Traumatic spinal cord injuries on the rise among older people

Traumatic spinal cord injuries are increasing with the population, and incidence is higher in older individuals, according to a Vanderbilt study that was published in the June 9 issue of the Journal of the American Medical Association.

The study, which analyzed data from 63,109 patients with acute traumatic spinal cord injury from 1993 to 2012, will help target specific populations for preventive measures, said lead author Nitin B. Jain, M.D., M.S.P.H, associate professor of Physical Medicine and Rehabilitation.

"We find that spinal cord injury as a result of falls is a major public health issue in the older patients, and we need to find what the causes for that are and appropriately design interventions," he said.

Jain noted that one in five with such injuries dies in the hospital.

Before the study, there was limited data on trends of the incidence and cause of spinal cord injury. Researchers discovered that while incidence rates among the younger male population dropped over about 20 years, rates for men ages 65 to 74 jumped to 131 cases per million from 84 cases per million.

"We don't really know the exact reasons for why there is an increased incidence of falls that cause spinal cord injury," he said, but noted that "older adults are likely much more active now, putting them at a higher risk."

For example, 70-year-olds today may be more likely to go skiing than 70-year-olds would have 20 years ago.

"We also find that the portion of patients who have surgical procedures is also increasing over time," he said.

The implications for the older population and the health care system are tremendous. People with traumatic spinal cord injury are often disabled for life, and require lifelong rehabilitation. That impacts their lives, because it is more difficult to find work when disabled. It also adds more demand for rehabilitation health care.

Most patients regain some function after such an injury, Jain said. But "most of these patients will have need for health care services throughout their life, many of them pretty intensive."

Walter Frontera, M.D., Ph.D., professor and chair of the Department of Physical Medicine and Rehabilitation, said Jain's research is important.

"This special issue of the Journal of the American Medical Association is dedicated to the 25th anniversary of the American with Disabilities Act," he said. "The study of the epidemiology of a disabling condition like spinal cord injury will help us define an action plan for future rehabilitation services."