persons with SCI is now about 40, Burns said.

In addition to the diseases and other health problems that the general population has to contend with later in life, certain issues are of special concern for people with SCI:

• Skin
  Everyone's skin becomes thinner and less resilient with age, so those with paralysis must increase their vigilance in order to avoid pressure sores.
• Cardiac
  Inactivity and weight gain, which can result from impaired mobility, have been linked to heart disease. In addition, people with higher-level SCI may not be able to feel the early warning signs of angina.
• Pulmonary
  The number-one cause of death among persons with SCI is pneumonia, and persons with high-level injuries may find that their ability to breathe becomes more impaired with age. Up to 5% of those over age 75 need to start using a ventilator at some point, Burns said, though not all require a tracheostomy and full-time ventilatory support.
• Urinary Tract
  "We want to preserve the function of the kidneys, and it seems that we're very effective at picking things up with the screening that we do and treating disorders that lead to kidney failure, " Burns said. The frequency of bladder cancer is higher among persons with SCI, but still very low (around 1-3%). Indwelling catheters may increase the risk of bladder cancer, but "the studies that are done are good at picking it up early on," Burns said. "It's not something you should lose sleep over."
• Gastrointestinal
  Decreased mobility and other changes associated with aging may make it more difficult to manage a bowel program, and this may lead a small percentage of people to decide to have colostomies in later years, Burns said. Some may also have problems with gallstones as they age.
• Neurological
  Any changes in neurologic function, such as a loss of strength, may indicate a complication such as syringomyelia (a cyst in the spinal cord), and should be evaluated right away in case treatment is needed to prevent permanent loss of function.
• Musculoskeletal
  Many people with SCI experience pain in their arms and shoulders, which is not too surprising when you consider how much extra work they do with their upper extremities, Burns said. By age 50, about half the general population has a tear in the rotator cuff, a system of four tendons that blend together to help stabilize and move the shoulder. Among those with SCI such problems are "a time bomb" waiting to go off, and any preventive efforts are worthwhile. "Everyone should know what contributes to it, in terms of types of transfers and so on," Burns said. A good physical therapist is probably the best source for this information.

  Many people with SCI also experience carpal tunnel syndrome, an injury that results from stress on the nerves in the wrist through repetitive motion, such as pushing a manual wheelchair. Surgery for carpal tunnel syndrome involves a period of immobility, which can be doubly difficult for someone who needs his or her hands for everyday activities like getting in and out of bed.

• Personal Care
  About 60% of persons with SCI under the age of 60 are independent for all self care needs. In those over 75 years old, that percentage decreases to 30%. Eventually, up to 25% may need to go into a nursing home at some point. "A lot of times, there's a spouse or significant other involved who may also have problems relating to aging," Burns said. The person who cares for you today may one day need to be cared for as well.
• Psychology / Adjustment
  In both injured and non-injured people, the incidence of depression increases to some extent with age, Burns said, although surveys of older people indicate that most consider their quality of life to be similar to when they were younger.
• Strength
  " On top of all that, there's just a normal loss of strength with aging," Burns said. "There'll be a point where it becomes more difficult to do things the way they're done now." For this reason, it makes sense to start thinking about other adaptive strategies, such as switching to a power chair or a van, that may help you keep participating in activities you enjoy when such changes occur down the road. "Not everyone will need to do these things," Burns said, "but it's something to keep in mind as a possibility."
• Smoking
  Burns offered another suggestion to smokers with SCI: stop smoking. Smoking increases the risk for bladder cancer, cardiac problems, and pulmonary problems, and interferes with healing after pressure sores. "There's really not much we can do to slow down the aging process, but smoking is something that can speed it up."

 

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