Factors associated with reduced life expectancy in patients aged 65 and older with traumatic spinal cord injury

CONTEXT/OBJECTIVE: Traumatic spinal cord injury (TSCI) in older adults is increasingly associated with falls and high mortality. This study aimed to estimate the life expectancy deficit associated with TSCI in patients aged ≥65 years and to identify predictors of mortality. DESIGN: Prospective cohort study. SETTING: National Hospital for Paraplegics (Toledo, Spain). PARTICIPANTS: Consecutive patients aged ≥65 years with TSCI admitted between 2009 and 2024 (n = 369). OUTCOME MEASURES: Mortality and life expectancy deficit compared with age-matched national life tables, as well as the identification of mortality predictors. RESULTS: The mean age at injury was 73 ± 5.7 years, and 71.5% were men. Falls were the main cause of injury (74.3%), and subaxial cervical lesions were the most frequent (65.6%). Overall mortality was 51.5%, with a mean estimated survival of 7.66 years. In the Cox model, older age at injury (HR = 1.054; P < 0.001), anticoagulant therapy (HR = 1.811; P = 0.002), and COPD (HR = 2.138; P = 0.015) independently increased mortality risk, whereas higher SCIM scores at discharge (HR = 0.975; P < 0.001) were associated with improved survival. Patients with complete and cervical injuries showed the shortest survival times. The life expectancy deficit attributable to TSCI decreased from 13.0 years in patients aged 65-69 years to approximately 3 years in those aged ≥80 years. CONCLUSION: TSCI in older adults is associated with high mortality and reduced life expectancy, particularly in complete and cervical injuries. Functional independence was associated with improved survival.