title: Spinal cord injury medicine. 5. Preserving wellness and independence of the aging patient with spinal cord injury: a primary care approach for the rehabilitation medicine specialist.
abstract: This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention.
  
  
  OBJECTIVE
  To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95118, USA. slgroah@hotmail.com
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Groah
authors.forename: Steven A
authors.initials: SA
authors.lastname: Stiens
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Gittler
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kirshblum
authors.forename: William O
authors.initials: WO
authors.lastname: McKinley
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011320:Primary Health Care; D013038:Specialization; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*