title: Comparing rehabilitation services and outcomes between older and younger people with spinal cord injury.
abstract: OBJECTIVE
  To compare patient and injury characteristics, rehabilitation services, and outcomes between people incurring traumatic spinal cord injury (SCI) at younger and older ages.
  
  
  METHODS
  Multisite prospective observational cohort study.
  
  
  METHODS
  Six acute rehabilitation facilities.
  
  
  METHODS
  Patients (N=866) aged ≥ 16 years admitted to participating centers for their initial rehabilitation after SCI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Motor FIM scores at discharge and 1 year postinjury, discharge location, and postacute clinical pathways.
  
  
  RESULTS
  Patients were divided into 4 age-at-injury groups: 16 to 29, 30 to 44, 45 to 60, and >60 years of age. Older adults (>60 y) incurring SCI were more likely to be married, retired/unemployed, on Medicare, and to have attained more education. Their injuries mostly resulted from falls and were incomplete in nature. The oldest group had the highest severity of illness, lowest admission and discharge motor FIM scores, and longer rehabilitation stay. They received relatively less rehabilitation than younger groups. They spent proportionately more time in occupational therapy working on preparatory activities and less time on self-care activities during inpatient rehabilitation. In the aged >60 years group, 80% went home at discharge; 17.2% were discharged to a nursing home. Younger groups were less likely to go to a nursing home. Admission motor FIM was the most significant predictor of motor FIM at discharge and 1-year anniversary across age groups. But the age groups differed significantly in patient and treatment factors that explained their respective outcomes.
  
  
  CONCLUSIONS
  Older injured individuals experienced a different clinical pathway from younger patients. The present study suggests the need for development of a rehabilitation program tailored specifically to older adults.
authors.affiliation: Center for Post-acute Innovation & Research, MedStar National Rehabilitation Hospital, Washington, DC 20010, USA. Jean.Hsieh@medstar.net
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Gerben
authors.initials: G
authors.lastname: DeJong
authors.forename: Suzanne
authors.initials: S
authors.lastname: Groah
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Ballard
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Wenqiang
authors.initials: W
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020127:Recovery of Function; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000534:rehabilitation*; D015599:Trauma Severity Indices; D014481:United States; D055815:Young Adult