This article summarises the key challenges and recommendations identified in clinical practice guidelines (CPGs) governing an ageing population with a spinal cord injury. It also highlights gaps and areas of improvement in existing guidelines.
Spinal cord injury in elderly
As the number of older people in societies increases, cases of both traumatic and non-traumatic spinal cord injuries (SCI), mainly due to falls and tumours, are also increasing. Improvements in emergency care, better rehabilitation methods, and long-term care have also helped people with SCI live longer. As a result, more people with SCI are now living past the age of 65.
The current study addresses the intersection of ageing and SCI, which presents significant challenges for global healthcare, with two main scenarios:
- SCI with Ageing: an increase in the average age of SCI onset, often due to falls or other age-related incidents.
- Ageing with SCI: increased life expectancy after SCI, due to better healthcare and rehabilitation strategies.
These scenarios result in complex health needs due to the combination of SCI-related impairments, ageing-related changes, and multiple comorbidities. Common health issues in ageing individuals with SCI include cardiovascular problems, obesity, diabetes, cancer, osteoporosis, urinary tract infections as well as bladder and bowel dysfunction.
Seijas et al. conducted a systematic search for relevant CPGs in databases like PubMed while also reviewing specific guideline repositories and websites focused on SCI. They included guidelines that were evidence-based and contained at least one recommendation related to ageing for SCI management.
The expert panel used the two core sets of the International Classification of Functioning, Disability and Health (ICF) to identify gaps. It became clear that the current guidelines do not comprehensively address the needs of the ageing SCI population.
Out of 52 identified CPGs, only 16 (30%) included recommendations related to ageing in SCI. Most of the 16 included guidelines were published within the last 5 years but none had a chapter devoted exclusively to ageing.
Current ageing-related recommendations for SCI
According to this review the existing ageing-related recommendations were predominantly focused on physiological and functional aspects but lacked comprehensive coverage of broader issues like mental health, mobility, and social participation.
It also became clear that the majority of recommendations were based on low-quality evidence. This was often due to the use of data extrapolated from the general population or younger SCI patients, which may not be fully applicable to older individuals with SCI.
Challenges of ageing with spinal cord injury
Some of the recommendations identified in CPG were also vague or simply raised awareness about issues without providing actionable guidance. For example, while certain guidelines acknowledged the risk of falls in older SCI patients, they did not offer detailed interventions tailored to this group.
There were no guidelines specifically developed to address the needs of older adults with SCI which reflects a significant gap in the literature and highlights the need for dedicated research for this population.
How can healthcare for elderly with SCI be improved?
Future research should prioritise generating robust evidence to support the development of comprehensive and practical guidelines that address the full spectrum of challenges faced by older adults with SCI.
Additionally, the development of future CPGs should involve a more inclusive approach that considers the preferences and values of patients and other stakeholders to enhance the applicability and acceptance of these guidelines in clinical settings.
Recommendations for future research and guidelines
- High-quality evidence: emphasise the generation of high-quality evidence specifically focused on ageing individuals with SCI to support the development of targeted CPGs.
- Comprehensive coverage: future guidelines should cover a wider range of health aspects, including mental health, sensory functions, and social participation, to provide a holistic approach to the care of ageing SCI patients.
- Stakeholder involvement: actively involve patients, caregivers, and healthcare professionals in the guideline development process to ensure that the recommendations are relevant, practical, and aligned with the needs and preferences of those directly affected.
- Development of age-specific guidelines: there is a critical need for age-specific guidelines that address the unique challenges of managing SCI in the context of ageing, including considerations of comorbidities and treatment with multiple medications. The reduced physiological reserves in older adults should also be acknowledged as this loss means that the individual living with frailty is in a state of increased vulnerability to stressors. He/she is also more likely to suffer adverse effects from treatments, diseases or infections.
In summary, while some progress has been made in incorporating ageing-related recommendations into SCI management guidelines, there remains a substantial gap that needs to be filled through focused research and the development of dedicated CPGs that comprehensively address the complex needs of the ageing SCI population.