Socio-Environmental Factors Associated with Healthy Aging after Spinal Cord Injury

The socio-environmental context in which individuals live is increasingly recognized for its vital importance in facilitating opportunities to lead healthy, active, independent and engaged lives. A growing body of evidence connects the social and physical environments to the processes implicit in disease and disablement, functional and cognitive decline, and general well-being. Despite the enormous health benefits that can be attained by regular physical activity, people with mobility impairment are far less likely to engage in physically active lifestyles than the general population. Barriers in the natural and built environments often limit opportunities to participate in various types of recreational, social, leisure and physical activities in both indoor and outdoor settings. Associated with the lack of opportunities to participate in physical activity is the risk for developing secondary conditions (e.g., shoulder pain, carpal tunnel) and age-related comorbidities (e.g., obesity, diabetes, cardiovascular disease).

This study is guided by a conceptual model of healthy aging after SCI based on the World Health Organization?s International Classification of Functioning, Disability and Health (ICF). The ICF draws attention to socio-environmental and personal factors that can interact with underlying impairments and injury factors to impede or enhance a person?s ability to engage in activities and participate fully in society. Understanding the interaction among these factors is critical to developing new interventions for those aging with SCI. As noted in the literature, a person can be highly responsive to their health by showing strong health behaviors and personal motivation, but not live in an accessible natural or built environment. Alternatively, an environment can be barrier-free, but the person may lack the motivation conducive to physical activity and good health. To achieve optimal healthy aging after SCI, both personal and environmental barriers must be taken into account. While healthy aging after SCI is gaining recognition as an important area of study, the role of socio-environment context has not been explored. The proposed study adds to the current literature on aging with SCI by focusing on this issue.

This study will contribute to the state of the art research on disability by assessing the role of socio-environmental factors for activity and participation in daily life and their impact on healthy aging after SCI. Contextual factors, injury and personal factors, pre-SCI health status and health behaviors will be examined. Three hypotheses or aims guide this study: 1) Health behaviors of persons aging with SCI (>45 years old) will be directly affected by the social and physical environment, along with personal and injury related factors (i.e., neurological classification, the presence of secondary conditions, and comorbidities associated with aging); 2) Activity and participation will be directly affected by these factors including the social and physical environments which in turn will impact health behaviors; 3) Healthy aging (defined here as the absence of secondary conditions and comorbidities) will be supported by enabling social and physical environments and their effects on health behaviors, activity and participation along with personal and injury related factors.