Twenty-Five-Year Cross-sequential Analysis of Self-reported Problems: Findings From 5 Cohorts From the Spinal Cord Injury Longitudinal Aging Study

Aging with spinal cord injury: A narrative review of consequences and challenges

Given the increase in life expectancy, aging with a pre-existing spinal cord injury (SCI) is becoming more common. This condition is challenging as compromised health status and functional independence can worsen. We aimed to provide an updated overview of the consequences of aging with SCI, highlighting the main challenges facing this population in a narrative review of the current literature we retrieved from the PubMed database from 2000 to 2022 on any aspect related to aging in persons with SCI. Here we address adverse circumstances that increase disability and hinder an active lifestyle, such as progressive physical deterioration, secondary health conditions, limitations in personal activity, changes in family and social support structures, aging of caregivers, and depletion of economic resources. Favorable changes are also observed, including psychosocial adjustments that improve quality of life. Additionally, various interventions are discussed to promote well-being, health, and social participation. Due to the relevance of this issue, people with SCI and all those who take care of them must have up-to-date information to carry out the necessary measures to promote healthy aging in a more inclusive social environment.

Continuity of Care in Adults Aging with Cerebral Palsy and Spina Bifida: The Importance of Community Healthcare and Socioeconomic Context

Continuity of care is considered a key metric of quality healthcare. Yet, continuity of care in adults aging with congenital disability and the factors that contribute to care continuity are largely unknown. Using data from a national private administrative health claims database in the United States (2007-2018). we examined continuity of care in 8596 adults (mean age 48.6 years) with cerebral palsy or spina bifida. Logistic regression models analyzed how proximity to health care facilities, availability of care providers, and community socioeconomic context were associated with more continuous care. We found that adults aging with cerebral palsy or spina bifida saw a variety of different physician specialty types and generally had discontinuous care. Individuals who lived in areas with more hospitals and residential care facilities received more continuous care than those with limited access to these resources. Residence in more affluent areas was associated with receiving more fragmented care. Findings suggest that over and above individual factors, community healthcare resources and socioeconomic context serve as important factors to consider in understanding continuity of care patterns in adults aging with cerebral palsy or spina bifida.

Social Integration among Adults Aging with Spinal Cord Injury: The Role of Features in the Built and Natural Environment

A growing number of adults are aging with spinal cord injury (SCI) acquired earlier in life. Social integration is important for health and participation after SCI. However, little is known about the role of the community built environment for supporting social integration among adults aging with SCI. Using a structured telephone survey with 182 adults aging with SCI in the Midwestern United States, we found that more community built environment facilitators (e.g., curb cuts, automatic doors, paved surfaces) and fewer barriers (e.g., gravel surfaces, crowds) significantly increased the odds of regularly engaging in both formal and informal social activities.

Social disconnectedness and perceived social isolation in persons with spinal cord injury/dysfunction living in the community: A scoping review

Context: Persons with spinal cord injury/dysfunction (SCI/D) are particularly at risk for social disconnectedness and/or perceived social isolation, which are key components to overall well-being. However, there is limited evidence that aims to understand these phenomena in this population.Objective: To investigate what is known about social disconnectedness and perceived social isolation for adults with SCI/D living in the community.Methods: A scoping review was conducted. A computer assisted search of four online databases was completed on all articles published until May 18th, 2021. Gray literature and key agencies were also searched for relevant documents. Two key concepts (spinal cord injury/dysfunction and social disconnectedness/perceived social isolation) and associated terms were used. All articles were double screened for inclusion by two reviewers.Results: Following deduplication, title and abstract screening and full-text screening, 37 articles met the criteria for inclusion in this review. Most of the included articles were published in North America, used quantitative methods and a cross-sectional design. Articles identified several factors that influenced social disconnectedness and perceived social isolation including participant characteristics, social support, psychological well-being, participation in activities, the built environment and physical health.Conclusion: The current literature suggests that issues with social disconnectedness and perceived social isolation exist for persons living with SCI/D in the community. More work is needed to better understand the relationship between these constructs. A more nuanced understanding can inform targeted interventions to help mitigate the impact of these phenomena on the SCI/D population.

Arbiters of Time: The Experience of Adults Aging with Spinal Cord Injury

Time is a fundamental component of our lives. It is both objective, a structure outside of ourselves, and subjective, an element that is relative to the life we live and how we experience it. The disabled body must come to terms with time to understand the future impact of the injury and its progression, as well as how the injury will impose a new more accelerated aging process in the body, resulting in a compressed lifespan. The body also challenges time's control of the body. This paper extends the literature on the study of time to the experience of adults aging with a spinal cord injury (SCI). Drawing from interviews conducted with adults with long-term SCI, it examines how their narratives about aging and the proactive management of their lives reflect their orientation toward and anticipation of the future. Recognizing that the spoken word often carries a multiplicity of meanings, it considers what participants' words might imply about their engagement with time. The results of this study show that the process of aging is characterized by uncertainty and the expectations of functional and health decline, requiring a sense of urgency and vigilance in the face of the uncertain course of aging with SCI. Participants understood that their lifespan was compressed due to the physiological impact of accelerated aging. Knowledge of this compression made time a scarce resource. Yet, despite it being the arbiters of their futures, so too were they the arbiters of time.

Shorter telomeres among individuals with physical disability: The moderating role of perceived stress

OBJECTIVES

Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown.

METHODS

The participants consisted of 119 male subjects (mean age 54.36 years, range 35-70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation.

RESULTS

Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression compared with able-bodied controls. Both the perceived stress and depression were correlated with a shorter TL. Nonetheless, perceived stress, rather than depression, moderated the relationship between disability and TL; among participants with higher perceived stress levels, in particular, individuals with physical disability had a shorter TL than the able-bodied controls.

DISCUSSION

The present findings suggest that individuals with physical disability and who exhibit high levels of perceived stress may be particularly vulnerable for accelerated cellular aging, suggesting that perceived stress can be used as a valuable target for intervention.