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A Closer Look at AgingThis article is from the Pushin' On Newsletter, Vol 18[1], Winter, 2000. By: Phil Klebine It is a fact. More people are living longer now than at any time in history. Improvements in health care have practically doubled the average life expectancy over the past 100 years. The medical community has learned a lot from past research on the affects of aging, and it continues to be a very hot topic for researchers. Aging is also an important topic for individuals with spinal cord injury (SCI). After all, you are living longer too. Research in SCI has helped improve the short and long term treatment and care. People with SCI are now living into their 60s, 70s and even longer. This means that you must prepare for getting older like everyone else. Not only do you need to know about the normal processes of aging that everyone faces, but you also need to prepare for the unique issues of aging with SCI. Osteoporosis Osteoporosis is a disease that thins and weakens bones to the point where they break easily - especially bones in the hip, spine, and wrist. Osteoporosis occurs in almost everyone who ages. Older women who have gone through menopause usually have many more problems with osteoporosis than men: one out of two women and one out of eight men in the general population over the age of 50 will have a bone fracture as a result of osteoporosis. Individuals with SCI have other risk factors associated with osteoporosis to consider. Regardless of your age or your sex, your bones lose minerals and become less dense soon after injury. This loss may continue over the first few years after injury. It will then usually level off. Most people with SCI will eventually loose about 50% of bone density after injury. This may sound extreme, but it is not probably going to put you at risk for osteoporosis related bone fractures. Your risk will increase if additional bone density loss occurs. This can be a problem for women. For more information women with SCI should read the feature article page 1, What Women Need to Know about Aging with SCI. Overall, between 1 and 6% of all individuals with SCI will have a fracture related to osteoporosis. You can help prevent osteoporosis by eating a healthy diet, not smoking and limiting your alcohol and caffeine use. Functional Electrical Stimulation (FES) may help to reverse osteoporosis. Some doctors believe that standing, or bearing weight on the bones, may also help to prevent bone loss. Other doctors do not think it is possible to stand long enough to make a difference in bone loss. Muscle spasms can also help prevent osteoporosis if they are not strong enough to cause fractures. Arthritis Arthritis has over 100 different forms and many symptoms. Arthritis usually causes pain and loss of movement in the joints of the body. It can occur over a long period of time and can cause swelling, redness pain and stiffness. In the general population arthritis occurs in one out of seven people and in about half of all people age 65 and older. People with SCI need to consider other problems related to arthritis. Accelerated degenerative arthritis can occur in the spine between two vertebrae. This may occur because of poor posture and/or stress on the spine. Other arthritis type problems include degenerative cartilage in bone and soft tissue damage. Carpal Tunnel Syndrome (CTS) can occur in the hand. Pain, burning, numbness and tingling in the wrist, hand, arm, and neck are symptoms of CTS. These problems are complicated because of the continual use of a manual wheelchair. The joints in your shoulders, arms, and hands are not made for years of daily activities performed by persons with SCI. One way for individuals with SCI to help prevent arthritis involves activity modification. Try to avoid the activities that aggravate the pain and other symptoms. You may also talk to your doctor about other treatment options that are available. Urinary System The urinary system has three major functions. It makes urine in the kidneys; stores urine in the bladder; and removes urine from the body through the urethra. Urinary incontinence is the most common problem of the urinary system among people aging in the general population. Incontinence is the loss of bladder control, or the leakage of urine. One of the most common types of incontinence is "Stress Incontinence." This is when leakage occurs during exercise, laughing, lifting, or other activities that put stress on the bladder. Some form of incontinence happens in at least one out of ten people age 65 and older. There is also some evidence suggesting that people in the general population with more than two or three urinary tract infections (UTIs) in a lifetime have an added risk of bladder cancer. Aging can have a big influence on the urinary system after SCI. People with SCI are technically incontinent because of the lose of bladder control after injury. This incontinence can lead to skin problems if the leakage is not controlled through effective bladder management. People with some bladder control may have less control as they age. There is also an increased risk of UTI's. In fact, one of the leading causes of death for individuals with SCI is renal failure. In addition, the risk of bladder cancer for people with SCI is about two times greater than the general population. People with SCI using an indwelling catheter for bladder management may have other problems. Prolonged use of an indwelling catheter by a women may result in urine leakage because the catheter can enlarge the urethra. There may be a greater increase in the risk of bladder cancer. Some research suggests that use of an indwelling catheter can make you three to four times more likely to develop bladder cancer. Should you be alarmed? Maybe not when you look at the big picture. Your risk of bladder cancer is still relatively small. You have about a 10% risk of bladder cancer after thirty years of indwelling catheterization. Individuals with SCI can help prevent problems by having a regular check-up that includes a renal scan. Tell your doctor about any problems you are having. This will help guard against renal failure. Drink plenty of water to help reduce UTIs. If possible use something other than an indwelling catheter as your method of bladder management. You will help to reduce your risk of bladder cancer by not smoking. Smoking is probably the biggest factor that contributes to bladder cancer in the general population and in individuals with SCI. You may also ask your doctor about getting a thorough cancer screening with your annual check up. Gastrointestinal System As people get older, changes in bowel function can occur. People are more likely to develop constipation later in life. Constipation is defined as having fewer bowel movements than usual, with a long or hard passing of stools. Many people worry that they are constipated because their bowel movements are not "usual" when compared to when they were young. However, older people in the general population may not need to worry. There is no "right" number of bowel movements in a week. An older individual can be "regular" with twice a day or twice a week bowel movements. Answering "yes" to the following questions is a warning sign for constipation. 1 Do you often have fewer than three bowel movements each week? Individuals aging with SCI can also take longer with bowel movements. You may find that your bowel program takes two hours to complete compared to only thirty minutes 15 years ago. This may be a normal decline of function. Many doctors also believe that the repeated use of laxatives, which is common with spinal cord injury, is a factor in problems with the regularity of your bowel program. If you feel that you have a problem with your bowel program, talk with your doctor about treatment options. Your problem may be a result of a poor diet, misuse of laxatives, or lack of physical activities. You may consider having a colostomy. This is probably not an appealing option for some people, but it can benefit people with decreased mobility and/or people who are having difficulty with bowel management. Skin Everyone's skin changes over time. Ultraviolet light from the sun damages the skin over time, and the skin naturally changes with age. Skin begins to sag, stretch, and loses its ability to "snap back" when stretched. Everyone's skin begins to wrinkle, dry out, and show other signs of aging. People who smoke can have more severe signs of aging because smoking prevents normal blood flow to the skin. The risk of skin cancer also increases as all people get older. The risk is greater for people who smoke and those with added exposure to the sun. People with SCI must be increasingly aware of the impact of skin change. Anything that relieves pressure will help prevent pressure sores. Increase your pressure releases. Standing upright with the help of assistive devices and/or lying on your stomach are options as you get older. Increasing the humidity in your home and using lotion on your skin may help prevent your skin from drying out. You can help your skin by not smoking and limiting the exposure of your skin to the sun's ultraviolet light. Finally, check your skin everyday and watch for dryness and/or redness. If you begin to see problems with your skin, talk with your doctor about ways to better protect your skin. Alcohol Abuse At least 10-15% of Americans age 55 and older abuse alcohol. This is a problem that is too often overlooked. Many people may begin as "social" drinkers, but it develops into alcohol abuse later in life because of "situational" factors. These factors include retirement, failing health, financial problems, and/or loneliness due to isolation after death of friends or loved ones. It is believed that as people get older they become less able to handle the consumption of alcohol. Alcohol slows down brain activity and affects alertness, coordination, and judgment. These impairments can lead to accidents. Continual abuse of alcohol can damage the brain, liver, kidneys, stomach and heart. Individuals with SCI abuse alcohol at more than twice the rate of the general population. This means that at least 20-30% of persons with SCI abuse alcohol. The increase in risk of abuse may be the result of underemployment, unemployment, health problems, loss of mobility, decrease in or loss of independence, or marital stress. The affects of alcohol abuse can be even more damaging to individuals with SCI because the body's organs and systems are often weaker after injury. Individuals with SCI who abuse alcohol can have increased risk of spasticity, bone fractures, pressure sores, UTIs, and malnutrition. Alcohol can also be dangerous when mixed with medication. People who abuse alcohol and their family members may deny there is a problem. How do you know if you have a problem? Ask yourself these four questions; 1 Have you ever felt you should cut down on your drinking? If you answered "yes" to one of the questions, it is a warning sign that you may have a problem with alcohol abuse. If you answer "yes" to 2 of these questions, there is an 81 to 97% chance that you abuse alcohol. If you believe that you have a problem, seek help! You can ask a family member, doctor, or clergy to help you find help. Personal Care Most everyone reaches a time in their life when they begin to need help with some everyday activities. At first you may only need help with yard work or heavy household duties. Over time some people need more help with shopping, cooking, walking, and other daily activities. Some people need more help than others. Some people rely on family assistance and/or assistive living. About 40% of all individuals with SCI who are under the age of 60 need some form of personal assistance. As you get older, you will need more assistance too. People with SCI and people in the general population need to plan ahead for this time. You may need to depend on others for some, if not all, of your daily activities. Many people rely on the assistance of a spouse or family member, but it often does not work out. You have to remember that your spouse/caregiver is getting older too. You should make a good personal and financial plan right now so that you are prepared in case of the loss of a spouse. Make a plan for assisted living arrangements, and make sure your family understands what you want. Conclusion It is impossible to cover all aspects of aging. You owe it to yourself to learn more about these topics along with topics like fatigue, respiratory function, and many others. You can be prepared for what you may experience as you get older. After all, everyone hopes for a very long and healthy life, but not everyone is prepared if life does not end up as they hoped. Talk with your family and your doctor and prepare for the future today. Much of the information from this article came from The Challenge of Successful Aging: Factors that can make a Difference in Longer Life by Daniel P. Lammertse, MD, SCI/Life, 1998. Dr. Lammertse was the featured speaker at the UAB RRTC Teleconference on Aging with SCI. A summary transcript of the event is available at www.spinalcord.uab.edu/show.asp?durki=25829. Additional Resources for this article include;  Pushin' On is supported by grants #H133B980016 and #H133N50009 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, D.C. Opinions expressed in Pushin' On are not necessarily those of the granting agency. |