Additive Effect of Age on Disability for Individuals With Spinal Cord Injuries

Abstract

Objective To examine the additive effect of age on disability for adults with SCI. Design Prospective cohort study. Setting Spinal Cord Injury Model Systems. Participants The study sample individuals with SCI with a discharge motor-FIM score and at least one follow-up motor-FIM score who also provided measures of other covariates (N=1,660). Seventy-nine percent of the sample was male, 72% was white, 16% had paraplegia, incomplete; 33.0% had paraplegia, complete; 30% had tetraplegia, incomplete; and 21% had tetraplegia, complete. The participants’ median age at injury was 32 years (range, 6–88). Main Outcome Measures The primary study outcome was the motor subscale of the Functional Independence Measure (motor-FIM). We used a mixed models approach to examine the additive effect of age on disability for individuals with SCI. Results When controlling for motor-FIM at discharge from rehabilitation, level and severity of injury, age at injury, gender, and race, the Age × Time interaction was not significant (p=0.07). Age at SCI was significantly associated with motor-FIM (F1,238=22.49, p<0.0001). Two sensitivity analyses found significant interactions for both Age × Time (p=0.03; p=0.02) and Age × Time2 (p=0.01; p=0.006) models. Trajectory of motor-FIM scores are moderated slightly by age at the time of injury. The older participants were at time of injury, the greater curvature and more rapid decline was found in later years. Conclusions These findings indicate that age moderately influences disability for some individuals with SCI, and the older one is upon injury the greater the influence age has on disability. They serve as an important empirical foundation for the evaluation and development of interventions designed to augment accelerated aging experienced by individuals with SCI.

Changing demographics of spinal cord injury over a 20-year period: a longitudinal population-based study in Scotland

“…Increased age at injury is associated with poorer functional outcomes 41, 42 and increases in comorbidities and secondary complications. 43 It has been reported that patients with a C1–C4 lesion spend 27% longer in acute care than patients with a C5–C8 lesion, and 77% longer than patients with paraplegia.…”

Aging with physical disabilities: experience intersected by stigma, social isolation and finitude

“…Despite advances in the last decades, people with disabilities still have worse health prospects, lower levels of schooling, lower economic participation, higher poverty rates, lower life expectations and worse quality of life. 6 As a consequence, people with disabilities are living longer, yet they face an accelerated aging process. 7 Even though aging of people with disabilities is admittedly a good reason to celebrate, its challenging character should also be recognized.…”

Participation and Life Satisfaction in Aged People with Spinal Cord Injury: Does Age at Onset Make a Difference?

“…3 If referred to a specialized center, elderly people with SCI may gain a similar rate of functional improvement 7 ; but because older patients generally have lower functional scores at admission, they also show worse rehabilitation outcomes compared to people who are injured at a younger age. 4,[8][9][10] The life expectancy of the population with SCI has grown over the last 50 to 60 years. 11 Many people with a new SCI can expect to live another 30 to 40 years or more.…”

“…However, the reverse -higher age at injury is an independent predictor of worse functional outcomes -has also been shown. 10 We therefore used data from earlier research with the following objectives: (a) to describe the levels of participation and life satisfaction in individuals with SCI aged 65 years or older, and (b) to analyze differences in participation and life satisfaction between individuals injured before 50 years of age or at or after 50 years of age.…”