An evidence-based review of aging of the body systems following spinal cord injury

Abstract

Study design: Systematic review. Objective: To systematically review evidence on aging of the body systems after spinal cord injury (SCI). Setting: Toronto, Ontario and Vancouver, British Columbia, Canada. Methods: Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with ablebodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale. Results: Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI. Conclusions: Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings. Sponsorship: Rick Hansen Institute; Ontario Neurotrauma Foundation.

Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches

“…disability on SHCs (for example, via the 'accelerated aging' pathway noted to occur in individuals with physical disabilities 4,[35][36] ). SHCs, in turn, can also influence disability.…”

“…Research is still needed to thoroughly identify and evaluate the factors that influence and contribute to the development of SHCs. For example, although we know that aging influences the musculoskeletal system in individuals with SCI differently than it does in individuals who are not disabled, 35 we do not know yet how neuromuscular aging affects respiratory complications in older adults with SCI. Similarly, the lack of evidence on natural aging processes of the gastrointestinal and genitourinary systems after SCI indicates there is not enough evidence to conclude that aging itself influences these body systems differently in individuals with SCI than in individuals without SCI.…”

Medication before and after a spinal cord lesion

“…In addition, persons with SCL are subjected to extreme physical inactivity that may have an influence on their lipid profile and lipoprotein concentration leading to more cardiovascular disease, maybe as a part of premature aging. 18 ATC group D (dermatologicals) showed a significant increase most pronounced in AIS A, B and C, indicating that it is associated with the more severe SCL. The increase in use of dermatological drugs The difference in age between the two populations was tested by a two-tailed t-test with P ¼ 0.093.…”

Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury

“…8 Predicting the possibility of adverse drug effects is more challenging in SCI because drug pharmacokinetics can be altered following the injury and the degree of alteration can vary depending on the level and severity of SCI. 9 Moreover, with age-related diseases and SHCs increasing over time in persons with SCI, [10][11][12] the likelihood of requiring multiple medications also increases, adding to the risk of adverse drug effects.…”

“…4 Adults who had sustained SCI during childhood are exposed to longer durations of SHCs and are at a higher risk of developing age-related chronic conditions earlier than their able-bodied counterparts. 12,14 These individuals are more likely to have taken multiple medications throughout childhood and may continue to do so throughout their lifetime, potentially leading to medication-related problems and negative health and psychosocial outcomes. Thus, the objectives of this study were to describe the medications taken by adults with pediatric-onset SCI and to report the prevalence of polypharmacy and its association with demographic, injury-related and psychosocial factors.…”