Tuesday, August 3, 2010

The Effect of Age on Adjustment to Injury (Elise)

I have been thinking a lot this week about how age can affect one's adjustment to injury. On the spinal cord injury (SCI) service, I work with individuals of all ages who are dealing with a tremendous loss of function and independence. Lately, I've observed a difference in how patients react to the changes in their bodies and in their lives.

In general, I feel like many of my young patients seem to more visibly/verbally express their emotions/feelings about the changes in their body. One patient in particular said, "I've barely even had a life. I was just starting to get out on my own and be my own person. Then this happened." A common theme with younger adults is how "unfair" the injury and situation is. In contrast, my older patients have more rarely expressed anger or denial in regard to their change in status. They seem to be more quiet in dealing with their body changes... and more accepting. Maybe they think that there were going to be changes to their body with aging anyway? Maybe it helps that most of the older patients are married, have had children (currently living at home or grown), worked a job, and got to see some of the world? Maybe they have more psychological resources to overcome life challenges because they have experienced more?

I decided to look to the literature this week to see what affect age has on adjustment post-injury. The literature does not support my hypothesis. A study by Krause et al. that examined adjustment over the course of 30 years post-injury showed that spinal cord injuries which occurred later in life resulted in an individual being more likely to have lower subjective well-being, poorer health, and a less active lifestyle. Dorsett et al. indicated that the two most significant factors leading to depression after SCI are 1) self-rated adjustment; 2) medical complications (pressure sores). Older adults are at higher risk for developing post-injury complications due to the aging nature of their systems: ex) less resistance of skin, less reserve in cardiac system, etc). Varma et al. showed that because older adults have more pre-existing conditions (ie. cardiac disease, diabetes, joint deterioration), their adjustment was less post-injury compared to younger individuals. It makes sense... but I was still surprised!

Certainly a number of factors affect an individual's response to injury: social support, educational level, employment history, financial resources, pre-morbid health, and prior coping methods (to name a few). The nature of the injury is also an important consideration: Was it a traumatic or gradual/degenerative? Was it violence-related, sport-related, or employment related? Over my years in working with individuals with SCI, I've come to realize that personality and outlook on life are probably the most crucial traits to adjustment post injury. Someone who can face adversity, have the motivation and desire to overcome many obstacles, have the willpower to set high goals, and to find positive in most situations-- they are the ones most likely to thrive post-injury. So maybe age doesn't matter that much after all...

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