Effects on age on spinal cord lesion patients' rehabilitation.
METHODS
The present study was undertaken to focus the age-related characteristics of a population of traumatic and nontraumatic spinal cord patients.


OBJECTIVE
to examine demographic, injury and outcome characteristics of older adults with spinal cord lesions as a result of trauma and nontrauma, and to compare these characteristics with those of younger patients in matched cohorts.


METHODS
Spinal Cord Unit, Fondazione Santa Lucia IRCCS, a large rehabilitation hospital of the centre-south of Italy.


METHODS
In total, 284 consecutive newly injured patients with traumatic and nontraumatic spinal cord lesions were retrospectively reviewed and divided according to age into two groups: under 50 years (group 1) and over 50 years (group 2). The following information was collected: onset of lesion to admission; injury variables: aetiology, level, associated injuries, medical complications and surgical intervention; length of stay; American Spinal Injury Association (ASIA) impairment and motor scores; Barthel Index (BI) and Rivermead Mobility Index (RMI) to assess independence in daily living; Walking Index for Spinal Cord Injury to assess ambulation; patients destination at discharge. In a subset of 130 subjects, a block design, matching procedure was used to control for the covariant effects of injury characteristics, time from lesion and aetiology on age effects.


RESULTS
In the entire group of 284 patients, older subjects had a higher probability of having incomplete tetraplegia of nontraumatic origin; they also showed a shorter length of stay and a higher rate of complications. In the matched cohorts, younger patients showed better neurologic recovery (intended as ASIA impairment grade improvement and motor scores increase), significantly higher Barthel Index and RMI at discharge, a higher level of independence in spontaneous bladder and bowel management and a higher frequency of independent walking.


CONCLUSIONS
Older individuals with spinal cord injury and disease do well, but have a less favourable outcome in regard to walking, bladder and bowel independence than younger subjects and have more associated medical problems. Different rehabilitative strategies, therefore, are required for older subjects, which maximises the shorter length of stay and provides the necessary medical care and increased physical assistant resources following discharge.
Scivoletto
G
G
Spinal Cord Unit, IRCCS Fondazione S. Lucia, Rome, Italy.
Morganti
B
B
Ditunno
P
P
Ditunno
J F
JF
Molinari
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D013904:Thoracic Vertebrae / Q000293:injuries; D016896:Treatment Outcome