How to improve life expectancy after spinal cord injury - Part 1
Introduction
Welcome to the first of a series of articles that will tackle the topic of improving life expectancy after a spinal cord injury. The goal of these articles is to provide valuable information on how to not just live longer, but healthier. We all want to age "gracefully", and that's why we need to start thinking about healthspan rather than just lifespan. Research suggests that the life expectancy of persons following a traumatic spinal cord injury has been improving since the 1950's but lifespan remains shorter compared with the general population. We will discuss why the length of life is not the only thing that counts.
In this first article, we will discuss the importance of healthspan and what we can do to achieve it. Living longer is great, but what's even better is having the physical ability to perform daily activities and participate fully in the life we want. Subsequent articles will delve into how spinal cord injuries affect lifespan and provide insights on creating a plan to live healthier. Part of the story is technology that can help you exercise despite paralysis but there is more to it than that.
So, let's take charge of our health and work towards enjoying a fulfilling life. Let's start by looking at the population at large and introduce the concepts of lifespan and "healthspan" and see why we don't want to have a long life unless it is also a healthy life. The principle ideas here are relevant to everyone.
Achieving Longevity
There was a time when each generation expected to live longer than the previous one. In the early 20th century, life expectancy in many parts of the world, including the UK, was significantly lower than it is today. So that seems like good news! A testimony to human progress.
In the UK around 1900, for instance, life expectancy at birth was about 45-50 years. Over the 20th century, many factors are believed to have contributed to increasing life expectancy including Improvement in public health measures, medical advances, better nutrition and positive lifestyle changes.
Can you guess which factor has been most important in improving life expectancy?
We will come to the answer shortly.
Increases in life expectancy have not been uniform across all groups or even regions of the UK. Disparities do exist based on factors such as socioeconomic status, race, and gender. Now, some countries are seeing stagnation or even declines in life expectancy due to factors such as sedentary lifestyle choices, poor diet and obesity, and other public health challenges.
Did you guess the answer to my question above?
Here is the answer - There was one dominant reason for the improvement in mortality rates since 1900. It's a fact that most of the reduction in mortality came about because of one influence: the reduction in contagious and infectious diseases made possible in the 1930s by the creation of antibiotics. The lesson here is that longevity is shaped by many factors and understanding the various influences is complex. It is also challenging to separate population trends from what the trends might mean for the individual - what they mean for you an I.
Chronic diseases associated with age
What seems to have happened over the last few decades is that we have been able to live longer (on average) as a society - but that does not mean we are also healthy and happy in old age. Most of us these days are likely to die as a result of one of the following classes of disease associated with ageing
Heart disease
Cancer
Neurodegenerative disease
Type 2 diabetes and related metabolic dysfunction
These are likely to develop slowly over many years and we must learn what we can to prevent these diseases from arising. If we don't, our last years are unlikely to be healthy and happy ones.
Is that just because we can't access healthcare?
As we age we wish to be healthy and able to enjoy life
In the UK we constantly hear in the media about how difficult it has become to access healthcare and how waiting lists for elective treatment have become longer than ever. The much-discussed "ageing population" means that a growing number of people have chronic conditions that need to be treated but our health service cannot cope with the demand. Of course, the COVID pandemic made things worse, but many of us today have our fingers crossed that we don't need to access the health service any time soon.
One of the limitations of our current healthcare system is that it is set up to fix people who are already broken, and it can't always do that very well. Modern healthcare might keep us alive a bit longer but not necessarily restore us to full health. We have talked for decades about the need to focus on prevention but this has yet to bear real fruit.
The four diseases above become difficult to treat when they are well established. At the moment we can hope to spot their origins as early as possible when they tend to be easier to treat and perhaps in the longer term we can act to prevent them from arising altogether.
Lifespan versus Healthspan
You might notice there is a lot of interest in longevity and this is perfectly reasonable because we all have a personal stake in it. Just this morning I listened to a news article that was discussing the UK's Biobank project where hundreds of thousands of us have had extensive health data captured for a long-term study that hopes to identify clues that can point to how to eliminate the impact of these major diseases and lead us to better longer lives. This study has to be decades-long to be useful and that points to the problem of longevity research: it takes a long time to get meaningful results.
What's the secret of your long life - "Wine, woman and song"
There are a growing number of books offering tactics that promise to extend our lives - typically this or that diet and particular types of exercise. it's easy to find self-proclaimed experts who are promising the "elixir" of life: use this diet, take this pill and live to 120 or 150 or even more. Unfortunately, the vast majority of the popular guidance is not informed by evidence.
You, like me, will have seen the media interviewing someone who has reached the ripe old age of one hundred and they will typically ask them
“What is the secret of your long life?”.
Once you have listened to a series of these interviews you will get the idea that there is no discernible secret. The story tends to be of more interest when the person interviewed confessed to a lifetime of smoking and drinking and other seemingly bad habits. This would seem to imply that our length of life is shaped by our genetic inheritance and there is not much we can do about it.
All of this misses the real point - we don't, as a rule, want a greater lifespan unless we also have the healthspan to enjoy it.
Am I alone in hoping for a long life in which I can be healthy and active - and then die quickly without pain?
My favourite author on the topic of longevity and lifespan is Dr Peter Attia who has a great podcast and a new book "Outlive" which inspired me to write about this topic. Peter's work, especially the Drive Podcast, stands out for its excellent content. I recommend subscribing to his podcast if you want to look in-depth for evidence on the things we all can do to maximise our healthspan. Don't bother if you just want the headlines - Peter's work is exhaustive in detail and eminently practical as well as informed by the latest research evidence.
Peter points out the uncomfortable fact that death comes at two speeds - fast and slow. Modern medicine tends to be really good at preventing fast death but not so good at fixing causes of slower death that tend to present as we get older.
Many of the things that rob us of our healthspan are things that develop slowly over time. By the time we discover that we have cancer, diabetes, cardiovascular disease or cognitive decline, we should know that these conditions were likely seeded many years before. Even excellent medicine and surgery can't always deal with these conditions once they come to light.
We need, in the next article to look at what research suggests is the impact of spinal cord injury on our lifespan.
Conclusion
When it comes to life expectancy after a spinal cord injury, what we're after is not just a longer lifespan, but a better one in every way. We want to be able to fully participate in activities of daily living, being physically able and active. This is what we call "healthspan", and it is the focus of this article series. Whether you are spinal cord injured or not the principles at work are the same. As we will see in later articles, spinal cord injury increases our risk of developing healthspan limiting conditions. Many will use products such as FES Cycling systems to exercise and preserve their health.
In the coming articles, we'll delve deeper into how spinal cord injuries can affect lifespan, but also, we'll discuss how individuals can take control of their health and create a game plan to live longer and, most importantly, healthier lives. No matter what your situation may be, or your starting point, these articles will provide empowering insights to help you achieve your goals and live life to the fullest.