Aging with spinal cord injury - Spinal Cord Injury, Part 3

American Rehabilitation,  Spring, 1997  by Kenneth A. Gerhart,  Susan W. Charlifue,  Robert R. Menter,  David A. Weitzenkamp,  Gale G. Whiteneck

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Many myths surround aging. One of the most common is the belief that getting older means being ill. Another says that older people are less physically and mentally active. A third common myth is that older people have a poorer quality of life.

These tales arise partly out of our fear of the unknown and partly out of our belief that aging is a wholly negative process. And, aging is not without is negative context. Undeniably, aging is evidence that life is transient and relatively short, proof that we have limited internal resources and defenses against countless external forces -- one of which is time itself. Indeed, aging is not a preventable process; it is something that all humans will encounter. It may occur at different rates and at different ages and in different ways for each person, but it will occur.

Unfortunately, differentiating normal aging from a host of other medical, social, environmental, chemical, physical, and psychological processes is virtually impossible. For example, are heart problems, cancer, or even just changes in the appearance of our skin or in our visual acuity a result of growing older or are they the result of specific environmental or chemical exposures or genetic makeups that have nothing to do with age? Indeed, all are highly interactive, all effect the aging process. How then do we separate aging from these other issues and influences?

If aging is a complex topic, superimposing disability -- like spinal cord injury (SCI) -- only complicates it further. In addition to all of the above "normal" aging-related processes, disability brings its own question, theories, and conceptualizations. In the World Health Organization's conceptualization of disablement,[1] there is impairment -- an abnormality of structure or function, for example, spinal cord damage at the C5 level. There is also disability -- the dependencies and limitations that result from an impairment, such as not being able to walk, to dress, to live independently. There is handicap -- the social barriers that result from impairments and disabilities, like not being able to work, to raise children, to be involved in the community. And, of course, there are complications and secondary disabilities and other issues that come later, after the initial disability. Some are medical, some are physical, and some are psychosocial. All impact and interact with the aging process and illustrate how both the topics of aging and disability are clouded and confused by a plethora of terms, concepts, and issues. In the end, it becomes very difficult to separate normal aging from medical complications and from the initial disability and it own complications.

When are a spinal cord injury survivor's chronic infection, depression, or painful shoulders just part of normal aging? After all, nondisabled people may have these very same problems. When are they a sign or a result of accelerated aging caused by the spinal cord injury? When are they neither and, as some might argue, when are they just coincidental secondary impairments and disabilities -- medical problems that are unrelated to either SCI or to aging? What happens when such problems occur within the context of a long-term SCI survivor's changing living situation -- a divorce, an aging caregiver, a lost job, a changing neighborhood that the survivor no longer feels safe in? As a result of this confusion, are true medical complications or psychosocial concerns -- treatable problems -- being passed off as expected age-related issues? Or, on the other hand, are we vainly struggling to "cure" problems that really are nothing more than normal aging? Are these questions just academic? And, do we care about their answers? To this last we must respond "Yes!" if how we answer affects how we understand long-term spinal cord injury and how interact with and treat the long-term spinal cord injured individual.

Longitudinal Research

Indeed, the issue of aging with a spinal cord injury is a complicated one. We need to approach it scientifically to learn "what's what." Here the concept of longitudinal research becomes important. Studying the same group of people over time helps us to understand the interrelationships of all of the issues described above and, most important, to understand risk factors.

In fact, there has been a fair amount of longitudinal aging research done. Thousands of people have been studied over long periods of time to track changes with age. Three well-known aging studies include the Baltimore,[2] Duke University,[3] and Framingham[4] studies. However, important as these studies have been in expanding our knowledge of physiological aging, the relationship between disease and aging, or of risk factors for later impairments or morbidities, they have not addressed the aging process as if affects people with disabilities, particularly those who have spinal cord injuries. None examines how the normal aging that occurs in a body system impacts the person aging with a superimposed spinal cord injury.