Improvements in health and social care mean that people are living longer than ever before. This is especially true for people with spinal cord injuries (SCI), as advances in medicine and medical technology mean that conditions which would previously have significantly shortened someone’s expected lifespan are now simply a facet of a long life.
There are naturally additional challenges for those of us living with spinal cord injuries as we age; aging and SCI are each independent risk factors for a wide range of conditions. Some of the conditions which are more common in people with spinal cord injuries are exacerbated or hastened as those people age. Additionally, SCI can also be a trigger for some of the processes which are usually associated with aging.
Life Expectancy for People with Spinal Cord Injury
A spinal cord injury cannot easily be generalised, as there is no one-size-fits-all; variations in the point of injury and completeness of the injury have a huge impact on the result of the injury. Therefore, the life expectancy of someone with a spinal cord injury is as variable as that of anyone else.[i] In addition, the data we have becomes outdated with every new advance in medical and surgical SCI management. Long-term studies into survival rates and life expectancy after SCI show remarkable improvement corresponding to advances in medicine and formal care, but the life expectancy of someone with an SCI is still lower than that of the general population.[ii]
Life expectancy after SCI correlates strongly to the level of neurological impairment.[iii] That said, some of the most likely causes of death in people with SCI are related to conditions that can often be well managed with good rehab, medical and nursing care.
Top Causes of Death in Spinal Cord Patients
The largest population studies into causes of death in people who have lived with spinal cord injuries, rather than those whose cause of death relates to the immediate cause of their spinal cord injury, have found that the largest proportion of deaths are due to respiratory complications.
High spinal cord injuries vastly increase a person’s risk of developing respiratory tract infections, so that risk needs to be carefully managed.[iv] After that, the most common causes of death are cardiovascular disease and cancer; similar to people without SCI, although causes of death for people with SCI do correlate closely to underlying problems relating to that injury.[v]
Staying healthy with an SCI, especially with a risk of respiratory complications – people who can’t breathe or cough without mechanical assistance, for example – takes extra care and management. An effective, specialised and holistic care package can significantly reduce the risk of some of the complications of living with an SCI, with knock-on effects on morbidity, mortality, and quality of life.[vi]
Effects of Ageing in the Vertebral Column
Aging can affect the bones of the spinal column in several ways. As we age, we are more likely to develop changes in our musculoskeletal system. This includes those that affect the bones, like osteoporosis; the bones and joints, like osteoarthritis, and the changes in muscle density and general tone that come with age and accompany reductions in mobility and exercise tolerance.
Conditions associated with aging also include spinal stenosis and vertebral compression fractures which can cause damage or compression to the spinal cord.
How Ageing Affects the Spinal Cord
The changes that affect the bony processes of the spine can have an impact on the spinal cord. Spinal stenosis, a condition where the canal encasing the spinal cord begins to narrow, can create pressure on the spinal cord, causing damage and triggering some symptoms of spinal cord injury.
Degenerative neurological conditions, while rare, also tend to increase in incidence with age. While these are often only associated with changes in the brain, some also affect the nerves in the spinal cord and sometimes the peripheral nervous system. Multiple sclerosis is one of the more common neurological conditions that can affect the brain and spinal cord and have an impact on sensation and movement.
Body Changes when Ageing with Spinal Cord Injury
Our bodies change as we get older – for many of us, our skin and other tissues lose elasticity and begin to sag. Our muscles often lose tone, and our bones can become more brittle with lower bone density. There’s a strong genetic element to the impact of aging; some very elderly people stay extremely fit and well, whereas other people show many of the physical signs of aging relatively early in life.
When we have a spinal cord injury that affects our mobility and sensation, the changes of aging can seem to be accelerated. Our bodies benefit immensely from exercise, and without the ability to move independently we begin to lose muscle tone, bone density, and flexibility almost immediately. Passive physiotherapy can help maintain flexibility, but the impact of simply being unable to exercise brings on some of those changes that we usually associate with aging.[vii]
Functional and Psychological Ageing
Longevity is easy to measure; quality of life is not necessarily so simple. Aging with a spinal cord injury means huge changes to lifestyle and expectations of work, family position, leisure interests, and effectively every part of a person’s life needs some adjustment. In the immediate to short-term, the psychological impact of a new spinal cord injury can be incredibly taxing.
Any new major diagnosis, especially one with a traumatic origin, can trigger strain on a person’s mental health. The level, acuteness and completeness of the injury again can influence a person’s emotional response. There are few diagnoses as all-encompassing as being told you now have permanent total quadriplegia, perhaps that you will be dependent some or all of the time on a mechanical ventilator, and that you’ll need support with almost all of your usual activities of daily living.
That said, the long-term impact of SCI on mental health seems to resolve to a level that may be surprising to those who experienced profound grief and feelings of loss at the first stages of their condition. In fact, the general quality of life and sense of wellbeing in older people living with spinal cord injury is overwhelmingly both high and stable.[viii]
Musculoskeletal Changes in Spinal Cord Injury
Chiropractor showing spinal cord bones to aged man for orthopedic diagnosis and physical recovery. Chiropractic assistant with human skeleton explaining spine injury to retired patient
Musculoskeletal changes can cause problems with the vertebrae and spinal cord – spinal stenosis, arthritic changes, and osteoporosis are some of the more common conditions that can affect the spinal cord. Spinal cord injury also causes significant musculoskeletal changes. A complete SCI means a lack of motor control and sensation from the point of injury downwards, and the loss of mobility means the loss of muscle mass and tone, and the loss of the benefits of exercise and weight-bearing. As these conditions tend to worsen with age even in those without SCI, the impact of SCI has the effect of profoundly accelerating these aspects usually associated with age.[ix]
Cardiovascular Changes in Spinal Cord Injury
A spinal cord injury can cause changes in the autonomic nervous system which can affect cardiovascular health. Changes in the activity of the sympathetic nervous system can trigger arrhythmias, hypotension, and chronic risk of autonomic dysreflexia, which in turn can cause arrhythmias, profound hypo- and hyper-tension, and cardiac arrest. As well as those risks intrinsic to SCI, immobility and loss of exercise is an independent risk factor for cardiovascular diseases like stroke and coronary artery disease.[x]
Respiratory complications
Respiratory problems are the most common and potentially serious of the sequelae of SCI. People with SCI, depending on the level and completeness of injury, may have lost some or all of their ability to breathe independently. People can become fully or partly dependent on mechanical ventilation, an independent risk factor for respiratory tract infection. People who cannot control their breathing and who cannot cough effectively find it harder to clear their lungs and are more prone to aspiration pneumonia. This risk is further increased for those who still take oral diet and fluids, but who have a compromised swallow reflex.
The risk of respiratory complications can increase with age for some people as any preserved motor function and musculature can weaken, exacerbating existing risk. Respiratory tract infections are the most common cause of death for people with SCI, but this risk can be reduced with effective medical and nursing care. The care of a person who is fully or partially dependent on mechanical ventilation requires specialist knowledge and experience. A dedicated care team – which can include training a close family member who wishes to be involved with ventilator care or have some knowledge of what to do if issues arise – can reduce the risk of problems and ventilator-associated infection.
Urinary and Bowel complications
Problems with continence, bowel and bladder function are common in people with SCI who lost control and sensation relating to those systems. While incontinence can cause serious problems with the skin, mental and physical health, urinary retention and severe constipation are both relatively common in people with SCI and have serious consequences, including bowel perforation and autonomic dysreflexia.
SCI can also impact the upper gastrointestinal system, with reduced motility increasing the likelihood of acute bowel issues.[xi]
Pressure Ulcers
Pressure ulcers, formerly known as ‘bed sores’ and moisture lesions are a huge risk for people with reduced mobility, and particularly so for those who are unable to sense the discomfort of staying too long in a position that puts pressure on some of the delicate tissues that take our weight.
Pressure ulcers are most commonly seen on the buttocks and back of the heels, but any part of the body where bony pressure is exerted on the tissues
below can develop pressure ulcers. Without good care they can become very serious, sometimes even exposing bone and causing significant risk of infection, fluid loss, autonomic dysreflexia and a range of adverse outcomes associated with open wounds.
Moisture lesions are areas of damage to the skin and underlying tissues causes by having urine or faeces, or even sweat, held against the skin for any length of time. It can begin as irritation but can degrade into open wounds, usually in the moist folds around the groin. Moisture also increases the risk of fungal as well as bacterial infections. Good nursing care and continence management can reduce this risk.
Ageing Well with Spinal Cord Injury
Although there are significant extra challenges to aging for people with spinal cord injuries, most people can expect to experience good quality of life, and there are solutions to many of the long-term risks associated with SCI.
If you’re living with an SCI, there will be changes in your care needs and lifestyle as you get older. You may have to have reassessments for your practical care needs if there are changes to your mobility, your respiratory needs, or any of the other areas where you need additional support. Housing, environment, and equipment may also need reassessment as needs change.
Some of the conditions associated with aging are unrelated to SCI, but having an SCI may pose additional challenges for people who do develop unrelated conditions. For example, cancer treatments can have significant side effects, some of which may be particularly difficult to manage for people with SCI.
As many health conditions become more common as we age, anyone with mobility and access needs can find particular challenges in their ongoing care. Regular trips to hospitals or clinics may already be a routine part of the life of someone with extra health needs due to an SCI. This is likely to increase for those of us who develop additional health conditions. Modern healthcare facilities are designed with accessibility in mind, but just getting around can become more difficult for people with SCI as they age.
With the right adjustments, a person with an SCI can expect good longevity and – perhaps more important – good quality of life. A care package designed for the individual which incorporates a team of specially trained and dedicated carers means that a person’s care needs can be met safely and effectively, allowing that person to live well and with a good expected lifespan, with support and adjustments for their extra needs.
[i] Chamberlain, J. D., Meier, S., Mader, L., Von Groote, P. M., & Brinkhof, M. W. (2015). Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology, 44(3), 182-198.
[ii] Savic, G., DeVivo, M. J., Frankel, H. L., Jamous, M. A., Soni, B. M., & Charlifue, S. (2017). Long-term survival after traumatic spinal cord injury: a 70-year British study. Spinal cord, 55(7), 651-658.
[iii] Middleton, J. W., Dayton, A., Walsh, J., Rutkowski, S. B., Leong, G., & Duong, S. (2012). Life expectancy after spinal cord injury: a 50-year study. Spinal cord, 50(11), 803-811.
[iv] Berlowitz, D. J., Wadsworth, B., & Ross, J. (2016). Respiratory problems and management in people with spinal cord injury. Breathe, 12(4), 328-340.
[v] Cao, Y., DiPiro, N., & Krause, J. S. (2019). Health factors and spinal cord injury: a prospective study of risk of cause-specific mortality. Spinal Cord, 57(7), 594-602.
[vi] Xia, Y., Wang, J., & Wang, P. (2022). Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction. Evidence-Based Complementary and Alternative Medicine, 2022.
[vii] Liem, N. R., McColl, M. A., King, W., & Smith, K. M. (2004). Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living. Archives of physical medicine and rehabilitation, 85(10), 1567-1577.
[viii] Sakakibara, B. M., Hitzig, S. L., Miller, W. C., & Eng, J. J. (2012). An evidence-based review on the influence of aging with a spinal cord injury on subjective quality of life. Spinal cord, 50(8), 570-578.
[ix] Biering‐Sørensen, B., Kristensen, I. B., Kjær, M., & Biering‐Sørensen, F. (2009). Muscle after spinal cord injury. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 40(4), 499-519.
[x] Partida, E., Mironets, E., Hou, S., & Tom, V. J. (2016). Cardiovascular dysfunction following spinal cord injury. Neural Regeneration Research, 11(2), 189.
[xi] Ebert, E. (2012). Gastrointestinal involvement in spinal cord injury: a clinical perspective. Journal of Gastrointestinal & Liver Diseases, 21(1).
