Grant: Project Grant

Spinal cord injury (SCI) causes paralysis and is a devastating, life-changing event. As Canada's population ages, these injuries are increasingly occurring in older life, most often after a fall. Best care for SCI is provided at specialized centres and involves emergency surgery, ideally within 24 hours, followed by intensive rehabilitation to maximize chances of recovery. However, older people may face barriers to receiving this specialized care. Age-related bias ("ageism") and assumptions that aggressive treatment may not be worthwhile could limit access to timely surgery and rehabilitation. This is concerning, because adults 65 and older represent Canada's fastest-growing segment, and SCI in this group is expected to rise. This study will use population data in Ontario to compare older adults (aged 65+) with younger adults (aged 18-64) who have sustained SCI. We have three goals. First, we will examine whether older persons have equitable access to specialized SCI hospitals and early surgery (within 24 hrs), and identify possible sources of treatment delay, such as transport issues. Second, we will study access to specialized rehabilitation and identify factors that may limit access, such as living in rural areas. Third, we will evaluate differences in outcomes after SCI, including time spent living at home, medical complications, survival, and costs, to discern whether differences may be related to access to care. We will pay special attention to older individuals who may be especially vulnerable to poorer outcomes, including women, persons from racialized or marginalized communities, and those living in rural communities. Patients, caregivers, health care providers, and policy leaders will be engaged throughout the study to help interpret findings and guide system-level implementation. By identifying actionable gaps in care, this research will inform practical strategies to improve access, quality of care, and outcomes for older adults with spinal cord injury.