Age Impacts Treatment Time, Options in Spinal Cord Injury Patients

Older spinal cord injury patients are less likely to get surgery than younger patients with the same injury, according to research published in the Canadian Medical Association Journal (CMAJ).

Researchers from St. Michael’s Hospital in Toronto, Canada observed 1,440 patients with traumatic spinal cord injury in order to evaluate the impact of older age (defined as greater than 70 years) on treatment decisions and outcomes. The researchers recruited participants for whom consent and detailed data were available between the years of 2004 and 2013 located at any of the 31 acute care and rehabilitation hospitals participating in a spinal cord injury registry.

Patients were divided into groups based on age: older or younger than 70 years. The majority of spinal cord injury patients ranged in age from 16 to 30 years, though the number of people with this injury over the age 70 is increasing, the researchers noted.

There were 167 patients included in the study who were older than 70 years (11.6 percent). It was these patients, the researchers found, that were more likely to be injured in a fall than the younger patients (83.1 percent vs. 37.4 percent, respectively). However, it was the patients younger than 70 years that were more likely to have severe injuries resulting in paralysis below the trauma site — the older patient cohort had less severe injuries.

For older patients, time between injury and arrival time at an acute care center was about twice as long as it was for the younger patient group. Once admitted to these centers, older patients typically waited about twice as long for surgery as the younger patients. The researchers additionally found that the older patients were significantly more likely to die from a traumatic spinal cord injury than younger patients.

“These delays may be due to delays in recognizing the less severe injuries in seniors or they may reflect a potential age related therapeutic bias,” study author Henry Ahn said in a press release. “These significant differences in injury demographics, timing of surgery and outcomes in older compared with younger patients necessitates rethinking the management of traumatic spinal cord injury in those in the oldest age group.”

The researchers believe that developing policies with mandated time frames, like the ones in place for hip fractures, may help solve this problem for older patients. They also believe that by reducing surgical delays for traumatic spinal cord injury, no matter the patient’s age, healthcare providers may be able to help maximize neurologic improvements and avoid adverse effects related to prolonged immobilization, such as pneumonia.