Comparing Rehabilitation Services and Outcomes Between Older and Younger People With Spinal Cord Injury

Objective: To compare patient and injury characteristics, rehabilitation services, and outcomes between people incurring traumatic spinal cord injury (SCI) at younger and older ages. Design: Multisite prospective observational cohort study. Setting: Six acute rehabilitation facilities. Participants: Patients (N=866) aged >= 16 years admitted to participating centers for their initial rehabilitation after SCI. Interventions: Not applicable. Main Outcome Measures: Motor FIM scores at discharge and 1 year postinjury, discharge location, and postacute clinical pathways. Results: Patients were divided into 4 age-at-injury groups: 16 to 29, 30 to 44, 45 to 60, and >60 years of age. Older adults (>60y) incurring SCI were more likely to be married, retired/unemployed, on Medicare, and to have attained more education. Their injuries mostly resulted from falls and were incomplete in nature. The oldest group had the highest severity of illness, lowest admission and discharge motor FIM scores, and longer rehabilitation stay. They received relatively less rehabilitation than younger groups. They spent proportionately more time in occupational therapy working on preparatory activities and less time on self-care activities during inpatient rehabilitation. In the aged >60 years group, 80% went home at discharge; 17.2% were discharged to a nursing home. Younger groups were less likely to go to a nursing home. Admission motor FIM was the most significant predictor of motor FIM at discharge and 1-year anniversary across age groups. But the age groups differed significantly in patient and treatment factors that explained their respective outcomes. Conclusions: Older injured individuals experienced a different clinical pathway from younger patients. The present study suggests the need for development of a rehabilitation program tailored specifically to older adults. Archives of Physical Medicine and Rehabilitation 2013;94(4 Suppl 2):S175-86 (C) 2013 by the American Congress of Rehabilitation Medicine