Aging

Depression and life satisfaction in aging polio survivors versus age-matched controls: relation to postpolio syndrome, family functioning, and attitude toward disability.

Kemp BJ, Adams BM, Campbell ML.
Rehabilitation Research and Training Center on Aging With Disability, Rancho Los Amigos Medical Center/University of Southern California, Downey, USA.
Arch Phys Med Rehabil 1997 Feb;78(2):187-92

Objective: To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables.

Design: A planned medical, functional, and psychosocial study with multivariate analyses. p. Setting: A large, urban rehabilitation center.

Participants: A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds.

Main Outcomes: Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale.

Results: The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community.

Conclusion: Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.

 

Expectations of life and health among spinal cord injured adults.

McColl MA, Walker J, Stirling P, Wilkins R, Corey P.
Queen’s University, Kingston, Canada.
Spinal Cord 1997 Dec;35(12):818-28

While our understanding of aging and mortality in spinal cord injury is evolving, precise estimates are still not available for expectations of life and health following a spinal cord injury. In order to derive these estimates, information about mortality and health must be combined into a single estimate. Health expectancy estimates have been widely used in the literature of the last decade to try to understand the relationship between population health and survival, both in the general population and in special populations. This study brought the benefit of this methodology to the question of long-term survival following spinal cord injury. Specifically, the study aimed to calculate life and health expectancy in a population of spinal cord injured individuals; and to estimate the effect of factors associated with survival and health. The study involved a retrospective cohort, all of whom sustained a spinal cord injury between the ages of 25 and 34 years, and between 1945 and 1990. The study predicted a median survival time of 38 years post-injury, with 43% surviving at least 40 years. These findings suggest an increase in life expectancy of about 5 years over previous research on the same cohort. Factors affecting survival were age at injury, level and completeness of lesion. Expectations of health found in the present study are similar to those found in studies of the general population. This study showed seven remaining years of poor health expected at injury, and five remaining years expected at 40 years post injury, presumably occurring at the end of life.

 

Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services.

Campbell ML, Sheets D, Strong PS.
National Institute of Disability & Rehabilitation Research, U.S. Department of Education, Washington, DC 20202, USA.
Assist Technol 1999;11(2):105-22

Data from the Aging with Disability (AwD) Study are used to examine variations in the types and frequency of secondary conditions experienced by 301 middle-aged individuals living with the effects of three disabling conditions: polio (n = 124), rheumatoid arthritis (RA) (n = 103), and stroke (n = 75). All respondents were randomly selected from a county rehabilitation hospital or a community-based subject pool. Secondary conditions are operationalized as (1) the number of new health problems diagnosed or treated since the onset of the primary disability and (2) the amount of change/decline in basic and instrumental daily activities since a previous reference period in the disability trajectory. Also analyzed are changes in use of assistive devices and unmet needs for services. Differences in secondary conditions are examined within the AwD sample by impairment group and between samples by comparing AwD rates to national estimates for the same cohort. Results reveal significant differences in the types of new health problems reported by persons living with polio, RA, and stroke and document marked disparities, or accelerated aging, between disabled and nondisabled adults. Findings are discussed in terms of the changing health care needs of persons aging with disability and the importance of improving access to preventive services, ongoing rehabilitation, and assistive technology.

 

Comorbidity of depression with other medical diseases in the elderly.

Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, McDonald W, Dew M, Alexopoulos G, Buckwalter K, Cohen PD, Evans D, Kaufmann PG, Olin J, Otey E, Wainscott C
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Biol Psychiatry 2002 Sep 15;52(6):559-88

A major factor in the context of evaluating depression in the elderly is the role of medical problems. With aging there is a rapid increase in the prevalence of a number of medical disorders, including cancer, heart disease, Parkinson’s disease, Alzheimer’s disease, stroke, and arthritis. In this article, we hope to bring clarity to the definition of comorbidity and then discuss a number of medical disorders as they relate to depression. We evaluate medical comorbidity as a risk factor for depression as well as the converse, that is, depression as a risk factor for medical illness. Most of the disorders that we focus on occur in the elderly, with the exception of HIV infection. This review focuses exclusively on unipolar disorder. The review summarizes the current state of the art and also makes recommendations for future directions.

 

Aging in individuals with lifelong disabilities.

Connolly BH.
Department of Physical Therapy, University of Tennessee, Health Sciences Center, 822 Beale Street-Suite 337, Memphis, TN 38163, USA.
Phys Occup Ther Pediatr 2001;21(4):23-47

The major research data and findings related to aging among persons with developmental disabilities are discussed. Differences between the aging processes noted in the general population and individuals who have developmental disabilities are highlighted. Topics addressed include prevalence of developmental disabilities and mortality rates for individuals with developmental disabilities. The effects of aging on the senses, the neuromusculoskeletal system, and the cardiopulmonary system are presented along with the clinical implications of these changes in individuals with developmental disabilities who are aging.

 

Depression and dementia in aging adults with Down syndrome: a case study approach.

Sung H, Hawkins BA, Eklund SJ, Kim KA, Foose A, May ME, Rogers NB.
School of Health and Human Performance, Indiana State University, Bloomington 47408-2601, USA.
Ment Retard 1997 Feb;35(1):27-38

Patterns of symptoms associated with depression and dementia were examined in 3 aging adults with Down syndrome. A case study approach (Yin, 1994) was employed to identify and link these symptoms. Results of the case analyses provide further insight into distinguishing between depression and dementia in older persons with Down syndrome.

 

Olfactory impairment increases as a function of age in persons with Down syndrome.

Nijjar RK, Murphy C.
Department of Psychology, San Diego State University, San Diego, CA, USA.
Neurobiol Aging 2002 Jan-Feb;23(1):65-73

Neuropathology similar to that found in the brains of patients with Alzheimer’s disease (AD) has consistently been observed in older individuals with Down syndrome (DS) and this neuropathology is particularly prevalent in areas involved in olfaction. The present study investigated the effects of age on the expression of olfactory impairment in Down syndrome to address the hypothesis that older adults with DS show greater deficits in olfactory function compared with younger persons with DS and compared with age and IQ matched control groups. Between group differences showed that persons with DS had significant deficits in olfactory functioning compared to the two control groups. Further, within the DS group, older adults performed more poorly than the young adults or children. Results support the hypothesis that in a group of persons at risk for AD because of DS, olfactory impairment is greater in older individuals, suggesting progressive impairment over time. Deficits in olfactory function may be useful in signalling incipient dementia in DS.

 

Prevalence of chronic medical conditions in adults with mental retardation: comparison with the general population.

Kapell D, Nightingale B, Rodriguez A, Lee JH, Zigman WB, Schupf N.
New York State Institute for Basic Research in Developmental Disabilities, Staten Island 10314, USA.
Ment Retard 1998 Aug;36(4):269-79

We interviewed caregivers and reviewed medical records of 278 adults with mental retardation with and without Down syndrome, 45 to 74 years of age. Standardized morbidity ratios were used to compare frequency of medical disorders in these adults to frequency in the general population. In adults with mental retardation, the frequency of common age-related disorders was comparable to that in the general population, but there was an increased frequency of thyroid disorders, nonischemic heart disorders, and sensory impairment. Surveillance of health status and increased access to health care for screening and treatment of age-related disorders that are more frequent in adults with mental retardation would be important to prevent the development or delay the impact of these conditions and to promote healthy aging.

 

Association of NIDDM and hearing loss.

Dalton DS, Cruickshanks KJ, Klein R, Klein BE, Wiley TL.
Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison 53705-2397, USA. dalton@epi.ophth.wisc.edu
Diabetes Care 1998 Sep;21(9):1540-4
Comment in: Diabetes Care. 1999 Jan;22(1):180.

Objective: To evaluate the association of NIDDM with hearing loss in a large population-based study.
RESEARCH DESIGN AND p. Methods: Data from population-based longitudinal studies of aging conducted in Beaver Dam, Wisconsin, were used in these analyses. Hearing thresholds were determined by pure-tone air- and bone-conduction audiometry performed by trained technicians following American Speech-Language-Hearing Association specifications. Hearing loss was defined as the pure-tone average of the frequencies 500, 1,000, 2,000, and 4,000 Hz greater than 25 decibels hearing level in the worse ear. Diabetes status was determined by self-report of physician-diagnosed diabetes or by elevated glucose or glycated hemoglobin levels at examination.
p. Results: Of 3,571 study participants, 344 were classified as having NIDDM. Subjects with NIDDM were more likely to have a hearing loss than were subjects without diabetes (59 vs. 44%). After results were adjusted for age, this difference was not statistically significant. After individuals with hearing loss patterns inconsistent with presbycusis were excluded, there was an association between NIDDM and hearing loss when controlling for potential confounders (odds ratio [OR] 1.41, 95% CI 1.05-1.88). There was no association between duration of diabetes or glycemic control and hearing loss. Individuals with NIDDM and nephropathy were more likely to have a hearing loss than were those with NIDDM but no nephropathy (OR 2.28, 95% CI 1.04-5.00).
p. Conclusion: These data are suggestive of a weak association between NIDDM and hearing loss.

 

Diabetes, cardiovascular disease, selected cardiovascular disease risk factors, and the 5-year incidence of age-related cataract and progression of lens opacities: the Beaver Dam Eye Study.

Klein BE, Klein R, Lee KE.
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA.
Am J Ophthalmol 1998 Dec;126(6):782-90

Purpose: To describe the relationships of diabetes mellitus, cardiovascular disease, and selected cardiovascular disease risk factors to cumulative incidence of age-related cataract and to progression of lens opacities over a 5-year interval.
p. Methods: A follow-up examination of the Beaver Dam Eye Study cohort was performed 5 years after the baseline evaluation. Ages at the census prior to baseline ranged from 43 to 84 years of age. Protocols for examination, lens photography, and grading were the same for both examinations.
p. Results: Age at baseline was the most significant characteristic associated with incidence of nuclear, cortical, and posterior subcapsular cataract in those without diabetes (P < .001) for all cataracts. The positive association of age with cataract was found for nuclear and cortical cataract in the worse eye (P < or = .04) but not posterior subcapsular cataract in those with diabetes. Progression of nuclear sclerosis was common, occurring in about 70% of subjects when considering either eye. Incident cortical and posterior subcapsular cataracts (P < or = .001 for worse eye for each lesion) and progression of cortical and posterior subcapsular opacities were more common in those with diabetes (P < or = .001 for either eye for each lesion). Increased glycated hemoglobin level was associated with increased risk of nuclear and cortical cataracts in those with diabetes. Relationships of risk factors to posterior subcapsular cataracts, especially among those with diabetes, were often in the expected direction but lacked significance possibly due to small samples.
p. Conclusion: Diabetes mellitus is associated with incidence over 5 years of cortical and posterior subcapsular cataract and with progression of more minor cortical and posterior subcapsular lens opacities. These changes may be related to level of glycemia. Cardiovascular disease and its risk factors have little effect on incidence of any age-related cataract.

 

Do medical conditions affect cognition in older adults?

Zelinski EM, Crimmins E, Reynolds S, Seeman T.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles 90089-0191, USA. zelinski@rcf.usc.edu
Health Psychol 1998 Nov;17(6):504-12

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

 

Older women with diabetes have an increased risk of fracture: a prospective study.

Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR; Study of Osteoporotic Features Research Group.
Department of Epidemiology, Division of Endocrinology, University of California-San Francisco, San Francisco, California 94105, USA. aschwartz@psg.ucsf.edu

To determine whether type 2 diabetes is associated with fracture in older women, we analyzed data from 9654 women, age 65 yr or older, in the Study of Osteoporotic Fractures. Diabetes with age at onset 40 yr or older was reported by 657 women, of whom 106 used insulin. A total of 2624 women experienced at least one nonvertebral fracture during an average follow-up of 9.4 yr, and 388 had at least one vertebral fracture during an average interval of 3.7 yr. Although diabetes was associated with higher bone mineral density, it was also associated with a higher risk of specific fractures. Compared with nondiabetics, women with diabetes who were not using insulin had an increased risk of hip [relative risk (RR), 1.82; 95% confidence interval (CI), 1.24-2.69] and proximal humerus (RR, 1.94; 95% CI, 1.24-3.02) fractures in multivariate models controlling for age, body mass index, bone density, and other factors associated with fractures and diabetes. Insulin-treated diabetics had more than double the risk of foot (multivariate adjusted RR, 2.66; 95% CI, 1.18-6.02) fractures compared with nondiabetics. This study indicates that diabetes is a risk factor for hip, proximal humerus, and foot fractures among older women, suggesting that fracture prevention efforts should be a consideration in the treatment of diabetes.

 

Oral health and the older diabetic.

Martin W.
Veterans Affairs Medical Center, Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63106, USA.
Clin Geriatr Med 1999 May;15(2):339-50

Older diabetics are at high risk for developing certain oral complications. Conversely, these oral health problems can complicate overall diabetic management, potentially undermining good blood-glucose control and impairing mastication of nutritionally appropriate foods. This article reviews the oral complications associated with diabetes. Additionally, special considerations in dental treatment of the older diabetic patient are discussed, including management of diabetic emergencies.

 

Prevalence of symptoms of depression and anxiety in a diabetes clinic population.

Lloyd CE, Dyer PH, Barnett AH.
School of Health & Social Welfare, The Open University, Milton Keynes, UK. C.E.Lloyd@open.ac.uk
Diabet Med 2000 Mar;17(3):198-202

Objective: To investigate the use of a short questionnaire to measure psychological symptoms in a busy clinic setting, and to examine the prevalence of these symptoms in adults with diabetes. The perceived need for psychological treatment services was also measured.

Methods: Adults (> 18 years) with either Type 1 or Type 2 diabetes were invited to complete a short demographic form and the Hospital Anxiety and Depression Scale (HADS) whilst waiting for their routine diabetes outpatients appointment. Complication status was measured via patients’ medical records. Glycaemic control (HbA(1c)) was also recorded.

Results: A high response rate (96%) was achieved. Prevalence rates of psychological symptoms were high (overall 28% of study participants reported moderate-severe levels of depression or anxiety or both). Men were somewhat more likely to report moderate-severe depressive symptoms, whereas women reported more moderate-severe anxiety. A significant association between depression and poor glycaemic control was observed in the men, but not in the women. Regression analysis demonstrated that the interaction between sex and glycaemic control, HbA(1c) and sex were all significantly associated with depression and anxiety (R2 = 0.16 and 0.19, respectively). One-third of subjects reported that at the moment they would be interested in receiving counselling or psychotherapy if it was currently available at the diabetes clinic.

Conclusion: This study has shown that the HADS is an appropriate questionnaire to use in a clinic setting in adults with diabetes. There may be a stronger association between glycaemic control and psychological symptomatology in men than in women. There remains a significant proportion of individuals with diabetes who require psychological support, which, if available, might help improve glycaemic control and thus overall wellbeing.

 

The prevalence of multiple diabetes-related complications.

Morgan CL, Currie CJ, Stott NC, Smithers M, Butler CC, Peters JR.
University Hospital of Wales, Heath Park, Cardiff, UK.
Diabet Med 2000 Feb;17(2):146-51

Objective: To determine the prevalence of the complications of diabetes and the interrelationship between them within a United Kingdom district health authority population.

Methods: Data extracted from a general practice diabetes audit were combined with data for patients with diabetes derived from a patient index constructed using record linkage techniques.

Results: A total of 10709 patients were identified as having diabetes (prevalence 2.47%). Coronary heart disease was present in 25.2%, cerebrovascular disease in 9.6%, complications of the ‘diabetic foot’ in 18.1%, retinopathy in 16.5% and nephropathy in 2.0%. Over a half of the patients (52.1%) had none of the studied complications, 30.2% had one, 12.7% had two, 4.1% had three, 0.8% had four and 0.1% had all five. All complications were related to both age and duration of diabetes but duration was particularly apparent for the microvascular complications (retinopathy and nephropathy). Macrovascular complications in the Type 2 diabetic population appear advanced in onset compared with Type 1.

Conclusion: Multiple complications are apparent in almost one fifth of patients with diabetes. Macrovascular morbidity in Type 2 diabetes of early onset indicates that a targeted approach to treatment may prove most beneficial in both patient and health service terms.

 

Aging after spinal cord injury: an exploratory study.

Krause JS.
Craford Research Institute, Shepherd Center, Atlanta, Georgia, USA
Spinal Cord 2000 Feb;38(2):77-83

Objective: To identify the relationship between two aspects of aging (age at injury onset and years since injury onset) with the post-injury prevalence of six classes of secondary conditions among a sample of participants with spinal cord injury (SCI).
p. Design: A cross-sectional study to identify the relationship between the two aging variables and secondary conditions after spinal cord injury.
p. Setting: A large southeastern rehabilitation hospital, with the collaboration of two midwestern hospitals.
p. Participants: Three hundred and forty-seven participants, all of whom had traumatic SCI of an average duration of 18.2 years.
p. Main Outcome Measures: The Secondary Conditions Questionnaire (SCQ), a 50-item self-report screening measure for secondary conditions after SCI, was used to measure the post-injury prevalence of six classes of secondary conditions.
p. Results: There was a significantly greater odds of kidney stones, non-urinary related infections, and three types of musculoskeletal conditions (ie, curvature of the spine, contractures, and fractures) among participant cohorts who were 20-29 years post-injury and 30 or more years post-injury. The odds of heart problems and bowel obstructions were higher with a greater age at injury onset, whereas the odds of seven other conditions decreased among older cohorts at injury. Among these seven conditions, the most dramatic findings were for kidney stones, where individuals who were less than 18 at injury had over 30 times the odds of having had the condition since injury than those who were injured at 40 or older.
p. Conclusion: Although the study was cross-sectional in nature, the results point to secondary conditions which may be problematic with increasing years since injury, as well as those conditions which are more or less likely to occur among individuals injured at different points in their lives.

 

Aging and life adjustment after spinal cord injury.

Krause JS.
Crawford Research Institute, Shepherd Center Atlanta, Georgia, USA.
Spinal Cord 1998 May;36(5):320-8

Design: A field study of aging after spinal cord injury (SCI) was conducted by surveying the life adjustment of a large sample of participants with SCI.

Objective: The purpose of the current study was to compare life adjustment scores between cohorts of participants based on chronologic age, age at injury onset, time since injury and percentage of life with SCI.

Summary of Background Data: Existing cross-sectional research suggests that age is negatively correlated and time since injury is positively correlated with life adjustment. However, few studies had investigated aging among people who have lived 30 or more years with SCI.

Methods: A total of 435 participants, 55 of whom were injured for 30 or more years, completed the Life Situation Questionnaire-Revised (LSQ-R), a measure of multiple SCI outcomes. p. Results: Results indicated that being injured later in life is associated with a lower overall level of subjective well-being, poorer health, and a less active lifestyle. However, subjective well-being appears to improve throughout the life-cycle, even beyond 30 years post-injury, thus neutralizing the adverse impact of age at onset on subjective well-being, but not on health or activities.

Conclusion: The results suggest that rehabilitation professionals need to pay special attention to problems presented by being injured after the age of 40, particularly as it relates to activities. Living 30 or more years with SCI does not appear to present overwhelming barriers to adjustment.

 

Aging and spinal cord injury: medical, functional, and psychosocial changes.

Kemp B, Thompson L.
Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.
SCI Nurs 2002 Summer;19(2):51-60

Fifty years ago, people who had a spinal cord injury had very limited life expectancies. Today, these individuals can expect to live into their 60s, 70s, and beyond. Advances in rehabilitation, technology, surgery, and medicines have been chiefly responsible for this change. Recent research in both Europe and the United States now indicates that as these people age, they often develop medical and functional problems that are not as common in their nondisabled peers until much later in life. The importance of these “premature” age-related problems has led the National Institute on Disability and Rehabilitation Research to fund the Rehabilitation Research and Training Center (RRTC) on Aging With a Spinal Cord Injury at Rancho Los Amigos National Rehabilitation Center in Downey, California. This article summarizes some of the important findings from this RRTC and from other sources.

 

An assessment tool for the older person with spinal cord injury.

Grudinskas LV, Nee MA.
Department of Geriatric Research Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA.
SCI Nurs 2002 Summer;19(2):61-6

Normal aging changes intensify the chronic problems that are experienced by individuals with spinal cord injury (SCI). These changes place them at greater risk for developing vital systems failure and functional impairments, which if unrecognized, may lead to institutionalization or death. Understanding the trajectory of aging, and its impact on structure and function, is paramount in caring for individuals with SCI. Moreover, trends in health care toward capitation, managed care systems, and shifts to outpatient care portend a delivery system with more limited resources and greater restrictions (Lubitz, Greenberg, Gorina, Wartzman, & Gibson, 2001; National Institute of Aging, 2000). These trends potentially compromise health care access, quality, and cost for at-risk populations, especially for individuals aging with an SCI. Therefore, it behooves SCI nurses to develop a comprehensive approach to assess individuals who have chronic and debilitating injuries such as SCI. More importantly, assessing these individuals will require SCI nurses to adapt current tools that will aid in this endeavor and perhaps create new ones that will reflect the magnitude of SCI presentations and care. Employing the nursing process, SCI nurses will need to gather data from a myriad of sources. The first important step is establishing a baseline. Using a functional health pattern tool (FHPT) developed by Gordon (1987), and adapted from the North American Nursing Diagnosis Association (1987), is one such method of constructing a database and formulating diagnoses (Gordon, 1994). The FHPT provides a holistic view of individuals and families in any practice setting and it can be easily adapted to specialty areas within nursing. Therefore its application to both SCI and aging is fitting (Popkess-Vawter, 1997). These authors adapted the FHPT format to create a tool that will make it more reflective of changes that occur in individuals who have SCI and are aging.

 

Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators.

Krause JS, Kemp B, Coker J.
Shepherd Center, Atlanta, GA 30309, USA.
Arch Phys Med Rehabil 2000 Aug;81(8):1099-109

Objective: To investigate the relation among aging, gender, ethnicity, socioeconomic indicators, and depressive symptoms after spinal cord injury (SCI). p. Design: Survey was done to collect cross-sectional data. A mediational model was used to analyze the interrelationships between predictors and depressive outcome variables. p. Setting: A large Southeastern rehabilitation hospital.
p. Participants: Participants, identified from outpatient records who met the following inclusion criteria: (1) traumatic SCI; (2) at least 18 years old at the time of study; and (3) injured for at least 1 year. There was an initial pool of 1923 potential participants in 1997, of whom 1391 (72%) participated.
p. Main Outcome Measures: The Older Adult Health and Mood Questionnaire, a 22-item measure of depressive symptoms designed following Diagnostic and Statistical Manual of Mental Disorders (DSM III-R) criteria, was used to measure depression. It has been validated against clinical assessments by psychiatrists and psychologists.
p. Results: Forty-eight percent of the participants reported clinically significant symptoms. Minority participants, particularly women, were at a substantially higher risk for depressive symptoms. This risk diminished but did not disappear after controlling for years of education and income, both of which were highly negatively correlated with depressive symptoms. Aging factors were modestly positively correlated with depression, although education or income did not mediate these associations.
p. Conclusion: Symptoms of depression are highly prevalent after SCI and are related to aging, gender or ethnicity, and socioeconomic status indicators (education and income).

 

Functional changes in persons aging with spinal cord injury.

Thompson L.
Rehabilitation Research and Training Center on Aging with Spinal Cord Injury, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA.
Assist Technol 1999;11(2):123-9

Declines in general physical function and the effect of these changes on activities of daily living and needs for assistance were assessed in 150 individuals with spinal cord injury (SCI). The sample consisted of outpatients returning for follow-up at the spinal cord injury clinic at Rancho Los Amigos National Rehabilitation Center in Downey, CA. The average duration of injury of the sample was 13 years (range 1-37), and average age was 38 years (range 18-64). Twenty-four percent of those sampled experienced a decline or change in their physical function within the last 5 years. Individuals experiencing declines were significantly older than those without changes, averaging 45 years versus 36 years. The group with change also had a longer duration of injury, averaging 18 years versus 11 years compared to the group reporting no declines. Fatigue was the most frequently reported problem, followed by pain and weakness. Over half of the group with changes required additional assistance with activities of daily living (ADLs). Family members were the primary helpers for both ADLs and instrumental activities of daily living (IADLs) for those persons experiencing changes. The use of assistive technology, primarily equipment for bathing, toileting, and low technology devices, increased with time. The increased vulnerability to loss of function in persons with advancing age and duration of injury in this population with SCI suggests the need for early preventative measures, routine assessments to detect changes, and access to health care and supportive services to alleviate or minimize the effect of these changes.

 

Health characteristics and health services utilization in older adults with intellectual disability living in community residences.

Janicki MP, Davidson PW, Henderson CM, McCallion P, Taets JD, Force LT, Sulkes SB, Frangenberg E, Ladrigan PM.
School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA. janickimp@aol.com
J Intellect Disabil Res 2002 May;46(Pt 4):287-98

Background: The health status and health needs of adults with intellectual disability (ID) change with advancing age, and are often accompanied by difficulties with vision, hearing, mobility, stamina and some mental processes.

Objective: The present study collected health status information on a large cohort of adults with ID aged > or = 40 years living in small group, community-based residences in two representative areas of New York State, USA.

Methods: Adult group home residents with ID aged between 40 and 79 years (n = 1371) were surveyed to determine their health status and patterns of morbidity.

Results: Most subjects were characterized as being in good health. The frequency of cardiovascular, musculoskeletal and respiratory conditions, and sensory impairments increased with age, while neurological, endocrine and dermatological diseases did not. Psychiatric and behavioural disorders declined with increasing age, at least through 70 years of age. Although most conditions increased with age, their frequency varied by sex and level of ID. Frequencies of age-related organ system morbidity were compared to data from the National Health and Nutrition Evaluation Survey III. It was found that adults with ID had a lower overall reported frequency of cardiovascular risk factors, including hypertension and hyperlipidaemia, and adult-onset diabetes. Inconsistencies with mortality data among older adults with ID were observed (which showed equal if not greater prevalence of deaths as a result of cardiovascular disease and cancer).

Conclusion: These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases.

 

International differences in ageing and spinal cord injury.

McColl MA, Charlifue S, Glass C, Savic G, Meehan M.
Queen’s University, School of Rehabilitation Therapy, Kingston, Canada.
Spinal Cord 2002 Mar;40(3):128-36

Design: The present study is part of a programme of longitudinal research on ageing and spinal cord injury involving three populations – American, British and Canadian. The design was multivariate.

Objective: To identify international differences in outcomes associated with ageing and spinal cord injury.

Setting: A sample of 352 participants was assembled from five large, well-established databases. The Canadian sample was derived from the member database of the Canadian Paraplegic Association (Ontario and Manitoba divisions). The British sample was recruited from Southport Hospital’s Northwest Regional Spinal Injuries Centre and Stoke-Mandeville Hospital’s National Spinal Injuries Centre. The American sample has been recruited through Craig Hospital in Denver, Colorado.

Methods: The sample included individuals who had incurred a spinal cord injury at least 20 years previously; were admitted to rehabilitation within 1 year of injury; were between age 15 and 55 at the time of injury. Data were collected using a combination of self-completed questionnaires and interviews. Data included medical information, general health, hospitalisations, and changes in bladder and bowel management, equipment, pain, spasticity, the need for assistance, and other health issues.

Results: Clear international differences existed between the three samples in the three different countries. After controlling for sampling differences (ie, differences in age, level of lesion, duration of disability, etc.), the following differences were seen: (1) American participants had a better psychological profile and fewer health and disability-related problems; (2) British participants had less joint pain and less likelihood of perceiving they were ageing more quickly; (3) Canadians had more health and disability-related complications (particularly bowel, pain and fatigue problems).

Conclusion: These differences are discussed in terms of socio-political, health care system and cultural factors that might be used to explain them, and to generate hypotheses for future research.

 

Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being.

Charlifue SW, Weitzenkamp DA, Whiteneck GG.
Research Department, Craig Hospital, Englewood, CO 80110, USA.
Arch Phys Med Rehabil 1999 Nov;80(11):1429-34

Objective: To specify the degree to which current age, duration of injury, and neurologic status affect the frequency of secondary health and psychosocial conditions in persons with long-term spinal cord injury (SCI), using both longitudinal and cross-sectional analysis techniques.

Design: Prospective longitudinal examination and data collection involving individuals with SCI studied initially at their 5th, 10th, and 15th anniversaries postinjury, and subsequently 5 years later at their 10th, 15th, and 20th anniversaries postinjury.

Setting: Five Regional Model Spinal Cord Injury Systems.

Participants: The 439 individuals who meet the inclusion criteria for the National SCI Database and who are enrolled in a longitudinal study of secondary conditions and SCI.

Main Outcome Measures: Physical and psychosocial status at various times postinjury. Results: There are different reports of various conditions when analyzing by neurologic groups, duration of injury, and age. Cross-sectional and longitudinal analyses also demonstrate different patterns of complications.

Conclusion: The longitudinal method, like cross-sectional research, allows for identification of physical and psychosocial changes soon after they occur. Longitudinal research, however, also makes possible the development of predictive models for various long-term outcomes.

 

Metabolic and endocrine changes in persons aging with spinal cord injury.

Bauman WA, Spungen AM, Adkins RH, Kemp BJ.
Department of Medicine, Mount Sinai Medical Center, New York, New York, USA.
Assist Technol 1999;11(2):88-96

Persons with spinal cord injury (SCI) have secondary medical disabilities that impair their ability to function. With paralysis, dramatic deleterious changes in body composition occur acutely with further adverse changes ensuing with increasing duration of injury. Lean mass, composed of skeletal muscle and bone, is lost and adiposity is relatively increased. The body composition changes may be further exacerbated by associated reductions in anabolic hormones, testosterone, and growth hormone. Individuals with SCI also have decreased levels of activity. These body composition and activity changes are associated with insulin resistance, disorders in carbohydrate and lipid metabolism, and may be associated with premature cardiovascular disease. Although limited information is available, upper body exercise and cycle ergometry of the lower extremities by functional electrical stimulation (FES) have been reported to have a salutary effect on these body composition and metabolic sequelae of paralysis. Perhaps other innovative, externally mediated forms of active exercise of the paralyzed extremities will result in an increased functional capacity, metabolic improvement, and reduction of atherosclerotic vascular disease.

 

Spinal cord injury medicine. 5. Preserving wellness and independence of the aging patient with spinal cord injury: a primary care approach for the rehabilitation medicine specialist.

Groah SL, Stiens SA, Gittler MS, Kirshblum SC, McKinley WO.
Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95118, USA. slgroah@hotmail.com
Arch Phys Med Rehabil 2002 Mar;83(3 Suppl 1):S82-9, S90-8

This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention. OVERALL ARTICLE p. Objective: To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI. Copyright 2002 by the American Academy of Physical Medicine and Rehabilitation

 

Teaching for life: integrating aging into the rehabilitation education program.

Colodny A.
VA Long Beach Healthcare System, Long Beach, California, USA.
SCI Nurs 2002 Summer;19(2):67-70

As the population with spinal cord injury (SCI) steadily ages, nurses find it more and more challenging to prevent secondary complications. SCI, an already complex topic, is made more so with the addition of the aging process. Aging need not be a negative occurrence, but can be viewed as a path in life that requires careful navigation along the way. Nurses need to incorporate the concepts of wellness and disease prevention education into the initial rehabilitation program to better prepare patients for a long and healthy life. This article briefly describes respiratory and genitourinary complications associated with aging with an SCI and some specific teaching strategies for prevention and management of these two complications.

 

Women with spinal cord injury and the impact of aging.

Pentland W, Walker J, Minnes P, Tremblay M, Brouwer B, Gould M.
School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, K7L 3N6, Canada.
Spinal Cord 2002 Aug;40(8):374-87

Objective: The objectives of this study were to describe what women with longstanding spinal cord injury (SCI) feel they are experiencing as they age, how they are coping and what they require in order to ensure their continued social and economic participation in society.

Study Design, Methods, and Setting: A naturalistic approach was taken, incorporating three focus groups (n=10) and key informant interviews (n=19) of women with SCI ranging in age from 31 to 70 years and living in rural and urban communities in Ontario, Canada.

Results: The women feel isolated and sense many of their key concerns are ignored or dismissed by health care and service providers. The common physical changes and concerns were gynecological/sexual and bowel and bladder issues. Socio-emotional changes with age included impact of their age-related changes on important relationships and re-evaluation of personal priorities. They articulated worries including declining health, increasing dependency and financial stresses. Additional resources they need to age successfully include improved environmental accessibility, assistive devices, more flexible and responsive attendant and household support, access to recreation and fitness opportunities and peer and psychological support.

Conclusion: Many of the issues raised by the women were consistent with the authors’ previous examination of aging in men with SCI and women with disabilities. The most striking difference was their profound sense of isolation and perceptions that health care and service providers were unprepared or unwilling to address the unique issues they face as women living and now aging with SCI.

 

Association of comorbidity with disability in older women: the Women's Health and Aging Study.

Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM.
The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Clin Epidemiol 1999 Jan;52(1):27-37

There is substantial evidence that physical disability results from chronic diseases and that the number of chronic diseases is associated with the presence and severity of disability. There is some evidence that interactions between specific diseases are of import in causing disability. Beyond arthritis, however, little is known of the disease pairs that may be important to focus on in future research. This study explores the associations between multiple disease pairs and different types of physical disability, with the objective of hypothesis development regarding the importance of disease interactions. The study population comprised a representative sample of 3841 women 65 years and older living in Baltimore, screened for participation in the Women’s Health and Aging Study. The study design was cross-sectional. An interviewer-administered screening questionnaire was administered regarding self-reported physical disability in 15 tasks of daily life, history of physician diagnosis of 14 chronic diseases, and MiniMental State examination. Task difficulty was empirically grouped into six subsets of minimally overlapping disabilities, with a comparison group consisting of those with no difficulty in any task subset. Multiple logistic regression models were fit assessing the relationship of major chronic diseases and of interactions of disease pairs with each disability subtype and with any disability, adjusting for confounders. Fourteen percent of the population reported mobility difficulty only; 5%, upper extremity difficulty only; 9%, both of these difficulties but no others; 7%, difficulty in higher function but not self-care tasks; 7%, self-care task difficulty but not higher function tasks; and 15%, difficulty in both higher function and self-care (weighted data). Almost all in the latter three groups had difficulty, as well, in mobility or upper extremity tasks. In regression models, specific disease pairs were synergistically associated with different types of disability. For example, important disease pairs that recurred in their associations with different disability types were the presence of arthritis and visual impairments, arthritis and high blood pressure, heart disease and cancer, lung disease and cancer, and stroke and high blood pressure. In addition, the type of disability that a disease was associated with varied, depending on the other disease that was present. Finally, when interactions were accounted for, many diseases were no longer, in themselves, independently associated with a given type of disability. Partitioning disability into six subtypes was more informative in terms of associations than was evaluating a summary category of “any disability.” These findings provide a basis for further hypothesis development and testing of synergistic relationships of specific diseases with disabilities. If testing confirms these observations, these findings could provide a basis for new strategies for prevention of disability by minimizing comorbid interactions.

 

Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study.

Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik JM;
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland 20892, USA. vlt@unife.it
Diabetes Care 2002 Apr;25(4):678-83

Objective: To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women.

Methods: Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women’s Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures.

Results: Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree.

Conclusion: Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

 

Early menopause in women with Down's syndrome.

Schupf N, Zigman W, Kapell D, Lee JH, Kline J, Levin B.
Laboratory of Epidemiology, NYS Institute for Basic Research in Developmental Disabilities, Staten Island 10314, USA.

We used the AAMR’s Adaptive Behavior Scale to ascertain current menstrual status in a population-based sample of 157 women with Down’s syndrome (DS) and 187 women with other intellectual disability, all 40 years of age or older. The age-adjusted likelihood of menopause was twice as high in women with DS syndrome as in women with other intellectual disability (OR = 2.3; 95% CI = 1.1-4.9). Treated thyroid conditions did not influence menstrual status and did not modify the relationship between DS and menstrual status. These findings support the hypothesis that women with DS experience menopause at an earlier age and that this may be associated with accelerated aging.

Risk factors for falling in home-dwelling older women with stroke: the Women’s Health and Aging Study.
Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM; Women’s Health and Aging Study
Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University/Warwick West Midlands Primary Care Network, Coventry, UK. s.lamb@coventry.ac.uk
Stroke 2003 Feb;34(2):494-501
Comment in Stroke. 2003 Feb;34(2):494-501.

Purpose: Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population.

Methods: This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments.

Results: Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling.

Conclusion: Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.

 

Emotional vitality among disabled older women: the Women's Health and Aging Study.

Penninx BW, Guralnik JM, Simonsick EM, Kasper JD, Ferrucci L, Fried LP
Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, Maryland 20892-9205, USA.
J Am Geriatr Soc 1998 Jul;46(7):807-15
Comment in: J Am Geriatr Soc. 1998 Jul;46(7):914-5.

Objective: To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women.
p. Design: A community-based study: The Women’s Health and Aging Study.
POPULATION: A total of 1002 moderately to severely disabled women aged 65 and older living in the community.
MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. Correlations with demographics, health status, and social context were examined.
p. Results: Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR=1.69) and for having higher income (OR=1.77), better cognition (OR=2.36), no vision problems (OR=1.61), adequate emotional support (OR=2.54), and many face-to-face contacts (OR=1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR=0.57).
p. Conclusion: A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.

 

Factors that modify the association between knee pain and mobility limitation in older women: the Women's Health and Aging Study.

Lamb SE, Guralnik JM, Buchner DM, Ferrucci LM, Hochberg MC, Simonsick EM, Fried LP.
School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. s.lamb@coventry.ac.uk
Ann Rheum Dis 2000 May;59(5):331-7

Objective: To investigate the influence of pain severity, knee extensor muscle weakness, obesity, depression, and activity on the association between recent knee pain and limitation of usual and fast paced walking, and ability to rise from a chair.
p. Methods: A cross sectional analysis of 769 older women (mean age 77.8, range 65-101) with physical disability, but no severe cognitive impairment. Severity of knee pain in the past month was classified as none, moderate, or severe. Mobility was measured using timed performance tests.
p. Results: The prevalence of recent knee pain was 53% (408/769). One third of the women with pain reported it to be severe. In general, knee pain was only significantly associated with limited mobility if severe. Obesity, activity and, to a lesser extent, depression intensified the effects of pain. Knee extensor weakness did not. Obesity was a distinctive risk factor in that it substantially increased the risk of mobility limitation, but only in women with pain. In women who had severe pain, activity (walking more than three city blocks in the past week) increased the risk of walking disability more than inactivity. Depression had a minor, but statistically significant effect on walking ability, but not the ability to rise from a chair.
p. Conclusion: In older women with recent knee pain, a high pain severity score, obesity, and activity are important factors that increase the risk of mobility limitation.

 

Maximizing health in menopausal women with disabilities.

Welner SL, Simon JA, Welner B.
Georgetown University Medical Center, Washington, DC, USA.
Menopause 2002 May-Jun;9(3):208-19

There are nearly 30 million women with disabilities in the United States. Of these, more than 16 million are over the age of 50. Years ago, women with disabilities did not commonly live to the age of menopause, and, if they did, they reached this stage of life in a very debilitated condition. Now, women with disabilities are entering their mature years as active members of society who can look forward to productive futures. Because the health needs of women with disabilities might differ from those of other women, special attention should be focused on how physiological changes of perimenopausal and menopausal states affect this population. In addition to functional changes that might affect menopausal women with disabilities, basic health maintenance issues may be adversely affected by environmental factors. Physical barriers can influence compliance with preventive health screening that is essential in aging populations. Treatment options might need to be tailored to the individual. The disabling condition itself may progress, resulting in secondary conditions requiring creative interventions. A comprehensive evaluation and the development of a suitable management plan, which takes into account the multifactorial nature of aging as a disabled woman, are essential in delivering optimal care to this population.

 

Menopause and aging with disability.

Vandenakker CB, Glass DD.
Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Jackson Memorial Medical Center, University of Miami Rehabilitation Center, Florida, USA.
Phys Med Rehabil Clin N Am 2001 Feb;12(1):133-51

Aging involves change and adaptation to change. The normal or usual changes of aging often have significantly greater impact on an individual whose disability has limited his or her physical or socioeconomic reserves. The aging process itself may be accelerated by overuse and compensatory mechanisms. The changes of aging have unique features in damaged body systems that exhibit physiologic adaptations. The changes of aging therefore often result in secondary impairments, leading to secondary disability. New adaptations or repeated rehabilitation are needed to regain the equilibrium among biologic, psychosocial, and environmental influences. Disabled women do not seem to have a significantly different experience of menopause from other women, but postmenopausal changes-accelerated bone loss and increased risk of heart disease-do appear to carry greater risk in those with mobility impairment. Hormone replacement therapy has both greater potential benefit and greater potential risks. Review of these issues makes evident the great need for research in the area of aging with disability, improvement in physician and consumer education, and future health care planning.