Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long‐term spinal cord injury

Abstract

Background: The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. Objectives: To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. Design: Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). Setting: Community settings, Sweden. Participants: From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. Interventions: Not applicable Main Outcome Measure: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). Results: Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p < .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p < .001). Activity limitations increased (SCIM III total score mean 67 to 61, p < .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. Conclusions: These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey

“…Using functioning as a health indicator [ 60 ] suitable to condense the complexity of SCI, our results show that the association between chronological age and functioning declines over time. This result goes partly in line with related literature that describes the broad range of health losses, like reduced independence and an increase in secondary health conditions, that persons with SCI face as they age [ 17 , 19 , 61 ]. We consider it partly in line because in countries with representative samples, the association was consistently observed for paraplegia but not for tetraplegia.…”

“…A European SCI registry, similar to US National Spinal Cord Injury Database [ 66 ], would be helpful to overcome the challenges and problems faced by different countries to recruit representative samples and provide researchers and policy makers with the data needed for understanding and improving how persons with SCI live and age. In Europe, besides InSCI, there are other ongoing projects focusing on ageing with SCI that can also greatly benefit from such registry, especially when longitudinal data is envisioned [ 61 ].…”

Sexually dimorphic extracellular vesicle responses after chronic spinal cord injury are associated with neuroinflammation and neurodegeneration in the aged brain

“…These survival changes have led neurotrauma researchers to examine how SCI affects the aging process and how aging alters the trajectory of SCI outcome. Patients with long-term SCI can have lower life expectancy and quality-of-life, along with higher risk of comorbidities and complications [ 6 , 7 ]. One of the long-term consequences is neuropsychological impairment, which includes deficits in memory, executive functions, attention span, processing speed and learning abilities [ 8 – 10 ].…”

Integrated Neuroregenerative Techniques for Plasticity of the Injured Spinal Cord

“…Depending on the severity of the injury, the main effect of SCI is the loss of motor and sensory functions in the parts of the body below the lesion [ 5 ]. In addition, there is a wide range of autonomic dysfunctions that unfold across different time periods, with effects on the respiratory, gastrointestinal, cardiovascular, immune, endocrine, and skeletal systems [ 6 ]. The presence of pain is a major problem after SCI, related to both the injury and stabilization measures and to changes in normal neurological activity [ 7 ].…”