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The population with spinal cord injury (SCI) is currently in an epidemiologic transition, characterized by increasing life span and a resultant change in health comorbidities. These health shifts, along with “life transitions” and aging experiences unique to people with SCI, require a specialized approach to aging with SCI. The purpose of this article is to provide a background to epidemiologic changes in the general population and in those with SCI. Then, a brief overview of the evidence base relevant to conditions associated with aging with SCI will be presented. By approaching SCI care with anticipatory knowledge of likely aging needs, health care professionals and consumers with SCI can better proactively address potential comorbidities and health decline and, using a coordinated approach, primary, secondary, and tertiary prevention and interventions can be implemented with the long-term goal of reducing morbidity, mortality, and improving health, wellness, and quality of life.