1.3. Aging with SCI
What Women Need to Know About Aging with SCI
This article is from the Pushin' On Newsletter, Vol 18, Winter, 2000.
What Women Need to Know about Aging with SCI
by Laura Mosqueda, M.D.
Women who have a spinal cord injury (SCI) need to prepare for the future when thinking about health care. Many people with SCI, as well as their physicians, operate in the "acute" mode. In other words they deal with problems and issues as they arise. Not enough people make plans for a healthy future. Thanks to better health care, self-advocacy and improved social programs a woman with SCI must plan to live into old age.
Thinking about the future means thinking about preventive health. This is important to all women regardless of disability status, but it is very important for women with SCI to be aware of their special health concerns. There are several types of preventive health care. Primary prevention refers to ways that may stop a person from getting a disease. An example of this is immunization for influenza, or flu shot. It is designed to actually prevent people from getting the flu. Secondary prevention refers to ways that may help doctors detect a treatable disease at an early stage, before it becomes a serious problem. An example of this is a mammogram. It will not prevent breast cancer, but mammograms can detect breast cancer at an early stage so that it may be successfully treated.
It is certainly important for everyone with SCI to remain up-to-date on immunizations. This includes the flu shot every year and tetanus shot every 10 years. It is also important for people with SCI to get a shot for protection against a particular type of pneumonia (pneumococcal pneumonia). Many physicians think that this protection is for the elderly or people with lung disease, but people with SCI need to remind their doctor that they, too, are at risk for pneumonia. This is because of the weakened respiratory function that occurs after injury.
Pap smears are used to detect cancer of the cervix. They may even detect changes in cells before they turn into cancer. Some women are at higher risk of developing cervical cancer than others. Women who began having sexual intercourse at an early age and/or who have multiple sexual partners are at a higher risk. Women at higher risk should be screened every two years. Those women who are sexually active but not at high risk should be screened every three years if they have already had two or three normal smears. After the age of 65, further screening is not needed unless high-risk behavior such as multiple sexual partners continues. Also, women who have undergone a hysterectomy (the surgical removal of the uterus) do not need to be screened unless the surgery was performed because of cervical cancer.
Women with spinal cord injury may need to plan ahead for the Pap smear. Some doctors' offices and rehabilitation facilities may be accessible and have adjustable examination tables. But most offices are not easily accessible. Some are not accessible at all! It can be a challenge for women with SCI to find an accessible office. There can be problems with transferring on and off the examination table. It may be difficult maintaining the proper position for the Pap smear. Women can help by taking an active role in guiding the physician and office staff in the best methods for assisting with transfers, positioning, and techniques for a more comfortable exam.
It is important to make the same accessibility preparations when getting a mammogram. There is a lot of controversy over the appropriate screening guidelines for mammograms. Most agencies agree that all women between the ages of 50 and 69 years should be screened once a year. Some doctors encourage women to have their first mammogram at age 40.
There are some factors to consider that may increase a woman's risk of breast cancer:
1 a history of breast cancer in a first-degree relative (a mother or sister), particularly if the cancer developed before menopause;
2 having no children or having the first child at an older age; and
3 certain types of benign (non-cancerous) breast disease that can be seen on a mammogram.
Some women with SCI have limited use of their hands. This can make breast self-examinations difficult. It is even more important that women with this difficulty have regular breast exams and mammograms as a routine part of a your health care plan.
All women will experience a gradual loss of bone density after the age of 30. At the time of menopause, there is a rather sudden increase in the loss of bone density. This may cause some women to develop osteoporosis. Osteoporosis is a disease that thins and weakens bones to the point where they break easily - especially bones in the hip, spine, and wrist.1
Women with spinal cord injury need to be especially cautious in preventing and treating low bone density. For the first few months following injury, there is a loss of bone density in many parts of the skeleton. This loss is due in part to the body's inability to bear weight on some bones. If a woman has a spinal cord injury at the age of 25, what will happen when she turns 50 and experiences menopause? There may be another dramatic loss of bone. This puts women with SCI at an even higher risk of breaking a bone.
Osteoporosis is related to a lack of estrogen and may be prevented by taking estrogen, a hormone replacement therapy. The issue of hormone replacement therapy and prevention of osteoporosis is something that women with SCI need to discuss with their doctor.
It is important for women with spinal cord injury to develop a partnership with their doctor and plan for a healthy future. Remind your doctor to treat health care issues that may be neglected in the acute setting. Make sure to practice primary and secondary prevention of conditions by getting regular immunizations, Pap smears and mammograms. Finally, talk with your doctor about what you can do to reduce the affects of osteoporosis.
Remember, better health care today can mean better health tomorrow.
Laura Mosqueda, MD is Director of Geriatrics and Associate Professor of Clinical Family Medicine, University of California, Irvine College of Medicine. She is Co-Director of the Rehabilitation Research and Training Center on Aging with A Disability, Rancho Los Amigos Medical Center, Downey, CA. This work was supported by the National Institute on Disability and Rehabilitation Research, US Dept of Education grant #H133B980024.