Steep Rise in Spinal Cord Injuries Among Elderly

Pauline Anderson

June 10, 2015

Although the absolute number of acute traumatic spinal cord injuries has remained stable and the incidence rate of such injuries has increased only modestly, owing to a larger population, the incidence of spinal cord injuries is increasing steeply among older adults, mostly owing to falls, new research shows.

The increase in fall-related injuries among this older population during a recent 19-year period represents a "major public health concern," according to lead study author Nitin B. Jain, MD, Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee.

"It's not just the sheer numbers but the proportion of spinal cord injuries due to falls in this age category is also increasing," he told Medscape Medical News.

Seniors today are a lot more active than they used to be. "They're hiking and skiing and doing recreational activities," said Dr Jain, adding that balance and cognitive issues may contribute to their increased risk for falls.

The study was published online June 9 in the Journal of the American Medical Association in an issue devoted to the Americans With Disabilities Act.

Decreasing Trend

Researchers used sampling weights provided by Nationwide Inpatient Sample databases to estimate the population-based number of patients with acute traumatic spinal cord injury in the United States between 1993 and 2012. They used these data to examine trends in incidence, causes, healthcare utilization, and mortality for acute traumatic spinal cord injury.

The number of cases of acute spinal cord injury increased from 2659 in 1993 to 3393 in 2012. The estimated annual incidence rate of such injuries was 53 cases per 1 million persons in 1993, and 54 cases per 1 million persons in 2012, which is "pretty consistent," said Dr Jain.

Age-stratified incidence rates showed a decreasing trend in younger age groups among males - from an estimated 144 cases/million in 1993 to 87 cases/million in 2012 for the 16- to 24-year-old age group, and from 96 cases/million to 71 cases/million for the 25- to 44-year-old age group.

Public education, improved motor vehicle safety features, stricter seat belt laws, and enforcement of drunk-driving laws may have contributed to this decline, say the authors.

However, injuries from firearms were still a major contributor to spinal cord injuries ― representing 14% to 18% of cases in the 16- to 24-year-old age group.

During the study period, there was a high rate of increase in spinal cord injuries among the elderly, both men and women. For example, the rate went from 84 cases/million to 131 cases/million in men aged 65 to 74 years.

Much of this increase was due to falls. There was an increase in fall-related spinal cord injury as a proportion of total spinal cord injury cases among those aged 65 years and older ― 28% in 1997-2000 and 66% in 2010-2012.

Catastrophic Injuries

Falls in older people can lead to "catastrophic injuries," and this major public health issue should be addressed, especially as more baby boomers enter this older age category, said Dr Jain. He believes that more research is needed into what is causing older people to fall and that strategies should be designed to help them avoid falls.

There was a modest increase in some surgical procedures performed post spinal cord injury. The rate of intervertebral disc excision went from 11.2% to 15.9%; for spinal canal decompression, it went from 10.2% to 15.9%.

The percentage of spinal cord injury patients undergoing venal cava filter placement showed a substantial increase, from 4% in 1993-1996 to 14.5% in 2005-2009.

This, say the authors, may represent increased awareness of deep venous thrombosis as a serious complication and the increased use of retrievable vena cava filters since the early 2000s. It may also represent improved coding of these procedures in the databases over time

Acute inpatient mortality was 6.6% in 1993-1996 and 7.5% in 2010-2012. However, inhospital mortality remained especially high (20%) among the elderly.

Dr Jain is supported by funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Foundation for Physical Medicine and Rehabilitation. His coauthors are supported by grants from VA Rehabilitation Research and Development Merit Review, the National Institute of Health, and the US Department of Education National Institute on Disability and Rehabilitation Research. Dr Jain reports no relevant financial relationships.

JAMA. 2015;313:2236-2243. Abstract

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