Aging with a Disability (Elise)

I think it's fair to assume that most people expect their health to decline with aging. Take, for example, the anticipated hip/knee joint problems, hearing or visual loss, osteoporosis, or maybe even a minor neuropathy. Those of us with a family history of more serious diseases like diabetes, cancer, heart disease, or stroke may take proactive steps to prevent or delay the onset of "aging" conditions in the future. Few of us, however, are prepared to age with serious permanent disability, such as a traumatic complete spinal cord injury.

Sam, a 63 year-old hispanic male, was enjoying his life as a husband, construction worker, father of 3 and new grandfather of 1. Last winter, his construction vehicle was rear-ended on the freeway going 50 mph. Immediately upon impact, Sam lost feeling in his legs and the ability to move them. After being emergently transported to the hospital, imaging revealed a thoracic-level complete spinal injury and he underwent spinal stabilization surgery. One week later, he was referred for inpatient rehabilitation. His wife and 3 daughters (and their families) were very supportive of Sam and provided much encouragement as Sam coped with this major life change.

As a PT, there are many things that I must consider when working with an older individual post-SCI:
1) First and foremost, I must consider Sam's desired life roles: What was involved in his role as husband (did he BBQ? fix appliances? do laundry?)? How will he remain intimate with his wife? How will a wheelchair impact his ability to play with his grandchildren? Does he see himself going back to work? What recreational interests does he have?
2) I must consider Sam's body: Does he have a prior injury to his shoulder that would prevent propelling a manual wheelcahir? Does he have a scoliosis, kyphosis, pelvic obliquity, or other postural deformity that requires special seating considerations? Does he have a significant history of diabetes or poor nutrition that may place him at increased risk for skin problems? Does he have heart or lung problems? Did he regularly exercise prior to his injury?
3) I must consider Sam's home: Can he access the kitchen, bedroom, bathrooom, etc? Are the doorways wide enough for his wheelchair? Are there stairs? Can he access his community?
4) I must consider equipment options: A padded bath chair for tub & toilet? A ramp for entering the home? A slide board to transfer into the car? Would a power w/c be more appropriate if it is medically justified?
5) I must consider Sam's ability to learn and desire to prevent long term complications: Will he understand the importance of regular pressure relief to avoid skin ulcers? Will he participate in a regular gym program to promote cardiovascular health and strong shoulder/trunk musculature? Will he understand the importance of a healthy diet to promote healing and avoid weight gain? Will he recognize the need for regular bowel/bladder management to prevent infection?

Many ways that Sam and I work together as patient-therapist are similar to younger patients. I must consider him as a whole person and understand those daily life activities which are most meaningful to him. But the things which are inherently different in working with older adults are: how prior medical history/past injuries impact current presentation; how prior life views on exercise and health will impact response to therapy education; and how cognitive ability to learn new information and movement strategies will promote reintegration to desired activities.