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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References
WHO | World report on ageing and health [Internet]. World Health Organization. 2016 [cited 2016-05-24 18:19:39]. http://www.who.int/ageing/publications/world-report-2015/en/. Accessed 24 May 2016
Cripps RA, Lee BB, Wing P, Weerts E, Mackay J, Brown D (2011) A global map for traumatic spinal cord injury epidemiology: towards a living data repository for injury prevention. Spinal Cord 49(4):493–501
Wyndaele M, Wyndaele JJ (2006) Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord 44(9):523–529
Shin JC, Kim DH, Yu SJ, Yang HE, Yoon SY (2013) Epidemiologic change of patients with spinal cord injury. Ann Rehabil Med 37(1):50–56
Knútsdóttir S, Thórisdóttir H, Sigvaldason K, Jónsson H, Björnsson A, Ingvarsson P (2012) Epidemiology of traumatic spinal cord injuries in Iceland from 1975 to 2009. Spinal Cord 50(2):123–126
Devivo MJ (2012) Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord 50(5):365–372
van den Berg ME, Castellote JM, Mahillo-Fernandez I, de Pedro-Cuesta J (2010) Incidence of spinal cord injury worldwide: a systematic review. Neuroepidemiology 34(3):184–192 (discussion 92)
Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O’Connor KC et al (2015) Traumatic spinal cord injury in the United States, 1993-2012. JAMA 313(22):2236–2243
Chen Y, He Y, DeVivo MJ (2016) Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972-2014. Arch Phys Med Rehabil 97(10):1610–1619
Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG et al (2012) Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology 38(4):219–226
Vanessa KN, Marcel FD, Michael GF (2013) Epidemiology of traumatic and nontraumatic spinal cord injury. Critical Care in Spinal Cord Injury: Future Medicine Ltd, London, pp 6–20
Guilcher SJ, Munce SE, Couris CM, Fung K, Craven BC, Verrier M et al (2010) Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord 48(1):45–50
New PW, Sundararajan V (2008) Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review. Spinal Cord 46(6):406–411
New PW, Marshall R (2014) International spinal cord injury data sets for non-traumatic spinal cord injury. Spinal Cord 52(2):123–132
DeVivo MJ, Kartus PL, Rutt RD, Stover SL, Fine PR (1990) The influence of age at time of spinal cord injury on rehabilitation outcome. Arch Neurol 47(6):687–691
McColl MA, Charlifue S, Glass C, Lawson N, Savic G (2004) Aging, gender, and spinal cord injury. Arch Phys Med Rehabil 85(3):363–367
Smith AE, Molton IR, Jensen MP (2016) Self-reported incidence and age of onset of chronic comorbid medical conditions in adults aging with long-term physical disability. Disabil Health J 9(3):533–538
Lauretani F, Bandinelli S, Bartali B, Di Iorio A, Giacomini V, Corsi AM et al (2006) Axonal degeneration affects muscle density in older men and women. Neurobiol Aging 27(8):1145–1154
Shaffer SW, Harrison AL (2007) Aging of the somatosensory system: a translational perspective. Phys Ther 87(2):193–207
Lammertse DP (1993) The nervous system. In: Whiteneck GG, Charlifue SW, Gerhart KA et al (eds) Aging with spinal cord injury. Demos Publications, New York
Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D et al (2005) A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord 43(7):408–416
Burns SP (2007) Acute respiratory infections in persons with spinal cord injury. Phys Med Rehabil Clin N Am 18(2):203–216
Stolzmann KL, Gagnon DR, Brown R, Tun CG, Garshick E (2008) Longitudinal change in FEV1 and FVC in chronic spinal cord injury. Am J Respir Crit Care Med 177(7):781–786
Leduc BE, Dagher JH, Mayer P, Bellemare F, Lepage Y (2007) Estimated prevalence of obstructive sleep apnea-hypopnea syndrome after cervical cord injury. Arch Phys Med Rehabil 88(3):333–337
Short DJ, Stradling JR, Williams SJ (1992) Prevalence of sleep apnoea in patients over 40 years of age with spinal cord lesions. J Neurol Neurosurg Psychiatry 55(11):1032–1036
Groah SL, Weitzenkamp D, Sett P, Soni B, Savic G (2001) The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured. Spinal Cord 39(6):310–317
LaVela SL, Evans CT, Prohaska TR, Miskevics S, Ganesh SP, Weaver FM (2012) Males aging with a spinal cord injury: prevalence of cardiovascular and metabolic conditions. Arch Phys Med Rehabil 93(1):90–95
Amsters DI, Pershouse KJ, Price GL, Kendall MB (2005) Long duration spinal cord injury: perceptions of functional change over time. Disabil Rehabil 27(9):489–497
Liem NR, McColl MA, King W, Smith KM (2004) Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living. Arch Phys Med Rehabil 85(10):1567–1577
Welk B, Liu K, Winick-Ng J, Shariff S (2016) Urologic morbidity in a contemporary cohort of SCI patients. J Urol 195(4 Suppl 1):e184–e2185
Choi HM, Oh D-J, Sung BM (2015) Neurogenic bladder and chronic kidney disease in spinal cord injury patients. Nephrol Dial Transpl 30(Suppl 3):164
DeVivo MJ, Fine PR, Cutter GR, Maetz HM (1984) The risk of renal calculi in spinal cord injury patients. J Urol 131(5):857–860
Chen Y, DeVivo MJ, Roseman JM (2000) Current trend and risk factors for kidney stones in persons with spinal cord injury: a longitudinal study. Spinal Cord 38(6):346–353
Donnellan SM, Bolton DM (1999) The impact of contemporary bladder management techniques on struvite calculi associated with spinal cord injury. BJU Int 84(3):280–285
Cardenas DD, Mayo ME, Turner LR (1995) Lower urinary changes over time in suprasacral spinal cord injury. Paraplegia 33(6):326–329
Schoeps TS, Schneider MP, Steffen F, Ineichen BV, Mehnert U et al (2015) Neurogenic lower urinary tract dysfunction in patients with spinal cord injury: long-term urodynamic findings. Eur Urol 14(2):e1095
Cameron AP, Wallner LP, Tate DG, Sarma AV, Rodriguez GM et al (2010) Bladder management after spinal cord injury in the United States 1972 to 2005. J Urol 184(1):213–217
Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA et al (1992) Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia 30(9):617–630
Menter R, Weitzenkamp D, Cooper D, Bingley J, Charlifue S, Whiteneck G (1997) Bowel management outcomes in individuals with long-term spinal cord injuries. Spinal Cord 35(9):608–612
Charlifue RHS (1999) Ageing with spinal cord injury: the impact of spousal support. Disabil Rehabil 21(5–6):250–257
Glintborg B, Andersen SE, Spang-Hanssen E, Dalhoff K (2004) The use of over-the-counter drugs among surgical and medical patients. Eur J Clin Pharmacol 60(6):431–437
Rouleau P, Guertin PA (2011) Traumatic and nontraumatic spinal-cord-injured patients in Quebec, Canada. Part 3: pharmacological characteristics. Spinal Cord 49(2):186–195
Kitzman P, Cecil D, Kolpek JH (2016) The risks of polypharmacy following spinal cord injury. J Spinal Cord Med 40(2):147–153
Patel T, Milligan J, Lee J (2016) Medication-related problems in individuals with spinal cord injury in a primary care-based clinic. J Spinal Cord Med 40(1):54–61
Saunders LL, Krause JS (2015) Injuries and falls in an aging cohort with spinal cord injury: SCI aging study. Top Spinal Cord Inj Rehabil 21(3):201–207
Matsuda PN, Verrall AM, Finlayson ML, Molton IR, Jensen MP (2015) Falls among adults aging with disability. Arch Phys Med Rehabil 96(3):464–471
Garland DE, Stewart CA, Adkins RH, Hu SS, Rosen C, Liotta FJ et al (1992) Osteoporosis after spinal cord injury. J Orthop Res 10(3):371–378
Edwards WB, Schnitzer TJ (2015) Bone imaging and fracture risk after spinal cord injury. Curr Osteoporos Rep 13(5):310–317
Goktepe AS, Tugcu I, Yilmaz B, Alaca R, Gunduz S (2008) Does standing protect bone density in patients with chronic spinal cord injury? J Spinal Cord Med 31(2):197–201
Goemaere S, Van Laere M, De Neve P, Kaufman JM (1994) Bone mineral status in paraplegic patients who do or do not perform standing. Osteoporos Int 4(3):138–143
Chang KV, Hung CY, Chen WS, Lai MS, Chien KL, Han DS (2013) Effectiveness of bisphosphonate analogues and functional electrical stimulation on attenuating post-injury osteoporosis in spinal cord injury patients- a systematic review and meta-analysis. PLoS ONE 8(11):e81124
Amsters D, Nitz J (2006) The consequences of increasing age and duration of injury upon the wheelchair posture of men with tetraplegia. Int J Rehabil Res 29(4):347–349
Eriks-Hoogland IEK, Engisch R, Van Drongelen S (2011) Acromio-clavicular joint arthrosis in persons with spinal cord injury and with shoulder pain compared to able-bodied persons with shoulder pain. Top Spinal Cord Inj Rehabil 16:18
Akbar M, Penzcofer S, Weber MA, Bruckner T, Winterstein M et al (2014) Prevalence of carpal tunnel syndrome and wrist osteoarthritis in long-term paraplegic patients compared with controls. J Hand Surg 39(2):132–138
Davidoff GN, Roth EJ, Richards JS (1992) Cognitive deficits in spinal cord injury: epidemiology and outcome. Arch Phys Med Rehabil 73(3):275–284
Strubreither W, Hackbusch B, Hermann-Gruber M, Stahr G, Jonas HP (1997) Neuropsychological aspects of the rehabilitation of patients with paralysis from a spinal injury who also have a brain injury. Spinal Cord 35(8):487–492
Faden AI, Wu J, Stoica BA, Loane DJ (2016) Progressive inflammation-mediated neurodegeneration after traumatic brain or spinal cord injury. Br J Pharmacol 173(4):681–691
Huang S, Wang W, Chou L, Liou T, Lin HW (2016) Risk of Dementia in patients with spinal cord injury: a nationwide population-based cohort study. J Neurotrauma 34(3):615–622
Knight KH, Buchholz AC, Martin Ginis KA, Goy RE (2011) Group S-SR. Leisure-time physical activity and diet quality are not associated in people with chronic spinal cord injury. Spinal Cord 49(3):381–385
Locatelli SM, LaVela SL (2016) Documentation of weight management practices for individuals with spinal cord injuries and disorders. Spinal Cord 54(12):1176
Sabour H, Javidan AN, Soltani Z, Pakpour AH, Yekaninejad MS, Mousavifar SA (2016) The effect of behavioral intervention and nutrition education program on serum lipid profile, body weight and blood pressure in Iranian individuals with spinal cord injury: a randomized clinical trial. J Spinal Cord Med 41(1):28–35
Wong S, Derry F, Jamous A, Hirani SP, Forbes A (2014) Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre? Eur J Clin Nutr 68(1):125–130
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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