Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury

Abstract

Objective: To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI).

Design: Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models.

Setting: Community-dwelling participants who resided in rural and urban areas.

Participants: One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury.

Interventions: Not applicable.

Measures: Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic - Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen's Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS).

Results: Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors.

Conclusions: Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.

Keywords: Comorbidities; Environmental factors; Health insurance; Healthy aging; Participation; Secondary conditions; Spinal cord injury.

Figure 1

Predicted number of comorbidities by neurological classification and community parking restrictions* among adults aging with SCI (n = 183). * Parking restrictions is a measure of the proportion of 13 community sites (eg, grocery stores, libraries, doctors’ offices) where study participants indicated that parking restricted their participation in activities. Predicted comorbidities are calculated for those indicating no parking restrictions (gray bars, 0/13 sites), and for those reporting parking restrictions in most community sites (black bars, 11/13 sites).