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Special considerations in the urological management of the older spinal cord injury patient

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Abstract

Purpose

This paper reports the key findings of Committee 8 of the Joint SIU–ICUD Consultation on Urologic Management of the Spinal Cord Injured Patient and address issues pertaining to the older person with a SCI and the time-related changes relevant to their urological, gastrointestinal and functional management.

Methods

A literature review using the Pubmed and Ovid search engines was performed examining pertinent literature regarding SCI in the older patient.

Results

There is a rising incidence of both traumatic and non-traumatic spinal cord injury (SCI) in older people and improvements in healthcare and nutrition mean patients with SCI are living longer. Outcomes after a SCI in the older person are a sum of the effects of injury and its management compounded by specific effects of ageing and the emergence of unrelated comorbidities. Changes in health, comorbidities, cognition and dexterity with ageing have an impact on function and are important considerations in the management of the older patient with SCI. Treatment decisions are thus increasingly complex due to the need to take into account these changes and accompanying polypharmacy. For the person living with a SCI, changes in circumstances (social and financial) have an impact on quality of life and influence management and support strategies.

Conclusions

Older patients with SCI face additional challenges both in the acute setting and with ageing. Clinicians should take into account comorbid conditions, mental health, physical function, cognition and social support in making management decisions. With the global ageing population, health services planning will need to allow for increase in resources required to care for older patients with SCI.

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Author information

Authors and Affiliations

  1. Department of Urology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia

    Lewis W. Chan

  2. Department of Urology and The Landon Center on Aging, The University of Kansas School of Medicine, Kansas City, USA

    Tomas L. Griebling

  3. Department of Surgery, Otago University, Christchurch, New Zealand

    Edwin P. Arnold

  4. Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong Special Administrative Region, China

    Peggy S. Chu

  5. Alfred Health and Epworth-Monash Rehabilitation Medicine Unit, Caulfield Hospital, Spinal Rehabilitation Service, Monash University, Melbourne, Australia

    Peter W. New

  6. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia

    Peter W. New

  7. Department of Medicine, University of Alberta, Edmonton, Canada

    Adrian Wagg

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  1. Lewis W. Chan
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  2. Tomas L. Griebling
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  3. Edwin P. Arnold
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  4. Peggy S. Chu
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  5. Peter W. New
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  6. Adrian Wagg
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Correspondence to Lewis W. Chan.

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Chan, L.W., Griebling, T.L., Arnold, E.P. et al. Special considerations in the urological management of the older spinal cord injury patient. World J Urol 36, 1603–1611 (2018). https://doi.org/10.1007/s00345-018-2326-3

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  • DOI: https://doi.org/10.1007/s00345-018-2326-3

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