Functional outcome and discharge destination in older patients with spinal cord injury: a retrospective cohort study

To evaluate functional outcomes and discharge destination after specialized inpatient rehabilitation in patients aged > 75 years with spinal cord injury (SCI).

This retrospective single-center cohort study included 160 patients aged ≥ 60 years who completed inpatient SCI rehabilitation at the specialized SCI unit of BG Trauma Center Frankfurt, Germany (2010-2025). Patients were grouped into 60-75 and > 75 years. Functional status was assessed using the Spinal Cord Independence Measure (SCIM) at admission and discharge. Outcomes included discharge destination, functional gain (ΔSCIM), in-hospital complications, and medication at discharge.

The mean age was 67 ± 5 years in the 60-75-year group and 80 ± 4 years in the > 75-year group; 75.0% and 64.1% were male, respectively. At discharge, 68.8% of patients aged > 75 years returned home compared with 81.3% of those aged 60-75 years. Only 7.8% of patients aged > 75 years were discharged home without nursing support. SCIM scores were lower in the > 75-year group (27 ± 18 vs. 40 ± 24; p = .003), as were functional gains (ΔSCIM: 12 ± 13 vs. 20 ± 19; p = .004). Baseline neurological status and in-hospital mortality (6.3% vs. 4.2%; p = .554) did not differ significantly between groups.

Most patients aged > 75 years were discharged home despite lower functional gains. Advanced age alone should not be considered a barrier to specialized inpatient rehabilitation. Early discharge planning and adequate post-acute support are essential to facilitate supported community discharge and reduce institutionalization.