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Ageing with a Spinal Cord Injury
Written by Paul Harrison RGN, ONC, MAEd, EMB371, Clinical Development Officer, Princes Royal Spinal Injuries Unit, Northern General Hospital, Sheffield.
Is there any satisfaction in growing old after SCI?
“While we often focus on the negatives of ageing, there are positives such as wisdom, maturity and the satisfaction of survival”.
Whiteneck et al (1992)
One of the benefits of increased survivability is our ability to utilise the accumulated experiences of people ageing with SCI to differentiate between natural and secondary ageing characteristics. Healthy ageing can be described as finding the best balance between personal fulfilment and personal risk. A life that limits spontaneous activity, lacks risk or smothers the sense of fulfilment may be safe, but it will be very boring.
How many of you attend for your annual ‘MOT’ at your local SCI Centre for the sole satisfaction of reminding your consultant that, despite his dire predications at your original discharge, you are still here and thriving?
Do people with SCI grow old gracefully?
“in my experience you just cope each day as new things occur. But then again, it depends on the individual”.
Zarb and Oliver (1993)
Unfortunately the consensus opinion is that people ageing with SCI will resist or deny the effects of natural ageing in order to retain a hard-won independence and quality of life. They do not always age gracefully and many will discover that their problems in later life may relate to the quality of their initial rehabilitation, their chosen lifestyle and activity level, and their ability to astound, frustrate and challenge the medico-social establishment by their continued survival. It is equally important that you do not neglect the services of other healthcare providers such as GPs, dieticians, opticians, dentists, pharmacists and chiropodists to maintain your general health and well being beyond your SCI.
In real terms, life expectancy amongst people with spinal cord injuries (SCI) has only improved significantly in the last 20 years in accordance with medical advances. Previously. The most common causes of death after SCI were medical complications such as pressure sores and infections, complications directly related to the long term implications of SCI and the ability of medical science to understand, identify and treat hem appropriately. Today the most common causes of death amongst people with SCI are cardiovascular disease and cancer, complications more associated with how individuals choose to live their lives and the associated risks that they take with their continued good health.
The Natural Ageing Process
“There is no such thing as ‘normal’ ageing. The limits of normality are set, in ordinary life by custom and experience”.
Taverner’s Physiology (1983)
It is a fact of life that we will all grow old eventually. Natural ageing is a physiological process defined as the gradual, natural deterioration and decay of body cells and their replacement over time. ‘Old Age’ however, is defined as the point at which cell deterioration, damage and death outstrips the body’s capacity for recovery, repair and growth. As a result of the natural and inevitable ageing process we experience, as mature adults, a gradual deterioration in our physical stamina and strength, our bodily functions and our ability to think, reason and communicate without difficulty. This is especially worrying when we are sober!
‘Secondary ageing’ is a term used to describe a range of lifestyle factors (such as smoking or poor diet) and additional disease processes (such as infections) that can appear to accelerate the natural ageing cycle of wear and tear. This may be as a result of the accumulated stress, strain, injuries and abuse that your body has had to accommodate or cope with since you first became paralysed.
Do people with SCI grow older faster than able-bodied people?
Whilst the rate of natural ageing in an individual is mostly influenced by genetic factors (parents and grandparents) the physiological implications of ageing such as joint pain, , constipation and fatigue do appear to become visibly apparent at an earlier age in comparison to able-bodied peers. These are the normal consequences of longevity but many people ageing with SCI report that they are experiencing these problems that are usually affecting individuals 10 years older than themselves. This can only be explained away as being the result of secondary ageing effects from surviving the original trauma that resulted in your SCI.
These complications may impact directly upon your ability to maintain your current level of active living. Fatigue may require you to consider the daily physical demands you are making upon your body and to reduce your involvement in recreational pursuits or sporting interests to a more tolerable level. This may be a great disappointment to you, but the same feeling exists in able-bodied peers facing the same inevitable need to reduce personal harm and conserve energy to maintain other healthy interests and activities for longer.
Retirement from work is also a necessary, but not always desirable consequence of ageing for us all, but it is important that you recognise that a planned, voluntary withdrawal from the rigours of employment is healthier in the long run than a sudden forced retirement on the grounds of ill health. Retirement can bring additional stress to the ageing individual. Perhaps it was the reason that you got up and out of bed in the morning?
But what if you never returned to work after your injury? Severe disability can also be perceived as a form of forced retirement from the workplace. In this instance you have already adapted to a significant change in your social circumstances. To some extent, you can cruise past the dreaded ‘age of retirement’ without any noticeable need to adapt your lifestyle accordingly.
What are the SCI centres doing for people ageing with SCI?
SCI Centres are learning how to manage and advise people with SCI regarding their extended life expectancy. However, they must be careful to direct resources, in principle, at the implicit influence of ageing upon the effects of living, or surviving, with SCI. They must do this without denigrating the essential local hospital medical, surgical, respite and palliative care services whose experience of managing the physiological diseases of ageing, such as heart disease and cancer is greater than that of SCI Centres and has contributed to longevity.
As an SCI person, it is important that you recognise and accept that admission to an SCI Centre may not always be in your best interest if your illness is not related to your spinal cord injury. However, whenever you are admitted to a local hospital, always ensure that staff discharge their professional duty to access and involve SCI Centres appropriately and that SCI related problems are also well managed.
References:
Taverner, D (1983) Taverner’s Physiology
Whiteneck, GG (1992) Aging with Spinal Cord Injury
Zarb, G and Oliver, M (1993) Ageing with a Disability: What do they expect after all these years?
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