Ageing. Organs declining at approximately 1% per year. Spinal cord injury - ageing commences at injury
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- Clare Hensley
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2 Ageing Ageing begins at 25 years old Organs declining at approximately 1% per year. Spinal cord injury - ageing commences at injury > 25 at injury - may influence functional outcomes
3 Impact of Long Term Spinal Cord Injury SCI exacerbates ageing process Research indicated 93% of individuals with a SCI experience decline of function by 15 years post injury Very individual & dependent on person s situation Decline related to;- Years post injury (YPI) Ageing
4 Factors that Influence Ageing/YPI Genetics Lifestyle Level of injury Age at onset of injury Age Weight Health history Level of support Other chronic diseases
5 Across the Lifespan Age of onset important 3 phases of function (Menter & Hudson, 1995) Restoration phase 2-3 yrs post injury, max function Maintenance phase yrs post injury, stable Decline phase 10-20yrs post injury, deterioration Age related changes approx 10 years earlier to non SCI population
6 Functional Decline
7 Implication for rehabilitation practices Health promotion Competition of activities Time limitations Health & disability services are not prepared for changes in needs National & international experience Emerging area of knowledge Funding disability vs aged Current funding does not take in to account preventative measure eg Individuals cannot get both a manual and powered wheelchair through MASS Past rehabilitation practises use it or loose it approach counter productive Individual responses to decline & acceptance to adopt different approaches / adaptations Ageing carers
8 Chronic Spinal Cord Injury Long-term effects of living with a SCI shoulder pain Other specific health changes related to having a SCI Syringomyelia Changes not related to but worsened by a spinal cord injury cardiovascular disease, increase risk of diabetes Degenerative changes Osteoporosis, arthritis Environmental changes social/contextual factors that can make the lived experience more difficult
9 Across the Lifespan Muscular skeletal Cardiovascular system Endocrine changes Gastrointestinal & urinary tract changes Neurological changes Pulmonary (Respiratory) changes Integumentary (Skin) changes Psychosocial Functional decline Activities of daily living
10 Musculoskeletal changes Upper extremity overuse syndrome Rotator cuff injuries Skeletal deformities Contractures Scoliosis / Kyphosis Arthritis Osteoporosis Fractures
11 Musculoskeletal changes (PVA, 2005) 1. Education & information PVA Consumer guidelines Peer support 2. Routine assessment Pain Wheelchair & equipment Environment Health 3. Manage pain Alter / avoid movement patters Support limbs Ergonomic techniques 4. Exercise Fitness & flexibility exercises shoulder motion pectoral muscle mobility 5. Transfers Heights Use handgrips first Vary technique / leading arm Equipment transfer boards electric hi lo bed Ceiling hoists
12 Musculoskeletal changes (PVA, 2005) 6. Wheelchair Regular reviews of wheelchair Propulsion technique Light weight manual wheelchair Consider wheelchair setup Rear wheel position Posture Alternative propulsion technology Power assist wheels FreeWheel Smart wheel Consider changing to a power drive wheelchair... Big step
13 Cardiovascular & Endocrine changes Systems ages prematurely Cardiovascular Cardiovascular disease (200% higher.) Peripheral vascular disease Increase in swelling (oedema) in the feet Decline in exercise tolerance reduced O2 Endocrine Increase risk of metabolic syndrome Diabetes (4 X more likely than general pop.) Low level HGH & testosterone (Reduced cellular repair)
14 Cardiovascular & Endocrine changes Contributing factors;- Lifestyle Decreased physical activity Obesity Diabetes Poor cholesterol profile, that is, low levels of good cholesterol High blood pressure
15 Cardiovascular & Endocrine changes Recommendations; Health checks (more frequent than non SCI pop) Yearly BP 1-2 yearly Cholesterol, triglycerides & diabetic bloods Nutrition Lifestyle BMI Exercise & fitness Eliminate risk factors eg smoking Diet Reduce calorie intake ( ½ energy needs) (Spinal Outreach Services Health Questionnaire, 2007)
16 Respiratory changes Declining pulmonary function Restrictive lung disease Sleep Apnoea ( up to 40% of people with a SCI) Develop or worsening of snoring Increase risk of respiratory infections Complicated by posture & respiratory muscle paralysis Risk factors; higher level of injury, >50 yrs & YPI, smoker, obesity
17 Respiratory changes Recommendations; Pneumococcal (5 yearly) & Influenza (yearly) vaccine Yearly check up of resting respiratory rate & vital capacity (VC) VC trending downwards Symptoms of daytime sleepiness or tiredness reduced concentration, BP Treat infections (Spinal Outreach Services Health Questionnaire, 2007)
18 Gastrointestinal and Urinary Tract changes Decline with age for everyone More problems for >65yrs or 30 YPI Gastrointestinal Slowing of gut transit time Worsening constipation & difficulties with evacuation Haemorrhoids, Abdominal distension Autonomic dysreflexia from bowel complication Weight gain Gall stones (especially >T10) Oesophagitis Aspiration Reduced function to manage own bowel care & FALLS
19 Gastrointestinal and Urinary Tract changes Urine infections Risk factors drinking less having a weakened immune system. Increased risk of bladder & kidney stones Increase risk of bladder cancer with catheter >20yrs Risk factors; IDC/SPC Recurrent UTIs Smoking Prostatic complication with ageing
20 Gastrointestinal and Urinary Tract changes Recommendations; Check ups; Regular health checks 1-2 yearly Renal ultrasound & KUB Yearly kidney function blood tests >2 UTI check causes Treat all UTIs with in/out catheter or if symptomatic with IDC/SPC Review diet Consider bowel & food diary
21 Syrinx Cyst fill with spinal fluid Ascending or descending Neurological Insidious progressive pain Loss of sensation or function over months/years Neurological review required Spasticity May worsen Related to other problems ie posture, constipation etc Neurological pain level unlikely to change with time
22 Skin Normal ageing process skin structure - loss of collagen, protein and elastin. Greater risk of pressure injures ;- Loss of skin elasticity Loss of muscle bulk over the boney areas Changes to posture Decline in upper limb strength - transfers Weight loss or gain Other illnesses & lifestyle factors Poor nutrition Decreased sitting tolerance Psychosocial depression, limited or lack of support
23 Management; Skin Monitor weight and girth Nutritional assessment and diet Review Wheelchair & cushion Pressure care & transfer technique Health check Blood tests Underlying infection Other illnesses eg diabetes Lifestyle Counselling Increase community supports
24 Nutritional guidelines Average (Anthropometric) measures for weight with long term SCI (for height & frame size) Paraplegia; Tetraplegia ; subtract kg subtract 7-9 kg Energy requirements ( with pressure injury (PI) ) Paraplegia; Tetraplegia ; /- 1.2 kcal of body weight /day /- 1.1 kcal of body weight /day NB; Stage 3-4 PI protein & water loss through wound Increase risk of malnutrition without wt loss or low BMI Trans Tasman Dietetic Wound Care Group (2011) Evidence based practice guidelines for dietetic management of adults with a pressure injury
25 Function and ADLs Functional decline Crucial skill independent transfers Increased need for assistance with ADLs Mobility Increased need for resources & aids Greater dependence on public funding schemes Ageing carers and increased carer stress
26 Psychosocial & Environment Life satisfaction indicators; Maintain relationships Important to engage in social, community and vocational activities Supports formal & informal Access to health services & counselling Access architectural barriers Community attitudes
27 Key messages for healthy ageing Information & education is require across the lifespan Health Promotion; Recognition of unique needs Community support Access; information, opportunities Promote self reliance Prevention Task adaptation Aids and equipment Lifestyle Early treatment & community base rehabilitation Participation; lifestyle choices & relationships Advocacy; The individual requires knowledge to make informed decisions The individual with the SCI is the EXPERT and best able to advocate for themselves listen to their story
28 Resources & Information ons.htm References Consortium for Spinal Cord Medicine.(1998) Neurogenic Bowel Management in Adults with Spinal Cord Injury, Clinical Practice Guidelines. Consortium for Spinal Cord Medicine.(2006) Bladder Management in Adults with Spinal Cord Injury, Clinical Practice Guidelines. Consortium for Spinal Cord Medicine. (2005) Preservation of Upper Limb Function Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals. Hitzig, S., Miller, W., Eng, J., Sakakibara, B. (2010). Aging Following Spinal Cord Injury. In: Eng Teasell, R., Miller W., Hsieh, J., Connolly, S., Mehta, S., Sakakibara, B. Editors. Spinal Cord Injury Rehabilitation Evidence, Vol3.0. Vancouver; p. 1-67Menter, R. (1998). Ageing with Spinal Cord Injury. CNI Review Medical Journal, 9 (1), 1-4. Spinal Outreach Services Health Questionnaire (2007) Electronic version; Accessed 10/11/ data/assets/pdf_file/0004/155398/sos_hq_questionnaire_2.pdf Winkler, T. (2008). Spinal Cord Injury and Aging [Electronic Version]. emedicine Physical Medicine and Rehabilitation, Retrieved 02/03/2010
29 Thank you &... Enjoy the rest of the day
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