Aging
with Spinal Cord Injury
Research Projects
Specific research projects were conducted to investigate problems people are facing as they age with spinal cord injury.
THE NATURAL COURSE OF AGING WITH SPINAL CORD INJURY: RRTC RESEARCH SUPPORT DATABASE
Robert Waters, M.D., Rodney Adkins, Ph.D., Keith Jamieson, M.D., Margaret Murphy, R.N., N.P. and Helen Pautsch, R.N., N.P.
Abstract
The natural course of aging with SCI is a complex phenomenon, influenced internally by both normal and injury-related biological processes and externally by medical and rehabilitative developments, as well as ever-changing social, cultural and physical environments. To gain a better understanding of the natural course of aging with SCI, only large databases using complex research designs and methods suitable for the task can be used. Cross- and time-sequential research designs, which control for the effects of age, duration and era of injury are essential. In addition, the effects of ethnic/cultural background, gender, age at onset, and extent of neurological deficit should be considered in the appraisal of any aspect of aging with SCI. This project continues and expands a database that provides information about the natural course of aging with SCI in cross- and time-sequential frameworks. The database also supports other research where designs appropriate to the investigation of the natural course of SCI as people age are necessary.
CARDIOVASCULAR DISEASE AND RISK FACTORS AMONG PEOPLE AGING WITH SPINAL CORD INJURY
William Bauman, M.D., Rodney Adkins, Ph.D., Robert Waters, M.D., Yaga Szlachcic, M.D., and Ann Spungen, Ed.D.
Abstract
Individuals with SCI have been shown to have the onset of physical ailments that are generally not seen until much older in the general population. Cardiovascular disease (CVD) is arguably the leading cause of death for those with SCI. CVD is also a possible contributor to increased morbidity, presenting as constitutional symptoms of fatigue, reduced endurance and strength, which may impact the general quality of life, including the ability to maintain employment. Metabolic abnormalities related to insulin resistance include impaired glucose tolerance and diabetes mellitus, dyslipidemia, and hypertension. Thus constellation of clinical findings comprises an atherogenic pattern of CVD risk factors in the spinal cord injured population, and may well contribute directly and indirectly to additional secondary conditions, including infection and pressure ulcers, as well as functional disorders of the bowel, bladder, and kidney. A major portion of the effort expended during the current funding cycle of this RRTC has been directed toward the assessment of CVD risk factors and aging with SCI. In the past three years, a number of landmark findings have been elucidated, in particular, several with regard to the serum lipid profile. The objectives of this project are extensions of the findings of our prior studies and include: 1) to evaluate the association of CVD risk factors to actual CVD across ages, 2) to assess the relationship between CVD itself with chronological age and duration of SCI, 3) to determine by statistical means the relative importance of generally accepted risk factors (particularly that of age) and risk factors that may be unique to the spinal cord injured population (level and completeness of SCI; duration of injury) for CVD, and 4) to test an intervention to reduce CVD risk factors.
PULMONARY ASPECTS OF AGING WITH SCI
Henry Gong, M.D., William Linn, M.A., and Rodney Adkins, Ph.D.
Abstract
People with SCI experience a high incidence of severe lower-respiratory infections, resulting in lost productivity and quality of life, increased health care costs, and increased risk of early death. These problems are common not only in those with tetraplegia who have considerable loss of respiratory muscle function, but also in individuals with paraplegia. Age, duration of injury, as well as the level of the SCI may be critical factors in determining lung health. The pulmonary component of this Center project aims to better characterize the natural history of long function and of general lung health and lung disease in individuals aging with SCI. This characterization will help to identify the risk factors for long-term lung function decline and increased respiratory illness following SCI, so that future interventions may mitigate these problems, thereby increasing life expectancy, productivity, and quality of life.
Douglas Garland, M.D. and Rodney Adkins, Ph.D.
Abstract
Bone loss associated with SCI is not the same as disuse osteoporosis and it is even different than osteoporosis related to other conditions. Bone loss in SCI is an unequivocal secondary condition of SCI that increases the chance of pathological fractures as persons with SCI age. While bone loss is inevitable with SCI, it is not clear that pathological fractures are. Bone loss also occurs with aging in the able-bodied, but not all individuals develop pathological osteoporosis as they age. The natural course of bone loss is not known with regard to SCI, aging and injury duration and the risk factors for pathological fractures with SCI are even less well understood. This project is designed to elucidate the natural course of bone loss in this population, and to identify risk factors associated with pathologic fractures and SCI through cross-sequential and time-sequential assessment of the phenomena of bone loss associated with SCI.
Robert Waters, M.D., Joy Yakura, Ph.D., and Rodney Adkins, Ph.D.
Abstract
Motor strength and activities of daily living (ADL) are intrinsically linked. Most ADLs require at least moderate strength to be accomplished. For individuals with SCI, changes in function have been noted to occur with increases in duration of injury because of the correlation and may change with age as well. While decline in function with duration has been noted, it has not been mostly self-report. Also, the causes for decline have not been delineated. This study involves an objective examination of ADL functional differences and differences in motor strength in a cross-sequential sample. Correlating the findings with other data in the RRTC database will also allow for the analysis of associations between function and strength and other factors such as obesity, pain, cardiovascular condition, and pulmonary function, as well as age and injury duration.
Bryan Kemp, Ph.D., James Krause, Ph.D., Jason Kahan, Ph.D., Laura Mosqueda, M.D., and Brad Williams, Pharm.D.
Abstract
People with SCI face serious challenges and threats to their independence as they age because of new health problems and functional changes that occur. Coping with these problems is difficult as evidenced by the high rates of psychological distress reported in the literature. The most serious form of psychological distress that occurs to people with SCI is depression. Depression can have profound effects on health, functioning and quality of life. Rates of depressive disorders are three times higher in long-term SCI survivors than in the non-disabled population, with a prevalence of between 25% and 40%. There are also significant differences across ethnic groups in the prevalence of depression, in the display of symptoms, and methods of coping. Surprisingly, there has not been a single controlled study of treatment for depression in people with SCI. This study evaluates the effectiveness and the benefits of treatment for depression in three different ethnic groups of people with SCI. It builds upon a successful pilot/feasibility study we conducted over the last three years.
Donald R. McNeal, Ph.D.
Abstract
A survey of currently employed individuals with SCI was conducted during the first four years of our RRTC on Aging with SCI. The results indicated that as these persons grew older, they experienced new work-related problems because of functional declines and changing job requirements. Many of these new problems were not satisfactorily accommodated. Furthermore, most employees with SCI were not aware of the resources and services currently available to help them solve these problems, nor were their employers, nor State Department Rehabilitation counselors. This project addresses these problems through a coordinated program of research, development, education and dissemination activities. It is expected that the project will result in greater awareness of the importance of job accommodations in maintaining employment of persons with SCI and provide greater access to the resources and services that are available to obtain accommodation for work-related problems.
Bryan Kemp, Ph.D., J. Stuart Krause, Ph.D., Brad Adams, M.A., and Isis Hernandez, Ph.D.
Abstract
People with SCI are aging in growing numbers and many are experiencing functional and health changes that require increased assistance. Family members of people with disabilities are most often called upon to provide that help. However, while data specific to providers of care for people with SCI are limited, most related studies show that families are often stressed by various aspects of caregiving and many develop significant health and mental health problems themselves. The SCI population is also highly ethnically diverse, with likely differences in levels of stress, social networks, coping styles and resources. Helping families to learn about aging-related changes in SCI, to cope with caregiving and to better use formal resources available to them are important for both their own well-being and that of the person aging with SCI. This study evaluates the effects of an intervention to assist caregivers from different ethnic backgrounds to meet these changing caregiver demands as people with SCI age.
Rehabilitation
Research and Training Center on Aging with a Disability
Rancho Los Amigos National Rehabilitation Center
7601 E. Imperial Hwy, Building 800-W
Downey, California 90242; (voice) 562-401-7402; (fax) 562-401-7011
webmaster: chuck.sanders@agingwithdisability.org
last updated 11/14/2006
