Aging Isn’t a Dirty Word: Insights on Aging with Spinal Cord Injury from the 5th Annual Sara Mulroy Symposium

Dr. Susan Charlifue, PhD, FISCoS, FASIA, FACRM speaking at the 5th Annual Sara Mulroy Symposium

When Dr. Susan Charlifue stepped up to speak at the symposium, her message was clear from the start: aging with SCI is not something to fear - it’s something to prepare for.

Whether a spinal cord injury (SCI) happens later in life or in youth, individuals will inevitably face the combined realities of injury and aging. In this session, Dr. Charlifue offered an expansive, big-picture look at the unique challenges, opportunities, and interventions that can improve quality of life for this growing population.

Aging and SCI: Two Intersecting Journeys

Aging is influenced by genetics, behaviors, and environmental factors. While we can’t rewrite our genes, behaviors like smoking cessation, alcohol moderation, exercise, and stress management can be addressed. Environmental challenges, such as air pollution or inaccessible spaces can also shape the aging process.

Globally, populations are aging, and with that comes a rising number of older adults living with SCI. Falls are now the leading cause of SCI in older adults in Western Europe, while in the U.S., motor vehicle crashes and violence dominate among younger groups, with falls still prominent among older individuals. Advances in trauma care and rehabilitation now mean more people survive injuries, which means more are aging with them.

Aging with SCI vs. SCI in Older Age

Dr. Charlifue distinguished between two groups:

1. Those injured at an older age

2. Those injured young who age into older adulthood with SCI

   
   

While both face complex healthcare and rehabilitation needs, their trajectories differ. Older-age injuries often involve additional age-related health conditions and greater dependence on caregivers. Younger-onset injuries may accumulate decades of secondary complications.

In both cases, a small decline in function, like shoulder pain that limits wheelchair propulsion, can cause major lifestyle changes, especially if finances don’t allow for adaptive equipment.

Health Risks and Complications

Individuals with SCI face a thinner “margin of health” than the general population. Minor illnesses can quickly escalate. Dr.Charlifue emphasized several high-risk areas:

• Cardiovascular Disease: Leading cause of death among people aging with SCI, with up to three times the risk for heart disease and six times the risk for stroke compared to the general population.

• Diabetes and Obesity: Driven by reduced activity, altered metabolism, and neurogenic obesity.

• Musculoskeletal Issues: Rotator cuff tears, joint damage, and osteoporosis, which can lead to fractures from minor impacts.

• Pain: Highly prevalent and often challenging to manage without opioids.

• Infections: UTIs, respiratory infections, and cellulitis are more common, compounded by antibiotic resistance.

• Cognitive Decline: Accelerated by chronic inflammation, sometimes appearing decades earlier than in able-bodied peers.

Resilience, Adaptation, and Quality of Life

One of the most encouraging findings from long-term studies is that many individuals with SCI can maintain or even improve their quality of life over time, despite increasing health issues. Depression rates are often lower than expected, and social participation limitations are usually due to physical or environmental barriers rather than withdrawal.

Dr. Charlifue shared stories of individuals who adapted creatively and embraced resilience:

• A woman injured at 27 maintained independence for decades by actively problem-solving and leaning on her social network

• Another, injured at 35, channeled her drive into advocacy, education, and personal growth.

The takeaway: people may not accept SCI, but they can adapt, and strong will, community support, and realistic expectations are key.

The Role of the Environment

Accessibility, transportation, and availability of equipment can make the difference between independence and isolation. The ADA has improved domestic conditions, but international travel remains a challenge. Homes and public spaces not designed for wheelchairs can restrict participation as people’s physical capacity changes.

Unsurprisingly, those with better access to care, adaptive equipment, and barrier-free environments maintain independence longer.

Biases in Care

Dr. Charlifue also noted troubling trends: older patients are less likely to receive timely surgical intervention after SCI, despite evidence that early surgery improves outcomes.

Rehabilitation intensity may also be reduced for older patients, sometimes due to clinician bias rather than true patient limitations. A critical takeaway for professionals that are susceptible to adopting this bias.

The Psychosocial Dimension

Social support networks grow in importance with age, especially after retirement or job loss. Asking for help should be normalized, and peer support remains invaluable. People often learn more from others living with SCI than from professionals.

Interestingly, injury level and completeness have little consistent effect on reported quality of life. Instead, factors like education level, relationship status, fewer chronic conditions, better sleep, and lower pain severity correlate more strongly with satisfaction.

Intervention Strategies for Clinicians

Dr. Charlifue stressed that clinicians can make great impact by encouraging and teaching patients how to reduce modifiable risk factors:

• Lifestyle: Support smoking cessation, healthy diet choices, and reduced risky behaviors.

• Exercise: Encourage safe, appropriate physical activity, including alternatives like electrical stimulation (E-stim) for those with limited mobility. Emphasize both health and social benefits while managing fall and injury risks.

• Fall Prevention: Especially for incomplete injuries, safe transfer training and environmental modifications are essential.

• Engaging Primary Care: Geriatricians and community providers need to understand SCI to support healthy aging.

• Leisure and Purpose: Not everyone wants or can safely manage competitive sports. Nonetheless, activities like gardening, crafts, woodworking, or caring for animals can provide purpose and enjoyment.

Final Thoughts

Dr.Charlifue closed with a reminder: research often focuses too heavily on functional recovery, like walking, rather than on independence and quality of life.

For many aging with SCI, the priority is not taking a few steps in a robotic device but maintaining autonomy, health, and social engagement in the ways that matter most to them.

In her words, the goal is to “improve quality of life as much as possible”through realistic preparation, creative adaptation, social support, and access to the right resources. Aging may bring challenges, but with the right interventions, it can also bring resilience, connection, and fulfillment.

View the full keynote session video here!

Stay tuned for more session recaps, coming soon!