The Swedish Aging With Spinal Cord Injury Study (SASCIS): Methodology and Initial Results

Hill

Lexell

2019

PM&R

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Risk Factors Among Older Adults With Long‐Term Spinal Cord Injury

Hill

Lexell

2019

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Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long‐term spinal cord injury

Waller

Lexell

2022

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Background: The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. Objectives: To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. Design: Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). Setting: Community settings, Sweden. Participants: From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. Interventions: Not applicable Main Outcome Measure: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). Results: Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p < .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p < .001). Activity limitations increased (SCIM III total score mean 67 to 61, p < .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. Conclusions: These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.

Coronary and carotid imaging of atherosclerosis and contributing factors in middle‐aged people with long‐term cervical and upper thoracic spinal cord injuries

Hill

Engström

et al. 2023

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IntroductionCardiovascular disease (CVD) is a major cause of death in people aging with spinal cord injury (SCI), and is predominantly caused by atherosclerosis, however, knowledge of atherosclerosis in people with SCI is scarce.ObjectiveTo describe coronary and carotid atherosclerosis in middle‐aged people with long‐term cervical and upper thoracic SCI using coronary computed tomography angiography, carotid ultrasound, and CVD risk factors, and to compare with the general population.DesignCross‐sectional study with matched controls.SettingOutpatient SCI unit in southern Sweden.ParticipantsParticipants (n=25) in the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2‐T6, American Spinal Injury Association Impairment Scale A‐C). Non‐SCI controls (n=125; ratio 5:1) from the Swedish CArdioPulmonary bioImage Study (SCAPIS).InterventionsNot applicableMain Outcome MeasuresPresence of coronary atherosclerosis, coronary artery calcium score (CACS), carotid plaques, carotid intima media thickness, blood pressure, lipids, Systematic Coronary Risk Evaluation (SCORE) and anthropometry.ResultsCoronary and carotid atherosclerotic plaques occurred in 44% of the participants, 67% of the controls exhibited coronary and 59% carotid plaques; odds ratios (OR; 95% CI): 0.38 (0.13‐1.17) and 0.54 (0.22‐1.32), respectively. Mean number of segments with coronary atherosclerosis were 1.0 in participants and 2.1 in controls (OR: 0.74 [0.52‐1.06]). CACS >100 occurred in 4 (18%) of the participants and 23 (21%) of the controls. The participants had significantly lower levels of total and non‐high density lipoprotein cholesterol and SCORE than the controls.ConclusionsThis is the first comprehensive assessment of atherosclerosis in people with SCI using advanced imaging techniques. The atherosclerotic burden in middle‐aged people with long‐term cervical and upper thoracic SCI was not increased, whereas SCORE was lower due to lower cholesterol levels. Imaging techniques may be valuable tools for assessment of atherosclerosis in SCI.This article is protected by copyright. All rights reserved.