As the population within the
United States ages, it is estimated that 20 percent of its population
will be older than age 65 by the year 2040, and will likely impact
spine surgeons and spinal cord Rehabilitation centers as these patients
become a larger proportion of the spinal cord injury (SCI) population.
The findings were just presented by Jefferson neurological surgeons at
a meeting in Phoenix, Ariz. of the Joint Section on Disorders of the
Spine and Peripheral Nerves of the American Association of Neurological
Surgeons.
"Spinal cord injuries in older
patients are becoming more prevalent," said James Harrop, M.D,
Assistant Professor of Neurological and Orthopedic Surgery, Jefferson
Medical College of Thomas Jefferson University, one of the study's
primary investigators. "The mortality of these patients is much greater
than younger patients and should be factored in when considering
aggressive interventions and counseling families regarding
prognosis." However, they also found that these patient have had
an increase in survival over this period.
Admissions by geriatric
SCI patients has increased five-fold and the percentage of geriatric
patients within the SCI population has increased from 4.2 percent to
15.4 percent since 1980. In comparison to younger patients,
geriatric patients are less likely to have severe neurological deficits
but have higher rates of mortality. Researchers reviewed a database of
3,481 consecutive acute penetrating and blunt spinal cord and
spine-injured patients treated at Jefferson Regional Spinal Cord Injury
Center over a 28-year period
(1978-2006).
Overall annual admissions for SCI at Jefferson's Spinal
Cord Injury Center have increased 60 percent since the early 1980's,
but geriatric SCI admissions have increased more than 580 percent
during that same time period, the researchers found.
"This
increase is likely a result of an aging population and propensity for
these patients to have SCI with minor trauma," Dr. Harrop
noted. "Falls continue to be the predominant mechanism for
geriatric spinal cord injuries with 74 percent of geriatric injuries
resulting from a fall in this series."
Geriatric patients also appear Prone to traumatic spinal cord injuries due to:
(1) changes in bone quality with aging
(2) increasing prevalence of Cervical spinal stenosis with older age
(3) an increased rate of Motor vehicle accidents per mile driven
It
is also believed that these older patients have an increased risk of
mortality due to their concurrent medical illnesses, as well as their
limited ability to overcome traumatic injuries, they said.
Mortality,
both during hospitalization and the first year after injury, was much
higher in the geriatric population-- approximately eight times higher,
the study showed
Mortality during hospitalization was 3.2
percent for adult patients less than age 70 and 27.7 percent for
geriatric patients. Mortality one year after getting out of the
hospital was 5.4 percent for the adult patients and 44.4 percent for
the geriatric patients. In both cases of mortality (hospital and
one-year), high-quadriplegic injuries were found to have the highest
mortality and Paraplegic injuries had the lowest mortality.
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