Now a days people can expect to live longer lives and the SCI community is no exception. In recent decades rates have dramatically increased. In 1940 the average expectancy after SCI was just 18 months, but by 1998 expectancy was much closer to that of the general population. Thanks to better survival rates from initial injuries, better treatment and understanding of secondary injuries such as bladder infections and pneumonia, life expectancy continues to improve.
As you age with SCI you will experience the same health issues that affect everybody, so the goals are the same. Minimise the impact of ageing and to maintain independence, overall health, and a good quality of life.
With age comes change, but thankfully the effect of these changes can be minimised with the right intervention and care.
Ageing joints can cause you some difficulty. You may experience pain and mobility issues from overuse syndrome, especially the upper limbs (shoulder, arm, wrist and hand).
This effects at least 50 percent of the SCI population and is more common and severe in older individuals and increases with time since injury. It is caused by overuse, wheelchair pushing, lifting to help with pressure releases and the use of crutches to help walking in individuals with incomplete SCI.
To minimise joint issues gentle exercise and keeping weight down are recommended. It may also be worth considering joint and limb preservation strategies even in the initial phases of rehabilitation training like using a transfer board to reduce the strain on your arms.
The ageing SCI population are most likely to experience respiratory disease, diseases of the urinary system and heart disease, in that order, so it is important to look at preventative care surrounding these conditions.
About 2/3 of people with SCI are overweight. Weight gain affects the fit of equipment, general mobility and the ability to perform safe transfers. In addition, it is more difficult to lose weight once it’s been gained.
It is well known that exercising is an important part of a healthy life. Helping to reduce the incidence of diabetes and increase lean muscle mass, exercise will help metabolise fat and improve your quality of life. There are lots of options you can look at to maintain your physical fitness as you age. For advice on the best option for you, talk to a physiotherapist or a trainer to determine the safe amount of resistance for strength exercises.
Respiratory disorders are the leading cause of death after SCI.
As we age we lose a little respiratory function over time. There is a gradual age-related reduction in our respiratory capacity due to loss of lung elasticity and reduced vital capacity (the ability to take a deep breath voluntarily).
The HSE recommends that you get the Flu jab every winter and if you are a smoker consider quitting.
Look out for:
- Unexplained shortness of breath
- Rapid breathing
- Daytime drowsiness or fatigue
- Fluctuating alertness and dramatic changes in breathing while sitting versus laying down
Bone loss and Osteoporosis
Bone loss starts immediately following the onset of SCI and continues for at least 12 to 16 month and then plateaus. This may increase the risk for fractures, and this risk continues to increase over time.
As skin ages it becomes thinner and loses elasticity making it vulnerable to pressure sores, blisters and skin breakdown in people with SCI.
Prevention and healing
Adequate nutrition is key to pressure sore prevention. If you do get a pressure sore, good nutrition is absolutely critical to healing the wound.
Looking after your skin
As you age you will need to be more diligent and aware of any changes in your skin. If you notice that your skin gets red more than usual you should look at changing your cushion or mattress for one that provides more pressure relief.
It is also important that you have a good balanced diet and are drinking enough water. If you are unsure about your diet, talk to a dietitian. Managing your weight is also imperative and it is important to remember that smoking has a significant effect on your skin.
Quality of life and maintaining independence
Maintaining independence and a good quality of life as you age is important to everyone. Talk to your physiotherapist or GP about any concerns you have and consider new approaches that can help keep your independence.
Changing care and equipment needs
As you age with a spinal cord injury your care and equipment needs may change including pressure relief, bowel and bladder care, your wheelchair, cushion and transfer regime.
Manual wheelchair users may at some point need to start using power mobility or power assist wheels to preserve upper body function. Those who are ambulatory may choose to use a wheelchair as their primary means of mobility if this helps preserve upper limb function.
All equipment should be assessed, including bathroom equipment, seating systems, cushions and mattresses. Therapy interventions may be necessary for shoulder protection and conservation strategies. Energy conservation or work simplification strategies may also be helpful for those who have considerable fatigue.
If you would like to change your wheelchair consult your Physiotherapist or Occupational Therapist. You may also need to talk to your Physiotherapist or Occupational Therapist about your shower chair and hoist options. There are many new innovations being introduced annually in disability aids so it is always worthwhile updating your knowledge.
You will find as you age that your strength will decrease and you may feel more pain in your arms, reducing your ability to carry out pressure relief, effecting your transfers to and from your wheelchair. You may need to look at your cushion to see if it is providing adequate pressure relief. If you feel you need to change your cushion consult your Physiotherapist or Occupational Therapist for advice on the best options.
If you are struggling or find it difficult to clear the wheel as well as you used to, consider using a transfer bar.
There are a number of transfer board options available from the traditional wooden board to the more modern Banana board which is also lighter and is shaped to help with your transfers.