Abstract
Study design
Cross-sectional and longitudinal.
Objectives
To (i) describe sense of coherence (SOC) and changes over six years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in SOC are associated with injury characteristics and changes in sociodemographics and secondary health conditions (SHCs; bowel-related and bladder-related problems, pain and spasticity).
Setting
Community in Southern Sweden.
Methods
From the initial 123 participants in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 76 individuals (33% women, median age 66 years, median time since injury 30 years, AIS A-D, 30% complete) responded to the 13-item SOC scale (range 13–91) twice with a 6-year interval. Data were analyzed with multivariable hierarchical regression.
Results
The participants rated a strong SOC at both assessments (median 73 and 76.5, respectively) which significantly increased over time. Overall, their marital status and vocational situation remained stable whereas SHCs increased. A change from not having a partner to having one was the only significant explanatory factor for a positive change in SOC.
Conclusions
The present study describes, for the first time, changes in SOC over time and associated factors in older adults aging with long-term SCI. They generally maintain a strong ability to understand, handle, and being motivated when dealing with stressful events arising in their lives as a result of their SCI. The associations emphasize the importance of the social context for successful adaptation to living with SCI along the aging process.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Data archiving
All data were archived according to the Swedish Act concerning the Ethical Review of Research Involving Humans and are available from the corresponding author upon reasonable request.
References
Savic G, Charlifue S. Aging with spinal cord injury. In: Chhabra HS, editor. ISCoS textbook on comprehensive management of spinal cord injuries. 1 edn. Haryana: Lippincott Williams & Wilkins; 2015. p. 906–17.
Nolvi M, Brogårdh C, Jacobsson L, Lexell J. Sense of coherence in persons with late effects of polio. NeuroRehabilitation 2018;42:103–11.
Eriksson M, Lindström B. Antonovsky’s sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health. 2006;60:376–81.
Antonovsky A. Unraveling the mystery of health: how people manage stress and stay well. San Fransisco, CA: Jossey-Bass; 1987.
Lustig DC. The adjustment process for individuals with spinal cord injury: the effect of perceived premorbid sense of coherence. Rehabil Couns Bull. 2005;48:146–56.
Nilsson KW, Leppert J, Simonsson B, Starrin B. Sense of coherence and psychological well-being: improvement with age. J Epidemiol Community Health. 2010;64:347–52.
Koelen M, Eriksson M, Cattan M. Older people, sense of coherence and community. In: Mittelmark MB, Sagy S, Eriksson M, Bauer GF, Pelikan JM, Lindström B, et al. editors. The Handbook of Salutogenesis. Cham: Springer; 2017. p. 137–49.
Eriksson M, Lindström B. Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Community Health. 2005;59:460–6.
Kennedy P, Lude P, Elfström ML, Smithson E. Sense of coherence and psychological outcomes in people with spinal cord injury: appraisals and behavioural responses. Br J Health Psychol. 2010;15:611–21.
Rosengren L, Brogårdh C, Jacobsson L, Lexell J. Life satisfaction and associated factors in persons with mild to moderate Parkinson’s disease. NeuroRehabilitation 2016;39:285–94.
Jacobsson LJ, Westerberg M, Malec JF, Lexell J. Sense of coherence and disability and the relationship with life satisfaction 6–15 years after traumatic brain injury in northern Sweden. Neuropsychol Rehabil. 2011;21:383–400.
Nolvi M, Brogårdh C, Jacobsson L, Lexell J. Sense of coherence and the association with sociodemographics and disability related factors in persons with late effects of polio. PM&R 2020;12:154–60.
van Leeuwen CM, Kraaijeveld S, Lindeman E, Post MW. Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review. Spinal Cord. 2012;50:174–87.
Jörgensen S, Martin Ginis KA, Iwarsson S, Lexell J. Depressive symptoms among older adults with long-term spinal cord injury: associations with secondary health conditions, sense of coherence, coping strategies and physical activity. J Rehabil Med. 2017;49:644–51.
Shakeri J, Yazdanshenas Ghazwin M, Rakizadeh E, Moshari A, Sharbatdaralaei H, Latifi S, et al. Do spinal cord-injured individuals with stronger sense of coherence use different psychological defense styles? Spinal Cord. 2016;54:843–8.
Jörgensen S, Iwarsson S, Norin L, Lexell J. The Swedish Aging With Spinal Cord Injury Study (SASCIS): methodology and initial results. PM&R. 2016;8:667–77.
Jörgensen S, Iwarsson S, Lexell J. Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury. PM&R 2017;9:356–66.
Jörgensen S, Hedgren L, Sundelin A, Lexell J. Global and domain-specific life satisfaction among older adults with long-term spinal cord injury. J Spinal Cord Med. 2019. https://doi.org/10.1080/10790268.2019.1610618.
Jörgensen S, Svedevall S, Magnusson L, Martin Ginis KA, Lexell J. Associations between leisure time physical activity and cardiovascular risk factors among older adults with long-term spinal cord injury. Spinal Cord. 2019;57:427–33.
Jörgensen S, Costa Andersson MV, Lexell J. Changes in health-related quality of life among older adults aging with long-term spinal cord injury. Spinal Cord. 2020. https://doi.org/10.1038/s41393-020-00579-0.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806–8.
Kirshblum SC, Burns SP, Biering-Sørensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.
Jensen MP, Smith DG, Ehde DM, Robinsin LR. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain. Pain 2001;91:317–22.
Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36:725–33.
Larsson G, Kallenberg KO. Sense of coherence, socioeconomic conditions and health: interrelationships in a nation-wide Swedish sample. Eur J Public Health. 1996;6:175–80.
Field A. Discovering statistics using IBM SPSS Statistics and sex and drugs and rock ‘n’ roll. 4th edn. London: SAGE Publications; 2014.
World Health Organization, International Spinal Cord Society. In: Bickenbach J, editor. International perspectives on spinal cord injury. Geneva: World Health Organization; 2013.
Krause JS, Newman JC, Clark JMR, Dunn M. The natural course of spinal cord injury: changes over 40 years among those with exceptional survival. Spinal Cord. 2017;55:502–8.
Geyh S, Nick E, Stirnimann D, Ehrat S, Muller R, Michel F. Biopsychosocial outcomes in individuals with and without spinal cord injury: a Swiss comparative study. Spinal Cord. 2012;50:614–22.
Kalpakjian CZ, McCullumsmith CB, Fann JR, Richards JS, Stoelb BL, Heinemann AW, et al. Post-traumatic growth following spinal cord injury. J Spinal Cord Med. 2014;37:218–25.
Super S, Wagemakers MA, Picavet HS, Verkooijen KT, Koelen MA. Strengthening sense of coherence: opportunities for theory building in health promotion. Health Promot Int. 2016;31:869–78.
Riedman E, Scott H, Clarke P, Meade M, Forchheimer M, Tate D. “Earth angels” and parking spots: qualitative perspectives on healthy aging with spinal cord injury. Disabil Rehabil. 2020. https://doi.org/10.1080/09638288.2020.1817987.
Acknowledgements
The authors are grateful to all participants in the SASCIS. The authors also wish to thank Lizette Norin, PhD, and Ulrica Lundström, PhD, for their involvement in the data collection in the initial and second assessment, respectively. This study was carried out within the framework of the longitudinal research project the Swedish Aging with Spinal Cord Injury Study (SASCIS), financed by research grants from Gun and Bertil Stohne’s Foundation, Lund University and Skåne University Hospital (ALF agreement), the Norrbacka-Eugenia Foundation, the Promobilia Foundation, the Research Fund of Neuro Sweden, Skåne University Hospital (SUS Stiftelser och donationer), Stiftelsen för bistånd åt rörelsehindrade i Skåne, the Strategic Research Area in Neuroscience (MultiPark) and the Swedish Association for Survivors of Accident and Injury (RTP). The initial assessment in the SASCIS was accomplished within the context of the Centre for Ageing and Supportive Environments (CASE), Lund University, financed by the Gustaf V and Queen Victoria’s Freemason Foundation, the Swedish Research Council and the Swedish Research Council for Health, Working Life and Welfare (Forte).
Author information
Authors and Affiliations
Contributions
The SASCIS was initiated and designed by SJ and JL. SJ managed and performed the data collection in the SASCIS and is responsible for the SASCIS database. SJ and JL designed the present study, SJ performed the data analyses and drafted the manuscript in collaboration with EL and JL. All authors critically revised the manuscript and all authors have read and approved the final version of the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
The SASCIS was approved by the Regional Ethical Review Board in Lund (No. 2010/692, initial assessment, and No. 2016/911, second assessment) and the study was conducted in accordance with the Declaration of Helsinki for research on humans. All participants received oral and written information about the study procedures, provided written informed consent to participate and were informed about their right to withdraw at any time without giving a reason. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jörgensen, S., Lennman, E. & Lexell, J. Sense of coherence and changes over six years among older adults aging with long-term spinal cord injury. Spinal Cord 59, 1278–1284 (2021). https://doi.org/10.1038/s41393-021-00713-6
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41393-021-00713-6
