Old age and ageing with a spinal cord injury

If you are already of a certain age, developing physical independence and returning to work may not be as much of a focus for you as they are for younger people with a spinal cord injury. Other issues are more important, such as

• Organising your day-to-day life and household: what can you / do you still want to do yourself?
• Being mobile and able to perform transfers: this has a direct impact on the possibility of being able to meet friends and run errands independently, etc.
• Feeling safe: how can you prevent accidents / falls and organise help in an emergency?
• Organising new forms of support: it is possible that your relatives can no longer support you to the same extent as they have also got older.

Age(ing) with a spinal cord injury from a medical perspective

When you consider age and spinal cord injuries, a distinction can be made between whether you have already been living with the spinal cord injury for years / decades or if it has only been for a short amount of time.

After years in a wheelchair, age-related effects may occur earlier and possibly be more pronounced than in the “able-bodied” population. These effects comprise, for example: greater susceptibility to infections (bladder, lungs); signs of wear and tear in the shoulder joints; reduction in strength and endurance; arteriosclerosis and vascular diseases; and skin changes (skin becomes thinner, loses elasticity and has a decreased blood supply). This makes skin more susceptible to shear forces, blisters and pressure sores. The buttocks are particularly adversely affected here as the pelvic bones place additional pressure on skin and tissue from the “inside” when sitting.

If you sustain a spinal cord injury at an older age, you may have pre-existing problems: your joints are no longer as mobile or are painful; you have cardiovascular disease; and your skin is showing signs of age.

However, irrespective of whether you have had your spinal cord injury for a long time or if it is recent, there are clear parallels in how you shape your life.

Funding for pensioners

Funding depends on the time of the event and its cause. If a disease or an accident occurs before a person has officially retired, the catalogue of non-cash and cash benefits is considerably more comprehensive.

Aids

• For disability insurance, protection of rights of possession applies to aids, but only in connection with the existing entitlement to benefits. If an age-related deterioration occurs, there is no entitlement to protection of rights of possession.
• For a pensioner, there is at most an entitlement to a contribution towards a certain aid, e.g. a manual wheelchair, and no assumption of costs.
• The disability insurance no longer finances adaptations to apartments or vehicles.
  No assumption of costs for electric wheelchairs.

Cash benefits

• Pensions that are paid through the Swiss accident compensation act (UVG) are reduced to the level of disability pensions once a person reaches retirement age. Disability pensions are changed into old age pensions. Reduction in pensions for married couples in accordance with the law on old age and survivors’ pensions.
• Protection of rights of possession applies to compensation for assistance in the same way as previously.
• Monthly supplementary benefits on top of the old age and survivors’ pension if the legal subsistence level is not guaranteed. Claims can be made for medical expenses irrespective of this.
• NB: When one spouse is admitted to a home, two budgets are established to enable one partner to remain in their own home and the person being admitted to the home to be able to claim for supplementary benefits.

Helplessness allowance

• Protection of rights of possession applies to the level of existing support requirements.
  The old age and disability insurance scale applies in the case of deterioration.

Care costs

• Basically covered by the existing compulsory accident or health insurance.

Changes to aids and organisation of care

Irrespective of how you have organised your surroundings at home, it is often no longer possible for your care to continue in the same way as you get older. Suitable aids can make your
day-to-day life considerably easier.

In the case of shoulder problems

• Use an electric wheelchair instead of a manual wheelchair
• Reduce the number of transfers, e.g. use a shower wheelchair rather than a WC transfer, maintain your ability to get around with Swiss-Trac rather than driving.
• Support in the form of an electric bed, sliding pad, patient lifter

In the case of bladder problems

• Bladder management, e.g. indwelling catheter instead of self-catheterisation

In the case of skin problems or to prevent complications

• Take pressure off the skin: evaluation of the mattress, wheelchair cushion, assessment of wheelchair seat, stick to a schedule for taking a break from sitting, e.g. lying in bed after lunch

It is also worth thinking about the following topics:

• Situation at night (changing position, catheterisation)
• More helpers: involve Spitex nursing and care services, assistants, household help services and volunteers

Remain physically and mentally active

Regular physical activity helps to prevent age-related problems. This also applies to a spinal cord injury. The aim is not to turn you into an elite athlete, but instead for you to maintain strength and endurance in order to manage day-to-day life. The Ausgleichstraining für Rollstuhlfahrer (complementary exercises for wheelchair users) brochure, which can be downloaded from the Swiss Paraplegics Association website under the Publications tab, provides suggestions for everyday exercises.

There are also several things you can do “for your mind”. As you get older, you can take up previous hobbies again, you have time to socialise, and you can take on voluntary work.

The philosopher Ludwig Hasler, a pensioner himself, says that the main thing is that you have something in your head, in your heart and in your hand. He lives according to this principle and makes it accessible to others.

Living situation as you get older

In the past, when strength started to diminish and support requirements increased, the only option was to move into an old people's home or a care home, but today there are numerous alternatives. In many places, the offers comprise not only residential options but also a complete range of services and support offers.

Nowadays, there are residential communities, housing cooperatives and private providers offering mid-price apartments with services that can be selected individually. These may comprise cleaning the apartment, laundry and meal services, but also care option in your own apartment and an emergency call button service.

Find out about the various offers in your area. Gather information about the residential options on offer and compare them to your requirements and ideas.

Conclusion

There are numerous opportunities to shape your life with a spinal cord injury as you get older. It is important that you combine your dreams and wishes with your physical and mental reality. This will enable you to think about and make a decision on how the rest of your life could and can be, in accordance with your personal definition of quality of life.