Differentiation of Normal Aging Related Changes in Employment, Health, Participation, and Quality-of-life from Those with Reduced Length of Survival after Spinal Cord Injury

Research Objectives Previous research has documented how employment, health, participation, and quality-of-life (QOL) may change over time after spinal cord injury (SCI), but has not differentiated changes that relate to normal aging from those that may be red flags for risk of diminished survival. Our purpose was to identify five-year changes in employment, health, participation, and QOL and then compare the amount, direction, and significance of changes between those surviving to follow-up and those deceased by follow-up. Design Cohort study. Setting This study was conducted at a medical university in the Southeastern United States. Participants There were 1,157 adult participants with traumatic SCI of at least 1-year duration who completed two self-report assessment measures separated by a five-year interval. Participants were identified from the SCI Longitudinal Aging Study, which is a 50-year longitudinal study with cohorts identified from two hospitals in the Midwest and a specialty hospital in the Southeastern United States. Interventions Not applicable. Main Outcome Measures The main outcome measures were 13 indicators related to employment, health, participation, and QOL/psychosocial indicators. Survival status was measured at follow-up. Results Basic traditional analysis indicated the survivors had higher employment percentages, better health, higher social participation, and better QOL at baseline compared to the deceased participants. During the five-year interval, the survivors had significant declines in employment percentage and social participation, while the deceased participants had significant undesirable changes in all four areas of employment, health, participation, and QOL before their death. Using the survivors as the control group, the deceased participants experienced more hospitalizations, had less nights away from home, and had lower global satisfaction scores before their death. Conclusions Declines in employment rates and some aspects of participation appear to be part of normal aging with SCI. However, increased hospitalizations, fewer dates away from home, and lower global life satisfaction are particularly more common among those deceased and may be taken as red flags for early mortality. Author(s) Disclosures The authors have nothing to disclose.