Senior Citizens Leading Rapid Increase in Traumatic
Spinal Cord Injuries in U.S.
Rates rising fastest among those over 65, and most
injuries now due to falls, not car crashes
27, 2014 Senior citizens are driving up the number of serious
traumatic spinal cord injuries in the United States, and the leading
cause no longer appears to be motor vehicle crashes, but falls, new
Johns Hopkins research suggests. These injuries - whose symptoms range
from temporary numbness to full-blown paralysis are rising fastest
among older people, suggesting that efforts to prevent falls in the
elderly could significantly curb the number of spinal injuries.
Falls were the leading cause of traumatic spinal
cord injury over the three-year study period (41.5 percent), followed by
motor vehicle crashes (35.5 percent). Fall-related spinal cord injuries
increased during the study period overall. Among the elderly, they
increased from 23.6 percent to 30 percent of injuries.
The average age of adults with a traumatic spinal
cord injury in a previous study that covered the years 2000 to 2005 was
41; the new study suggests it is now 51.
"We have demonstrated how costly traumatic spinal
cord injury is and how lethal and disabling it can be among older
people," says Shalini Selvarajah, M.D., M.P.H., a postdoctoral surgical
research fellow at the Johns Hopkins University School of Medicine and
leader of the study published online in the Journal of Neurotrauma.
"It's an area that is ripe for prevention."
For their study, the Johns Hopkins researchers
analyzed a nationally representative sample of 43,137 adults treated in
hospital emergency rooms for spinal cord injury in the United States
between 2007 and 2009. While the incidence among those aged 18 to 64
ranged from 52.3 per million in 2007 to 49.9 per million in 2009, the
incidence per million in those 65 and older increased from 79.4 in 2007
to 87.7 in 2009.
The investigators say that even when taking into
account injury severity and other illnesses experienced by the patients,
older adults with traumatic spinal cord injury are four times more
likely to die in the emergency room from such an injury compared to
younger adults. If they survive and are admitted, they are six times
more likely to die during their inpatient stay.
While the researchers say they can't pinpoint the
exact reason that falls have surpassed car crashes as a cause of
traumatic spinal injuries, they believe it may be a combination of the
general aging of the population, the more active lifestyles of many
Americans over 65, and airbags and seatbelt laws that allow drivers and
passengers to survive crashes.
"We are seeing a changing face in the epidemiology
of spinal cord injury," says Edward R. Hammond, M.D., Ph.D., a research
associate at the International Center for Spinal Cord Injury at Kennedy
Krieger Institute and another of the study's leaders.
Beyond the personal toll of disability and death,
spinal cord injuries are a growing financial burden on the health care
system, the researchers say. They estimate that from 2007 to 2009,
emergency room charges alone for traumatic spinal cord injury patients
totaled $1.6 billion.
The leading causes of TBI are:
Motor vehicle traffic (17.3%);
Struck by/against events (16.5%); and
Falls continued to be the leading cause of TBI (35.2%) in
the United States. Falls cause half (50%) of the TBIs among
children aged 0 to 14 years and 61% of all TBIs among adults
aged 65 years and older.
Motor Vehicle-Traffic Crashes
Among all age groups, motor vehicle crashes and
traffic-related incidents were the second leading cause of TBI
(17.3%) and resulted in the largest percentage of TBI-related
But that is "just the first drop in a long-filling
bucket," says Eric B. Schneider, Ph.D., an epidemiologist at the Johns
Hopkins University School of Medicine's Center for Surgical Trials and
Outcomes Research. Those charges increased by 20 percent over the study
period, far more than just the cost of inflation.
The spinal cord injuries captured by the data for
this study were those serious enough to land the patient in the
emergency room and included temporary bruising to severed or permanently
damaged cords that cause paralysis, difficulty breathing, an inability
to fill and empty the bladder and other motor disabilities.
According to the National Spinal Cord Injury
Statistical Center, lifetime costs of care for someone with a serious
spinal cord injury can range from $1 million to $5 million, depending on
the age of the person at the time of injury and the severity of the
injury. Improvements in rehab care are leading to longer life expectancy
among patients with spinal cord injury and bigger medical bills.
"With so much emphasis on trying to reduce health
care costs right now, this is another reason why preventing the injury
altogether is so vital," Selvarajah says.
A recent campaign by the National Institutes of
Health is funding the search for better ways to prevent falls that lead
to traumatic brain injury in the elderly. Schneider says the effort
could also lead to a coincidental reduction in traumatic spinal cord
The spinal cord is a long bundle of nerve tissue
that sits inside a bony structure called the vertebral column or
backbone. It is the conduit that connects the brain to the rest of the
body, enabling nearly all of the latter's functions.
Other Johns Hopkins researchers involved in the
study include Adil H. Haider, M.D., M.P.H.; Christopher J. Abularrage,
M.D.; Daniel Becker, M.D.; Nitasha Dhiman, M.S.P.H.; Omar Hyder, M.D.,
M.S.; and James H. Black III, M.D.
Johns Hopkins Medicine (JHM), headquartered in
Baltimore, Maryland, is a $6.7 billion integrated global health
enterprise and one of the leading health care systems in the United
States. JHM unites physicians and scientists of the Johns Hopkins
University School of Medicine with the organizations, health
professionals and facilities of The Johns Hopkins Hospital and Health
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