Secondary Health Conditions, Activity Limitations, and Life Satisfaction in Older Adults With Long-Term Spinal Cord Injury

Background: Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI.

Objectives: To (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction.

Design: Cross-sectional descriptive cohort study.

Setting: Home and community settings.

Participants: A total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

Methods: Baseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses.

Main Outcome Measurements: Bowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale.

Results: Bowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury.

Conclusion: Older adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI.

Level Of Evidence: III.