Introduction

1. Follow Up Outcomes of a Longitudinal Study on Secondary Conditions and Quality of Life after Spinal Cord Injury Denise G Tate PhD, ABPP, FACRM1, Sara J McLaughlin PhD², Martin Forchheimer MPP1, 1Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; 2Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI Results: Factors Associated with Secondary Conditions, Mortality and Life Satisfaction Introduction • Types of Secondary Conditions and Correlates • Pain and Urinary Tract Infections were the most prevalent secondary conditions in this sample. In terms of numbers of secondary conditions: 22.4% reported none; 34.2% reported one and 41.4% reported two or more. Significant correlates of secondary conditions (p=.001) included depression (CES-D scores ≥16); neurological classification (Tetra ABC); and time since injury (≥20 years). While the mean age and proportion of the SCI population older than 65 years are increasing, data from the National Spinal Cord Injury Statistical Center (NSCISC) suggests that increases in life expectancy in the SCI population have not kept pace with those without SCI over the last 15 years.1 This study is part of a larger 15 year collaboration between five SCI Model Systems (SCIMS). Findings reflect the last wave of data collection. The study was led by Craig Hospital, in Colorado. The University of Michigan was one of the collaborating sites. • Depression Rates Measured by CES-D • 68.6% had scores of 0 – 14 (none to minimal symptoms); • 13.9% (15 – 21 suggesting moderate symptoms); and • 17.5% (22 – 57) suggesting high moderate to severe symptoms. 68.6% Purpose of the Study • Secondary conditions are considered major issues for those aging with SCI and can affect their quality of life, health and mortality.2 This study examined 1) potential demographic, health and behavioral correlates of secondary conditions in those aging with SCI and 2) the association between secondary conditions and these same factors with life satisfaction and mortality. • Research Questions: What factors are associated with secondary conditions? What are the correlates of mortality and life satisfaction as one ages with traumatic SCI? • Geographical sites of respondents: 13.6% from Ann Arbor, MI; 16.5% from Atlanta, GA; 25.7% from Englewood, CO; 30.9% from Birmingham, AL; and 13.4% from San Jose, CA . . • Correlates of Mortality • Significant correlates of mortality included age, neurological status and health perceptions. Each one year increase in age was associated with 7% increase in the odds of death; for those classified as Tetraplegia ABC, the odds of dying were nearly 6 times greater (OR=5.86) than for those classified as ASIA D. Relative to their counterparts, the odds of dying were 10 times greater (OR=10.1) for those who reported that they were not “generally healthy”. Design, Methods and Participants • Correlates of Life Satisfaction • The odds of a lower level of life satisfaction were: 1.6 times greater for current smokers than non-smokers; 2.6 times greater for non-whites compared to whites; 2.1 times greater for those with one secondary than for those with none; 3.4 times greater for those with 2 or more secondary conditions relative to those with none; 6.8 times greater for those who reported that they are not healthy compared to those who believed that they were. • Data on 389 individuals with traumatic SCI were analyzed using binary multiple logistic regression. Correlates were regressed on 3 outcomes: # of secondary conditions (including pain interference with general activity; presence of UTIs, pressure sores and pneumonia in the last 6 months); life satisfaction (LSI-Z); and mortality following SCI. • Potential correlates included: age, gender, education, race, neurological status (ASIA D, Para ABC, Tetra ABC), time since injury (< 20 years vs. ≥ 20 years), self-rated health, depressive symptoms (Center for Epidemiological Studies Depression Scale: CES-D), current smoking status, and current level of engagement in a physical fitness program. • Participants were on average 45.8 years old; 19 years since injury; age of injury: 26.7 years old; 90% reported high education or greater levels of education; 25% were smokers; and 56 deaths (14% of the sample) occurred following data collection. 22.4% Conclusions • In this sample of adults aging with SCI, a greater number of secondary conditions were observed among those with higher level of depressive symptoms, more severe injury, and 20 or more years post injury. • Not surprisingly, mortalitywas predicted by older age, greater injury severity, and the belief that one is not healthy. • Being non-white, reporting that one is not “generally healthy”, having a greater # of secondary conditions, and being a current smoker were associated with lower levels of life satisfaction. • 1Groah SL, Charlifue S, Tate D, Jensen MP, Molton IR, Forchheimer M, Krause JS, Lammertise DP, Campbell M. Spinal cord injury and aging: Challenges and recommendations for future research. Am J Phys Med Rehabil 2012, 91(1): 80-93. • 2Charlifue S. A collaborative longitudinal study of aging with spinal cord injury: overview of the background and methodology. Topics in Spinal Cord Injury Rehabilitation, 2007; 12(5): 1-14. Support: The University of Michigan Spinal Cord Injury Model System (SCIMS) Grant #H133N110002 from the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitative Services (OSERS), U.S. Department of Education , Washington DC; and The University of Michigan Injury Center, Ann Arbor, Michigan.