Ageing with spinal cord injury

Ageing is natural process that is an accumulation of changes in the body over time including physical, psychological and social changes. People with spinal cord injury are living longer due to improvements in health care, with life expectancy approaching that of the population without spinal cord injury (Mortenson et al., 2014).  However, it has been proposed that health declines associated with natural ageing are compounded by a spinal cord injury and likely to occur earlier and more frequently in people with spinal cord injury (Withers et al., 2019).  

For all of these reasons, healthcare for people with spinal cord injury needs to take a lifespan approach to treatment and care planning, including how factors, like ageing, can impact patient outcomes.

Physical changes

As people with spinal cord injuries age, they face specific health risks that can uniquely affect their wellbeing, including: 

• Increased risk of skin breakdown: skin quality changes over time, increase the risk of pressure injuries. 
• Musculoskeletal changes: overuse from activities like transfers and wheelchair propulsion can cause complications in the hands, wrists, elbows and shoulders. Osteoporosis may also develop, heightening the risk of bone fractures.   
• Postural changes: changes in posture may impact skin integrity, functional independence, pain levels and respiratory function. 
• Cardiovascular changes: heart disease and diabetes are more common among people with spinal cord injury.
• Increased fatigue: the need for physical assistance may increase over time. 
• Sleep-disordered breathing: sleep-related breathing issue remain a persistent concern. 
• Catheterisation concerns: long-term urethral catheterisation can affect prostate-specific antigen test results; any concerns should be discussed with a spinal injuries specialist or urologist. 

These factors highlight the importance of comprehensive health management and follow-up care for people with spinal cord injury as they age. Understanding family health history and maintaining regular age-appropriate health check-ups are equally important for people with spinal cord injury as they change.

Psychological impact of physical changes

People with spinal cord injuries can experience psychological stress due to pain, physical changes and the ongoing demands of managing secondary health issues. Chronic stress can lead to various cognitive and physical symptoms, including impaired memory, decision-making difficulties, mood disturbances, sleep issues, digestive problems, headaches, and increased inflammation. 

Functional changes associated with ageing can also alter daily living: 

• Wheelchair modifications: transitioning from a manual to a power wheelchair can lead to feelings of increased disability, changes in identity, and difficulties in manoeuvrability. 
• Transfer methods: adjustments in transfer techniques, such as using a transfer board or requiring a hoist, can affect independence. 
• Care supports: increased reliance on caregivers can result in a loss of autonomy. 
• Bladder management changes: difficulty with toilet transfers or a need for an indwelling catheter can diminish independence. 

These changes may trigger feelings of “re-injury,” heightening the risk of mental health issues. Supporting resilience and adjustment is vital to reduce these risks and improve wellbeing.

Social changes 

As people with spinal cord injury age, community participation often declines, leading to social isolation and loneliness. These factors can contribute to memory and cognitive changes.

Several factors influence social engagement, including:

• Financial challenges: people who do not return to work after spinal cord injury may face financial difficulties, especially if they rely on funding for care and equipment.
• Transportation: difficulty driving or transferring into vehicles can limit mobility and social interaction.
• Fatigue: managing daily activities while conserving energy for social interaction can be challenging.
• Support networks: changes in formal and informal support systems, especially as partners age, can impact social involvement.
• Infrastructure: physical decline may affect the ability to navigate barriers like curbs or ramps independently.

Promoting community engagement and addressing these barriers is essential to improve quality of life. 

Prioritising quality of life 

Several proactive strategies can enhance well-being for people with spinal cord injury:

• Health management: regular follow-up care to prevent complications before they arise.
• Engagement in activities: hobbies like singing, reading, creative writing, and art can enrich life.
• Social interaction: staying socially active improves both physical and mental health.
• Connection with networks: staying connected with family and friends boosts mood and emotional resilience.
• Overall wellbeing: a balanced lifestyle, including nutritious eating, adequate sleep, and stress management, promotes health.

Supporting people through lifestyle changes, encouraging their agency, and fostering positive adaptations are crucial for maintaining quality of life.

Review equipment and routines 

Regular assessments of equipment and routines can significantly enhance daily functioning and quality of life:

• Review equipment: regularly assess the effectiveness of current equipment and routines to identify areas for improvement.
• Managing fatigue: strategies like reducing the number of transfers and spacing activities throughout the day can help manage fatigue.
• Bladder and bowel routines: regular reviews of these routines can improve comfort and independence.
• Ceiling track hoists: consider a ceiling track hoist to make transfers easier and safer.
• Wheelchair options: lighter manual wheelchairs or power assists can reduce strain and improve mobility.

These adjustments contribute to better daily functioning, reducing physical strain and promoting overall wellbeing for people with spinal cord injury.