Growing Older With a Physical Disability: A Special Application of the Successful Aging Paradigm

Trajectories of Physical Function and Behavioral, Psychological, and Social Well-Being in a Cohort of Swedish Older Adults

Background and Objectives

Successful aging has been described as a multifactorial and dynamic process. The aims of the study were to detect aging trajectories of physical function and behavioral, psychological, and social well-being; and to explore the correlations between functional versus well-being trajectories by age group.

Research Design and Methods

Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (N = 1,375). Subjects' physical function was assessed through walking speed and chair-stand tests, behavioral well-being through participation in mental and physical activities, psychological well-being through life satisfaction and positive affect, and social well-being through social connections and support. All exposures were standardized (z-scores). Linear mixed models were used to estimate trajectories of physical function and well-being over a 12-year follow-up.

Results

The steepest declines were seen for physical function (relative change [RC] in z-scores across ages; RC = 3.01), followed by behavioral well-being (RC = 2.15), psychological well-being (RC = 2.01), and social well-being (RC = 0.76). Correlations between physical function and the different well-being domains were weak, especially for slopes. Stronger intercept correlations were observed among the oldest-compared to the youngest-old, especially with behavioral (r = 0.39 vs r = 0.24) and psychological (r = 0.33 vs r = 0.22) well-being.

Discussion and Implications

Physical function declines the fastest throughout aging. The different well-being domains decline at a slower rate, which may be a possible sign of compensation against age-related functional decline, especially among the youngest-old, for whom discordances between physical function and the different well-being domains were more common.

Patient experience (PX) among individuals with disabilities in Japan: a mixed-methods study

Background

People with disabilities (PWDs) tend to be disadvantaged in terms of receiving preventive medicine and medical checkups. About 7.6% of the Japanese population is estimated to have a disability. Although patient experience (PX) is an effective measure of patient-centeredness, little is known about the PX of PWDs. The present study aimed to compare the PX of PWDs with those of the non-disabled both quantitatively and qualitatively.

Methods

The present study involved a questionnaire survey and a free-response question on the survey form. The quantitative part of the study involved a comparison of JPCAT scores between PWDs and non-disabled participants. JPCAT is composed of five primary care principles: First contact, Longitudinality, Coordination, Comprehensiveness (service provided and service available), and Community orientation. Descriptive statistics were used to assess age, sex, years of education, self-rated health status, and type of disability (for PWDs). Multivariable analysis was performed using a linear regression model to detect differences between PWDs and non-disabled participants in total and domain-specific JPCAT scores. The model included the following confounding variables: age, sex, years of education, and self-rated health status. The qualitative part of the study involved a thematic analysis of answers to the free-response question.

Results

Data from 338 participants (169 PWDs and 169 non-disabled participants) were analyzed (response rate of 36% for PWDs). After adjusting for age, sex, years of education, and self-rated health status, PWD scores were significantly lower than those of non-disabled participants for the Longitudinality, Community Orientation, and Comprehensiveness (services available) domains of the JPCAT. Qualitative analysis yielded six themes, each of which was further divided to have Disability-Specific and General themes.

Conclusions

JPCAT scores in PWDs were significantly lower than those of non-disabled participants for the Longitudinality, Community Orientation, and Comprehensiveness (services available) domains. Qualitative analysis revealed that PWDs shared several themes with non-disabled participants, but also to face unique challenges due to disabilities, such as the lack of a health care provider familiar with disabilities and the insurance transition at age 65, a unique feature of the Japanese health care system.

Trial registration

The study was a non-interventional, observational research trial, and thus registration was not required.

Successful Aging for Community-Dwelling Older Adults: An Experimental Study with a Tablet App

Mobile health (mHealth) technologies offer an opportunity to enable the care and support of community-dwelling older adults, however, research examining the use of mHealth in delivering quality of life (QoL) improvements in the older population is limited. We developed a tablet application (eSeniorCare) based on the Successful Aging framework and investigated its feasibility among older adults with low socioeconomic status. Twenty five participants (females = 14, mean age = 65 years) used the app to set and track medication intake reminders and health goals, and to play selected casual mobile games for 24 weeks. The Older person QoL and Short Health (SF12v2) surveys were administered before and after the study. The Wilcoxon rank tests were used to determine differences from baseline, and thematic analysis was used to analyze post-study interview data. The improvements in health-related QoL (HRQoL) scores were statistically significant (V=41.5, p=0.005856) across all participants. The frequent eSeniorCare users experienced statistically significant improvements in their physical health (V=13, p=0.04546) and HRQoL (V=7.5, p=0.0050307) scores. Participants reported that the eSeniorCare app motivated timely medication intake and health goals achievement, whereas tablet games promoted mental stimulation. Participants were willing to use mobile apps to self-manage their medications (70%) and adopt healthy activities (72%), while 92% wanted to recommend eSeniorCare to a friend. This study shows the feasibility and possible impact of an mHealth tool on the health-related QoL in older adults with a low socioeconomic status. mHealth support tools and future research to determine their effects are warranted for this population.

Classification of Center of Mass Acceleration Patterns in Older People with Knee Osteoarthritis and Fear of Falling

(1) Background: The preoccupation related to the fall, also called fear of falling (FOF) by some authors is of interest in the fields of geriatrics and gerontology because it is related to the risk of falling and subsequent morbidity of falling. This study seeks to classify the acceleration patterns of the center of mass during walking in subjects with mild and moderate knee osteoarthritis (KOA) for three levels of FOF (mild, moderate, and high). (2) Method: Center-of-mass acceleration patterns were recorded in all three planes of motion for a 30-meter walk test. A convolutional neural network (CNN) was implemented for the classification of acceleration signals based on the different levels of FOF (mild, moderate, and high) for two KOA conditions (mild and moderate). (3) Results: For the three levels of FOF to fall and regardless of the degree of KOA, a precision of 0.71 was obtained. For the classification considering the three levels of FOF and only for the mild KOA condition, a precision of 0.72 was obtained. For the classification considering the three levels of FOF and only the moderate KOA condition, a precision of 0.81 was obtained, the same as in the previous case, and finally for the classification for two levels of FOF, a high vs. moderate precision of 0.78 was obtained. For high vs. low, a precision of 0.77 was obtained, and for the moderate vs. low, a precision of 0.8 was obtained. Finally, when considering both KOA conditions, a 0.74 rating was obtained. (4) Conclusions: The classification model based on deep learning (CNN) allows for the adequate discrimination of the acceleration patterns of the moderate class above the low or high FOF.

Impact of Depression, Resilience, and Locus of Control on Adjustment of Health-Related Expectations in Aging Individuals With Chronic Illness

Objectives

Quality of Life (QoL) depends on the discrepancy between desired and current experiences (referred to as the Calman gap), thus in chronic illness, adjustment of expectations and interpretation of the current situation are crucial. Depression is known to influence this gap, and the present study aims to further assess the role of resilience and health locus of control (HLC).

Methods

A total of 94 patients (age M = 71.8, SD = 7.7 years) with neurological disorders were screened via telephone regarding depression, resilience and HLC. Current and desired state of several life domains were assessed, such as Fitness, General Health, Pain, Daily Activities, Finances, Leisure, and Family. Elastic net regularization and analyses of variance were used to disentangle the impact of depression, resilience, HLC, and sociodemographic factors on the perception of current and desired state, and the gap between both.

Results

A gap was present for all domains but largest for pain. Interpretation of the current state was linked to desired state, HLC, and age. All gaps were related to depression; certain domains were in addition influenced by resilience, HLC and sociodemographic factors. Of note, for most domains, patients did not select the highest possible desired state.

Conclusion

Older patients with neurological disorders report a gap between current and desired state for many aspects of life. Adjusting expectations is beneficial in the face of declining health, but a reasonably increased desired state may positively influence the perception of the current situation. Depression negatively influences the interpretation of the Calman gap.

Longitudinal Association between Sarcopenia and Cognitive Impairment among Older Adults in Rural Malaysia

Sarcopenia is a condition that is highly prevalent among older adults. This condition is linked to numerous adverse health outcomes, including cognitive impairment that impairs healthy ageing. While sarcopenia and cognitive impairment may share a common pathway, limited longitudinal studies exist to show the relationship between these two conditions. Therefore, this study aimed to examine the longitudinal association between sarcopenia and cognitive impairment. This is a cohort study among older adults residing in Kuala Pilah District, Negeri Sembilan, Malaysia. There were 2404 respondents at the baseline and 1946 respondents at one-year follow-up. Cognitive impairment was determined using Mini-mental State Examination scores. Sarcopenia was identified using the Asian Working Group for Sarcopenia 2019 criteria, gait speed was measured using a 4-meter gait test, handgrip strength was assessed using Jamar handheld dynamometer, and appendicular skeletal muscle mass was measured using bioelectrical impedance analysis. Generalized estimating equation (GEE) was used to determine the longitudinal association between sarcopenia and cognitive impairment, presented as relative risk (RR) and its 95% confidence interval. The prevalence of sarcopenia was 5.0% (95% CI 4.00–5.90), and severe sarcopenia was 3.60% (95% CI 2.84–4.31). Upon adjusting for covariates, older adults with sarcopenia have an 80 per cent increased risk of cognitive impairment compared to those without (RR 1.80; 95% CI 1.18–2.75). Similarly, severe sarcopenia was found to significantly increase the risk of cognitive impairment by 101 per cent in the adjusted model (RR 2.01; 95% CI 1.24–3.27). Our study showed that sarcopenia, severe sarcopenia, low physical activity, depressive symptoms, hearing impairment and chronic pain were associated with a higher risk of cognitive impairment among community-dwelling older adults. Therefore, early intervention to prevent sarcopenia, depressive symptoms, hearing impairment, chronic pain, and higher physical activity among older adults is recommended.

Coping Strategies of Women With Long-Term Spinal Cord Injury: The Role of Beliefs About the World, Self-Efficacy, and Disability

The present study aimed to investigate the indirect effect of appraisal of disability on the relationship between basic hope and coping strategies in women with long-term spinal cord injury (SCI), taking into account the moderating role of general self-efficacy. A cross-sectional study with 187 women with paraplegia was conducted. Main outcome measures, the Coping Orientations to Problems Experienced (COPE), the Basic Hope Inventory (BHI), Appraisals of Disability Primary and Secondary Scale (ADAPSS), and General Self-Efficacy Scale (GSES), were used. Our study showed that the strategies most commonly used by participants are seeking emotional support, religion, and acceptance. More than 45% of the respondents reveal average levels of basic hope, 58.82% reveal high levels of general self-efficacy, and most of them assessed their disability as determined resilience while noticing its negative aspects. The indirect effect of disability appraisal on the relationship between basic hope and coping strategies (denial, focus on emotions, seeking emotional support, religion, and acceptance) was confirmed. The moderating role of general self-efficacy in this analysis of mediating was also confirmed. General self-efficacy plays a significant role in explaining the relationship between basic hope and coping strategies mediated by appraisals of disability in women with long-term SCI.

Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why?

Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.

Growing Old in a Transnational Setting: Investigating Perceptions of Ageing and Changing Filial Ties Among Older Indians in Saskatoon

Numerous studies have examined the experience of growing old in a transnational context among Indians. However, in most of these studies, the older adults had immigrated as senior citizens to be with their adult children. Indians who have grown old in transnational settings have not been examined in detail in the gerontological scholarship. Adopting a cross-cultural lens, the present study focusses on perceptions of ageing among older Indians who have grown old in the city of Saskatoon. The study demonstrates how these older Indians refute the Successful Ageing model and accept their physical weaknesses in their course of ageing. Additionally, the study also examines how caregiving arrangements and intergenerational relationships are shaped among these older Indians and their adult children, in a transnational city, such as Saskatoon. Finally, the study highlights how later life gender roles are constructed in a transnational backdrop.

Global and domain-specific life satisfaction among older adults with long-term spinal cord injury

OBJECTIVE

Although life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions.

DESIGN

Cross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS).

SETTING

Community settings in southern Sweden.

PARTICIPANTS

Seventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

The Life Satisfaction Questionnaire (LiSat-11).

RESULTS

The participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains.

CONCLUSION

Life satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury.

Changes in health-related quality of life among older adults aging with long-term spinal cord injury

STUDY DESIGN

Cross-sectional and longitudinal.

OBJECTIVES

To (i) describe health-related quality of life (HRQoL) and changes over 6 years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in HRQoL are associated with age, gender, and injury characteristics.

SETTING

Community in southern Sweden.

METHODS

From the initial 123 participants (years 2011-2012) in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 77 individuals (32% women, C1-L3, AIS A-D, median age 66 years, median time since injury 31 years, 30% complete injuries) were assessed 6 years later. HRQoL was rated with the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23). Associations were investigated using multivariable linear regression analyses.

RESULTS

The median rating of global QoL (scale range 0-100) was relatively high at both assessments (67 and 83, respectively). There was a large variability in all HRQoL-domains and no significant changes over 6 years. As compared to an AIS D injury, a tetraplegia AIS A-C injury and tetraplegia and paraplegia AIS A-C injuries were associated with positive change in depressive symptoms and global QoL, respectively.

CONCLUSIONS

Older adults aging with long-term SCI show large variations in all HRQoL-domains and have the potential to maintain a high and stable level of HRQoL over time. Persons with AIS D injuries may need increased attention to mitigate negative changes in depressive symptoms and global QoL. Further studies are needed to identify modifiable factors associated with changes in HRQoL in older adults aging with long-term SCI.

Aging With Disability: Populations, Programs, and the New Paradigm An Introduction to the Special Issue

Objective: The purpose of this article is to introduce a special issue dedicated to research at the intersection of aging and disability. Method: We provide some context for the importance of cross-disciplinary collaboration among aging and disability researchers and summarize the nine articles in this issue. Results: Articles in the special issue are centered around several overarching themes. These include meaningful social and community participation, goals and values in the context of disability, and the reach and effectiveness of programs and policies on rehabilitation and service utilization. Conclusion: As care models continue to merge aging and disability services, collaboration among traditional aging and disability research networks can lead to improved outcomes for adults aging with long-term disability.

Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors

Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.

Profile of social self-management practices in daily life with Parkinson's disease is associated with symptom severity and health quality of life

Purpose: Social participation is a key determinant of healthy aging, yet little is known about how people with Parkinson's disease manage social living. This study describes individual differences in social self-management practices and their association with symptom severity and health quality of life.Methods: People with Parkinson's disease (N = 90) completed measures of healthy routines, activities and relationships, symptom severity, and health related quality of life. Cluster analysis identified profiles of social self-management practices. Analysis of variance tested differences between profiles in symptom severity and health quality of life.Results: Participants clustered into one of seven groups according to different combinations of three practices: health resources utilization, activities in home and community, and social support relationships. The healthiest cluster engaged equally in all three practices at above sample average degree of engagement. Four clusters that engaged at or above sample average in activities in home and community experienced less health problems than three clusters that engaged below average. Variation in aspects of social lifestyle unrelated to health appeared also to contribute to profile diversity.Conclusion: Findings provide insight into similarity and variation in how people with Parkinson's disease engage with social self-management resources and point to person-centered interventions.Implications for RehabilitationSocial self-management is a biopsychosocial construct to identify and describe self-care practices that engage one's social resources for managing healthful daily living.People with Parkinson's disease vary in their profiles of engaging in social self-management practices in daily living, and this variability relates to severity of symptoms and health quality of life.Learning how to identify health-centered social self-management practices may help people with Parkinson's disease to focus on the healthfulness of their own practices.Learning how to strategically engage one's social resources as part of self-care may help people with Parkinson's disease to master managing their health and well-being in daily life.

Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability

Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; M_AGE = 58.3 years, range = 46-68; M_{DISEASEDURATION} = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.

Perceived interpersonal and institutional discrimination among persons with disability in the U.S.: Do patterns differ by age?

RATIONALE

One-third of U.S. adults have an activity-limiting health condition and this proportion increases with age. However, it is unclear whether functional limitation renders one vulnerable to institutional and interpersonal discrimination, and whether this vulnerability differs over the life course. Stigma theories suggest disability would be more discrediting to younger persons relative to older adults, as it violates cultural norms and expectations regarding able-bodied working-age adults.

OBJECTIVE

We evaluate whether U.S. adults with functional impairment report higher levels of perceived interpersonal mistreatment and institutional discrimination relative to persons without impairment, and whether these patterns differ across age groups.

METHOD

We use data from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), collected between 2004 and 2006 (n = 3931). We estimate OLS and logistic regression models to predict interpersonal and institutional discrimination, respectively.

RESULTS

Persons with impairment report more frequent encounters of disrespectful treatment, insults, and being treated as if they have a character flaw, and elevated odds of workplace- and service-related discrimination, net of sociodemographic, and physical and mental health characteristics. Effects are significantly larger among early (age 40-49) and late (age 50-64) midlife versus older (age 65+) adults.

CONCLUSIONS

We discuss implications for policy and practice, and underscore that stigmatization processes may further amplify health and socioeconomic disparities between those with versus without functional limitations.

Assessing Perceived Success in Valued Living in Individuals With Long-Term Physical Health Conditions

Objective: To evaluate the reliability and validity of a brief measure of successful aging in a sample of adults with long-term health conditions. Method: The brief (eight-item) version of the valued living scale (VLS) and measures of pain intensity, pain interference, and depression were administered to 1,457 adults aging with one of four long-term health conditions. Results: Analyses indicated that the VLS items assessed two types of valued living domains: (a) a social and relational domain and (b) a health and productivity domain. The findings also supported the construct validity for the VLS items, in that both domains were associated significantly (and negatively) with the measures of pain intensity, pain interference, and depression. Discussion: The results provide preliminary support for the reliability and validity of the VLS items for assessing two important domains of successful aging in individuals with long-term health conditions.

Secondary health conditions and social role satisfaction in adults with long-term physical disability

OBJECTIVE

Individuals living with physical disability due to early acquired or traumatic conditions often experience a range of psychological and physical health problems that are associated with their condition but are not directly caused by it. Known as "secondary health conditions," these problems can interact with existing functional limitations and other medical comorbidities to limit social participation. The current study assessed the concurrent and longitudinal associations between secondary health conditions, chronic medical comorbidities, and functional limitations, with a PROMIS® measure of social role participation.

METHODS

A longitudinal survey study of community-dwelling adults with one of four chronic physical conditions (multiple sclerosis, muscular dystrophy, spinal cord injury, postpoliomyelitis syndrome). The baseline survey (T1) was mailed to 2041 individuals, and1862 baseline surveys were completed and returned (91% response rate). The follow-up survey (T2) was mailed roughly three years later; 1594 completed and returned the T2 survey (86% of T1 survey completers).

RESULTS

Multiple linear regression analyses revealed that secondary health conditions, functional impairments, and chronic medical comorbidities accounted for 52% of the variance in satisfaction with social roles concurrently at T1. The amount of variance of change in satisfaction with social roles over the ∼3-year period accounted for by these variables was 3%. Functional limitations and more psychologically oriented secondary conditions were the strongest predictors of satisfaction with social roles.

CONCLUSIONS

Findings suggest that, for people with disabilities, addressing psychologically oriented secondary health conditions may be as important as functional impairment in predicting long-term social health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The health and quality of life of Thalidomide survivors as they age - Evidence from a UK survey

Background

In the late 1950s and early 1960s the drug Thalidomide was marketed across the world as a non-addictive tranquilizer. Despite being given to pregnant women as a safe treatment for morning sickness, Thalidomide caused serious damage to the unborn child. Much has been written about the drug and the birth defects it caused but evidence about the health of Thalidomide survivors as they age is limited.

Aim

The aim of this study was to: explore the health and wellbeing UK Thalidomide survivors; document the health problems experienced by them as they reach their mid-50s; and examine the impacts on their health-related quality of life and employment.

Methods

A health and wellbeing survey of 351 UK Thalidomide survivors, which gathered information about home and employment circumstances, recent health problems, and health related quality of life (using SF12 Health Survey). Overall analysis focused on descriptive statistics; the association between respondents’ health related quality of life and original impairment was examined using Pearson Correlation; and a three step Hierarchical Regression was used to explore the influence of five factors which narrative responses suggested might be important.

Results

As Thalidomide survivors reach their mid-50’s they are experiencing a wide range of secondary health problems, in particular musculoskeletal problems, and depression and anxiety, with multimorbidity a growing issue. These health problems are having a negative impact on their employment (two fifths are unable to work) and their physical health related quality of life, which is significantly poorer than the general population.

Discussion

Having lived relatively independent lives, many Thalidomide survivors are now having to adjust to growing disability. The study provides further evidence of the accumulative impact of disability over peoples’ lifetimes and highlights the value of a life course perspective in understanding the complex experience of growing older with a disability.

Ageing, Disability, and Spinal Cord Injury: Some Issues of Analysis

Spinal cord injury is a disabling disorder, worldwide spread, with important consequences on functioning and health conditions and impacts on physical, psychological, and social well-being. The consequences are related to the lesion itself and to other complications related to the lesion. In the last decades, there have been an increasing of the mean ages of onset and also an increase in life expectancy after the lesion. So, differently from the past, people with spinal cord injury can age after the lesion. Taking into account the need to share data and information about specific disabling conditions and their relationship with ageing, this paper aims to discuss some issues from recent literature on the relationship between aging and disability in the spinal cord injury, according to a narrative review approach. A narrative review of the literature on ageing and spinal cord injury was undertaken. Search was based on the following electronic databases: PubMed/Medline and Ovid/PsychINFO. A combination of the following keywords was used: (1) “ageing” or “aging” and (2) “spinal cord injury” or “spinal cord lesion” and (3) disability. Data on consequences of the lesion in the life of aging people, secondary health conditions, life expectancy, participation, and quality of life are discussed. Then, a brief discussion of clinical issues and the role of interventions aimed to promote wellbeing, health, quality of life, and participation of people with spinal cord injury is proposed.

Health Service Utilization and State Costs Among Adults Aging With Early-Acquired Physical Disabilities in Medicaid Managed Care

Objective: We evaluated the impact of Medicaid managed care (MMC) on health service use and state costs among adults with early-acquired physical disabilities. Method: Using claims data, we tracked utilization of the emergency department (ED), inpatient admissions, outpatient physician visits, and state expenditures on enrollees who transitioned to MMC (n = 881). The inverse propensity score weight and a difference-in-differences regression model were used to estimate the impact of MMC using their counterparts who remained in fee-for-service (n = 1,552) as the comparison group. Results: MMC reduced ED use by 3.2% points/month (p < .001). Relative to younger enrollees (age ⩽45 years), MMC reduced inpatient admissions of older enrollees (age ⩾46 years) by 3.3% points/month (p < .001), and state expenditures by US$839/month (p < .01). Discussion: MMC could reduce the hospital service use of and state spending on enrollees with early-acquired physical disabilities. This impact may vary depending on the enrollees' age.

Successful Aging and Chronic Osteoarthritis

Background: Aging is commonly accepted as a time period of declining heath in most cases. This review aimed to examine the research base concerning the use of the term 'successful aging', a process and outcome deemed desirable, but challenging to attain. A second was to provide related information to demonstrate how health professionals as well as individuals can aim for a 'successful aging' process and outcome, despite the presence of disabling osteoarthritis. Methods: Information specifically focusing on 'successful aging' and the concept of improving opportunities for advancing 'successful aging' despite osteoarthritis was sought. Results: Among the many articles on 'successful aging', several authors highlight the need to include, a broader array of older adults into the conceptual framework. Moreover, conditions such as osteoarthritis should not necessarily preclude the individual from attaining a personally valued successful aging outcome. Conclusions: Pursuing more inclusive research and research designs, and not neglecting to include people with chronic osteoarthritis can potentially heighten the life quality of all aging individuals, while reducing pain and depression, among other adverse aging and disability correlates among those with osteoarthritis.

Growing older with post-polio syndrome: Social and quality-of-life implications

Objectives

To understand the quality-of-life implications for post-polio syndrome survivors.

Methods

For this qualitative study, a focus group methodology, with a case study design, was used. The data were analyzed for themes using a social ecological conceptual framework.

Results

Three focus groups were conducted with a total of 24 participants (N = 24). Participants defined quality of life as being able to engage in meaningful activities of daily living. Participants shared experiences of adapting to declining physical health and embracing new activities of daily living. They expressed hope and shared stories that demonstrated resiliency.

Conclusion

The literature states that individuals aging with post-polio syndrome express concern that health providers often know little about their disability condition. The participants in this study reflected this experience by sharing feelings of misunderstanding from the medical community and expressing a desire to have more dynamic education for health providers.

Preparing for a paradigm shift in aging populations: listen to the oldest old

PURPOSE

Current healthcare systems are not suitable for serving future societies in which the oldest old are commonplace. The objective of this study was to understand what the oldest old care most about in their daily lives.

METHODS

Semi-structured in-depth interviews and thematic analysis were used. Face-to-face interviews were conducted in 17 elderly residents (≥ 95 years) of Arakawa-ku, Tokyo, Japan from July to November 2017.

RESULTS

Three themes emerged from the interview responses: "unshakable beliefs and social ties," "natural acceptance," and "my day-to-day life with precious moments." The oldest old strongly believe in diligence and compassion and maintain strong relationships with people around them. Despite their small social networks, they are concerned about future society. They accept their selves and their lives, including their impending deaths. Despite their functional decline, they control their lives by making very small decisions. They live on a moment-to-moment basis, cherishing simple events.

CONCLUSION

Maintaining autonomy through making small decisions and enjoying small pleasures are important to the oldest old. Understanding the needs of the oldest old is the first step towards developing optimal geriatric care for an aging population.

Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support

Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS–related research.