Kennedy et al. 2003
UK
Case Control
(Inadequate control)
Initial N=200;
Final N=192

Population: Traumatic and nontraumatic SCI: Mean age = 40.7 yrs; Gender: males = 147, females = 45; Level and severity of injury: incomplete tetraplegia = 23%, complete tetraplegia = 21%, complete paraplegia = 34%, incomplete paraplegia = 22; Mean time post-injury to admission = 28.8 days.
Treatment: No treatment per se, but various outcomes associated with inpatient rehabilitation focusing on goal attainment in younger vs. older patients.
Outcome Measures: Needs Assessment Checklist (NAC) collected within 2 weeks of mobilization and within 6 weeks of discharge.

• Improvements were noted in ↓ “percentage to be achieved" scores for all 9 areas of need (p<0.0001).  No significant differences were seen between age groups.
• Those with complete lesions showed greater improvement in bowel management than those with incomplete lesions (p<0.005) and those with tetraplegia showed greater improvement in the area of skin care than those with paraplegia group (p<0.005) Otherwise no other differences.
• Mobility needs of older subjects were significantly higher compared to the younger subjects (p<0.005) initially, but lower for the community score (p=0.01).  Higher scores (i.e., more unmet need) assessed close to discharge were noted for older vs younger for the areas of skin management (p<0.01), bladder management (p<0.01), bowel management (p<0.05) and mobility (p<0.01). 

Scivoletto et al. 2003
Italy
Case Control
Initial N=284;
Final N=284

Population: Mean age = 50.4 yrs; Gender: males = 184, females = 100; Level of injury: cervical = 81, thoracic = 148, lumbosacral = 55; Severity of injury: AIS: A-D; Mean time post-lesion to admission = 56.9 days.
Treatment: No treatment per se, but various outcomes associated with inpatient rehabilitation focusing on younger (<50) vs older (>50) patients. Mean LOS was 98.7±68.1 days.
Outcome Measures: LOS, AIS, ASIA Motor Index, Barthel Index (BI), Rivermead Mobility Index (RMI), Walking Index for SCI (WISCI), Discharge Destination. All collected at admission and discharge.

• Although LOS was longer for younger patients (111.3±63.88 vs 89±69.9, p<0.008) which was related to a higher incidence of incomplete lesions and etiology, a matched-block sub-analysis (N=130) showed differences were not significant.
• Neurological recovery was more frequent with younger group (p=0.006) and for those at AIS C. Matched group sub-analysis showed more ASIA grade (p=0.027) and motor score improvements in younger group.
• Gains for independence of daily living measures (BI and RMI) were significantly greater for younger group (p<0.001).
• Younger age group had more people reach independent walking levels on WISCI than in older group (p<0.004). Similar findings for related subscales in BI and RMI.
• Younger age group had more people reach autonomous bladder (p=0.005) and bowel control (p=0.014) than in older group. Similar findings for bladder subscales in BI.

Seel et al. 2001
USA
Case Control
Initial N=180;
Final N=180

Population: Traumatic SCI from US Model Systems database: Gender: male, female, 3 equal (N=60) age groups (18-39, 40-59, >59) matched for neurological level and ASIA classification, paraplegia, AIS A-D, 84% admitted within 21 days post-injury.
Treatment: No treatment per se, but various outcomes associated with inpatient acute and rehabilitation care focusing on age effects by comparing results between 3 age categories.
Outcome Measures: LOS, Charges, ASIA motor index score, Functional Independence Measure (FIM), change scores and efficiencies for FIM. All collected at admission to acute care and admission to rehabilitation care and discharge.

• FIM improvement was greater for the younger and middle group that for the older group (p<0.001). FIM efficiency was greater for the young group as compared to the 2 older groups (p<0.001).
• There were no significant differences in ASIA motor index scores at any of the time points across the different ages.
• No systematic significant differences were noted between the 3 age groups for acute care LOS or hospital charges.
• Rehabilitation LOS was significantly shorter for younger than middle or older groups. There was no difference in associated hospital charges for the 3 groups.
• All age groups were equally likely to be discharged to a private residence (≥92%).

Cifu et al. 1999a
USA
Case Control
Initial N=375;
Final N=375

Population: Traumatic SCI from US Model Systems database: Gender: male and female, 3 equal (N=125) age groups (18-34, 35-64, >64) matched for neurological level and completeness, tetraplegia, AIS A-D, 85% admitted within 21 days post-injury.
Treatment: No treatment per se, but various outcomes associated with inpatient acute and rehabilitation care focusing on age effects by comparing results between 3 age categories.
Outcome Measures: LOS, Charges, ASIA motor index score, Functional Independence Measure (FIM), change scores and efficiencies for FIM and ASIA motor index, Discharge destination. All collected at admission to acute care and admission to rehabilitation care and discharge.

• The younger the age group, the greater the FIM motor score improvement and greater FIM motor efficiency.
• The younger and middle age groups had significantly greater ASIA motor index score increases and efficiency than the older age group.
• No systematic significant differences related to age were noted for acute care or rehabilitation Length of Stay or hospital charges.
• The older the age group, the more likely individuals would be discharged to an institutional setting.

Cifu et al. 1999b
USA
Case Control
(Inadequate control)
Initial N=2,169;
Final N=2,169

Population: Traumatic SCI from US Model Systems database: Mean age = 31.72 yrs; Gender: males = 83%, females = 17%; Level of injury: paraplegia; Severity of injury: AIS: A-D.
Treatment: No treatment per se, but various outcomes associated with inpatient acute and rehabilitation care focusing on age effects by comparing results between 11 age categories. Mean acute LOS was 13.2±16.92 days. Mean rehabilitation LOS was 56.76±34.28 days.
Outcome Measures: LOS, Charges, ASIA motor index score, Functional Independence Measure (FIM), change scores and efficiencies for FIM and ASIA motor index. All collected at admission to acute care and admission to rehabilitation care and discharge.

• FIM improvement was less for people ≥ 60 than those younger.
• There were no significant differences in ASIA motor index scores, change scores or efficiency scores across different ages.
• No systematic significant differences were noted for acute care LOS or hospital charges.
• Rehabilitation LOS was longer and associated hospital charges greater for older individuals (trend beginning for those > 54 and peaking in the 60-64 age group).
• Younger age groups were more likely injured as a result of vehicular crashes or violence while older groups were more likely injured as a result of falls or other events including being struck by falling objects, pedestrian accidents and medical/surgical complications.

Devivo et al. 1990
USA
Downs & Black score=17
Case control
N=866

Population: Group 1 (Age = 1-15yrs): Gender: males = 80%, females = 20%; Level of injury: paraplegia = 47.5%, tetraplegia  52.5%; Severity of injury: complete = 52.5%, incomplete = 47.5%; Group 2 (Age = 16-30yrs): Gender: males = 84.6%, females = 15.4%; Level of injury: paraplegia = 52.1%, tetraplegia  47.9%; Severity of injury: complete = 55%, incomplete = 45%;Group 3 (Age = 31-45yrs): Gender: males = 81.1%, females = 18.9%; Level of injury: paraplegia = 52%, tetraplegia  48%; Severity of injury: complete = 45.9%, incomplete = 54.1%; Group 4 (Age = 46-60yrs): Gender: males = 79%, females = 21%; Level of injury: paraplegia = 46%, tetraplegia  54%; Severity of injury: complete = 43%%, incomplete = 57%; Group 5 (Age = 61-86yrs): Gender: males = 70%, females = 30%; Level of injury: paraplegia = 28.6%, tetraplegia  71.4%; Severity of injury: complete = 36.2%, incomplete = 63.8%.
Treatment: Patients were retrospectively divided into 5 age groups: Group 1 (1-15yrs), Group 2 (16-30yrs), Group 3 (31-45yrs), Group 4 (46-60yrs), Group 5 (61-86yrs). Data was then used to assess the effects of age on rehabilitation outcome.
Outcome Measures: Relationship of age with clinical outcomes.

• Increase in age at admission was significantly related to increase in:
  • Cervical injuries with patients over 60 yrs old (p=0.006).
  • Diabetes (p<0.001).
  • Obesity (p=0.007).
  • Alcohol abuse (p<0.001).
  • Heart disease (p<0.001).
  • Arthritis (p<0.001).
  • Pulmonary embolus (p<0.001).
  • Gastrointestinal hemorrhage (p=0.008).
  • Pneumonia (p=0.003).
  • Mechanical ventilatory support use (p=0.004).
• Increase in age was significantly related to a decrease in:
  • Percentage of complete lesions (p=0.039).
• No significant relationship was found between age at admission and:
  • Number of days from injury to admission.
  • Initial length of hospitalization of acute care.
  • Hospital charges.
  • Days of rehospitalization in the second year post injury.
• Increasing age at admission was inversely related to percentage of patients independent in self-care activities at discharge (p=0.016).

Yarkony et al. 1988
USA
Downs & Black score=17
Case control
N=708

Population: Traumatic SCI: Mean age = 28.3yrs; Gender: males = 82%, females = 18%; Level and severity of injury: complete paraplegia = 30%, incomplete paraplegia = 15%, complete tetraplegia = 27%, incomplete tetraplegia = 28%.
Treatment: Patients were retrospectively divided into four groups: Group 1 (6-19yrs), Group 2 (20-39yrs), Group 3 (40-59yrs), Group 4 (60-88yrs) and data was analyzed.
Outcome Measures: Relationship of age to clinical outcomes.

• Age was not significantly related to admission or discharge MBI.
• Admission and discharge MBI was related to level of injury (p<0.001) and severity (p<0.001).
• Increase in age in patients with complete paraplegia was related to increased dependence in seven functional skills including: bathing, upper and lower body dressing, stair climbing, and transfers to chair, toilet and bath.

Tchvaloon et al. 2008
Israel
Case series
N=143

Population: Mean age=37.8yrs; Gender: M:F=4.95:1; Level of injury: C=43%, T=49.3%, L=7.7%; Severity of injury: complete=41%, incomplete=59%.
Treatment: Data from patients with a SCI due to a road accident was analyzed.
Outcome Measures: Neurological recovery, Functional recovery, complications

• Negative association was seen between survival and age at injury (p<0.001) and pressure sores (p=0.006).
• No significantly affect on recovery was seen due to age at injury, gender, presence of pressure sores and complications.

Anzai et al. 2006
Canada
Case series
N=52

Population: Mean age=45.3yrs; Gender: males=77%, females=23%; Level of injury: C4=63%; Severity of Injury: AIS A=60%
Treatment: Retrospecitive chart review was conducted on patients admitted to GF Strong Spinal Cord Program between 1994 and 2003.
Outcome Measures: Discharge destination, factors associated with discharge to ECU.

• Older individuals had a 4% increased risk of being discharged to an extended care unit.
• Good levels of social support were found to be protective factors
• Pre-existing medical conditions were associated with 10 times greater risk
• Unemployment and not having funding from insurance were associated with 5 times greater risk.