Article 12 Comparing Rehabilitation Outcomes Between Older and Younger People With SCI

Abstract

Examine patient and injury characteristics, post-acute rehabilitation, and outcomes between older people incurring SCI and younger peers. Multi-center prospective observational cohort. Six acute rehabilitation facilities in US. 866 patients admitted to participating centers for rehabilitation following SCI. Not applicable. Length of stay, FIM-motor at discharge and one-year post-injury, discharge locations, and clinical pathway. Study group was divided into four groups based on age at injury: 16-29/30-44/45-60/60+ y/o. People incurring SCI at >60 y/o were likely married, retired/unemployed, with Medicare, and higher education attainment. Their injury was mostly resulted from falls and incomplete in nature. Older group had severe comorbidity, the lowest admission and discharge FIM, and longer LOS. They received less amount of post-acute rehabilitation than younger groups. They spent high proportion of occupational therapy time working on basic skills and less on self-care activities. 80% of the 60+ group and the majority of younger groups went home at discharge. 17.2% older group was discharge to nursing home. The older group demonstrated different clinical pathways in one that 10.8% was discharged to nursing home first then went home at anniversary. While admission FIM-motor was the most significant predictor of discharge and one-year FIM-motor in all groups, there appeared to be other differing factors in regression models in the 60+ group. Older people incurring SCI experienced a different clinical pathway from younger cohorts. Results from the study suggested the need to develop an age-at-injury specific health care planning, specifically, a rehabilitation program tailored to the older cohorts.