Bryan Kemp

Depression and life satisfaction among people ageing with post-polio and spinal cord injury

PURPOSE AND BACKGROUND Attention has recently begun to focus on the ageing of individuals with disability, not only as a long-term follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a psychological perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression. METHODS This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 non-disabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomatology and a 10-item life satisfaction scale with four-point ratings on each item used. RESULTS Life satisfaction varied by the group, with the non-disabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomatology. CONCLUSION The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.

Decreasing the burden in families caring for a relative with a dementing illness. A controlled study.

The purpose of this study was to investigate the efficacy of a specifically designed group support program for relatives of patients with Alzheimers disease and related disorders. The group program included educational/supportive activities and used basic principles of the cognitive‐behavioral approach. Twenty‐two subjects participated in an eight‐session program. Eighteen control subjects received no treatment. Measures of family burden, levels of depression, and knowledge of dementia were obtained. Experimental subjects showed a significant decrease in total family burden, whereas control subjects actually showed a significant increase, experimental subjects also showed reduction in their levels of depression. Experimental subjects showed a significantly greater improvement than did control subjects on knowledge of dementia. The acquisition of new knowledge was an important ingredient in reducing perception of burden and levels of depression, but other facets of the intervention also accounted for the improvement. Results indicated that a relatively short but intensive support experience can have a positive effect in reducing some of the burden and depression associated with the care of a demented relative.

Ethnic and Gender Differences in Distress Among Anglo American, African American, Japanese American, and Mexican American Spousal Caregivers of Persons with Dementia

Distress, coping, and social resources were compared in a sample of 202 Japanese-, Anglo-, African-, and Mexican American spousal caregivers of persons with dementia using a Stress-Coping model. Both ethnicity and gender showed differential effects on the outcome and on the moderating variables. Female caregivers in all ethnic groups reported significantly higher levels of psychiatric symptomatology. All 4 ethnic groups reported high rates of psychological distress, with Mexican Americans reporting significantly higher rates of depression than Anglo or African Americans. Ethnicity was related to (1) the kind of caregiving appraisals (spiritual, pessimistic, and lack of support), (2) coping styles (escape-avoidance and seeking social support), and (3) social support. African Americans were more likely to be spiritual appraisers, to have more positive appraisals, and to have more social support available to them. Gender differences were evident on 4 out of the 6 caregiver appraisals, but none of the coping styles. Although males tended to have more perfectionistic appraisals, they were also more likely to view caregiving with a less negative and more self-efficacious outlook.

Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort.

Objective: The potential effects of ethnicity, gender, and adiposity on the serum lipid profile in persons with spinal cord injury (SCI) were determined. Subjects: Subjects with SCI were recruited during their annual physical examination from Rancho Los Amigos Medical Center, Downey, California. Sedentary able-bodied controls were Bridge and Tunnel Officers of the Triboro Bridge and Tunnel Authority of the New York City metropolitan area. Methods: Serum lipid profiles were investigated in 320 subjects with SCI and compared to those obtained from 303 relatively sedentary able-bodied controls. Serum lipid studies were obtained in the fasting state. Data were collected between 1993 and 1996. All lipid determinations were performed by the same commercial laboratory. Main outcome measures: The dependent variables were the values from the lipid profile analysis. The independent variables consisted of study group, gender, ethnic group, age, duration of injury, and anthropometric measurements. Results: The serum high-density lipoprotein cholesterol (HDL-c) level was reduced in the SCI compared with the control group (mean±SEM) (42±0.79 vs 47±0.67 mg/dl, P<0.0005). The serum HDL-c level was significantly lower in males with SCI than males in the control group (39±0.83 vs 45±0.70 mg/dl, P<0.0001), but not for females (51±1.54 vs 54±1.52 mg/dl, n.s.). Within the subgroups for whites and Latinos, HDL-c values were also lower in subjects with SCI than in controls (whites: 41±1.02 vs 46±0.86 mg/dl, P<0.0001; Latinos: 37±1.53 vs 42±1.59 mg/dl, P<0.05), but not for African Americans (49±1.56 vs 51±1.27 mg/dl, n.s.). African Americans had higher HDL-c values than whites or Latinos (SCI: 49±1.56 vs 41±1.02 or 37±1.53 mg/dl, P<0.0001; controls: 51±1.27 vs 46±0.86 mg/dl, P<0.01 or 42±1.59 mg/dl, P<0.0005). In persons with SCI, the serum HDL-c values were inversely related to body mass index and estimated per cent body fat (r=0.27, P<0.0001). Conclusion: In white and Latino males, but not in females or African Americans, immobilization from SCI appears to be associated with lower HDL-c values than in controls.

The effect of residual neurological deficit on serum lipoproteins in individuals with chronic spinal cord injury

Subjects with spinal cord injury (SCI) have been shown to have an adverse lipid profile. Prior studies performed with smaller numbers of subjects have not been able to demonstrate any relationship between the level and degree of the neurological deficit and plasma lipid levels. Over a 2 year period we investigated the lipid profiles in 541 subjects from Rancho Los Amigos Medical Center, Downey, California. Subjects were grouped by tetraplegia (Tetra; n=247) or paraplegia (Para; n=294) and by subgroup for degree of neurological deficit: complete Tetra (n=156), incomplete Tetra (n=91), complete Para (n=206) and incomplete Para (n=88). The serum high-density lipoprotein (HDL) cholesterol level was lower in the Tetra than in the Para group (38±0.7 vs 45±0.8, P<0.01). The group with Tetra had a higher percentage of subjects with serum HDL cholesterol values <35 mg/dL [an independent risk factor for coronary heart disase (CHD)] than those with Para (38% vs 21%, P<0.0001). A significant inverse relationship was found for degree of neurological deficit and mean serum HDL cholesterol level (r=0.19, P<0.001), with the greater the deficit, the lower the serum HDL cholesterol level. Serum total cholesterol levels were higher in the Para group than in the Tetra group (198±2.6 vs 184±2.6, P<0.01). However, the ratio of total cholesterol to HDL cholesterol (a discriminator of risk for CHD) was significantly lower in the Para group than the Tetra group (4.8 vs 5.2%, P<0.01). Thus, in persons with SCI a spectrum of depressed serum HDL cholesterol levels and increased cardiovascular risk occur, with the most adverse lipid changes correlating with the severity of neurological deficit.

The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia.

Abstract Background/Objective: For persons with spinal cord injury (SCI), severe bodily pain is related to a lower quality of life. However, the effect of pain from a specific body region on quality of life has yet to be determined. The shoulder joint is a common site of pain among persons with SCI. Therefore, our purpose was to identify the relationship of self-reported shoulder pain with quality of life, physical activity, and community activities in persons with paraplegia resulting from SCI. Methods: Eighty participants with shoulder pain who propel a manual wheelchair (mean age: 44.7 years; mean duration of injury: 20 years; injury level T1-L2) completed the following questionnaires: Wheelchair Users Shoulder Pain Index, Subjective Quality of Life Scale, Physical Activity Scale for Individuals with Physical Disabilities, and Community Activities Checklist. Correlations between shoulder pain scores and quality of life, physical activity, and community activities were determined using Spearmans rho test. Results: Shoulder pain intensity was inversely related to subjective quality of life (rs=-0.35; P=0.002) and physical activity (rs =-0.42; P < 0.001). Shoulder pain intensity was not related to involvement in community activities (rs = -0.07; P= 0.526). Conclusions: Persons with SCI who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. However, shoulder pain intensity did not relate to involvement in general community activities. Attention to and interventions for shoulder pain in persons with SCI may improve their overall quality of life and physical activity.

Metabolic and Endocrine Changes in Persons Aging with Spinal Cord Injury

Persons with spinal cord injury (SCI) have secondary medical disabilities that impair their ability to function. With paralysis, dramatic deleterious changes in body composition occur acutely with further adverse changes ensuing with increasing duration of injury. Lean mass, composed of skeletal muscle and bone, is lost and adiposity is relatively increased. The body composition changes may be further exacerbated by associated reductions in anabolic hormones, testosterone, and growth hormone. Individuals with SCI also have decreased levels of activity. These body composition and activity changes are associated with insulin resistance, disorders in carbohydrate and lipid metabolism, and may be associated with premature cardiovascular disease. Although limited information is available, upper body exercise and cycle ergometry of the lower extremities by functional electrical stimulation (FES) have been reported to have a salutary effect on these body composition and metabolic sequelae of paralysis. Perhaps other innovative, externally mediated forms of active exercise of the paralyzed extremities will result in an increased functional capacity, metabolic improvement, and reduction of atherosclerotic vascular disease.

Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial

Background Shoulder pain is a common problem after spinal cord injury (SCI), with negative effects on daily activities and quality of life (QOL). Objective The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI. Methods/Design Eighty individuals with paraplegia from SCI and shoulder pain were randomly assigned to receive either an exercise/movement optimization intervention or an attention control intervention. The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises, along with recommendations on how to optimize the movement technique of transfers, raises, and wheelchair propulsion. The attention control group viewed a 1-hour educational video. Outcome measures of shoulder pain, muscle strength (force-generating capacity), activity, and QOL were assessed at baseline, immediately after intervention, and 4 weeks later. Results Shoulder pain, as measured with the Wheelchair Users Shoulder Pain Index, decreased to one third of baseline levels after the intervention in the exercise/movement optimization group, but remained unchanged in the attention control group. Shoulder torques, most 36-Item Short-Form Health Survey questionnaire (SF-36) subscale scores, and QOL scores also were improved in the exercise/movement optimization group, but not in the attention control group. Improvements were maintained at the 4-week follow-up assessment. Limitations Many of the outcome measures were self-reported, and the participant dropout rate was high in both groups. Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia. Conclusions This home-based intervention was effective in reducing long-standing shoulder pain in people with SCI. The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL.

Epidemiology of depression and dysphoria in an elderly Hispanic population. Prevalence and correlates.

Depression among older minority groups, including Hispanics, has not been well studied. Little is known of the true rates of depression, its correlates or how well it is treated. This research is part of a series examining health status of older Hispanics using the Comprehensive Assessment and Referral Evaluation (CARE). Seven hundred older Hispanics living in Los Angeles County were studied using an area‐probability sampling method. The CARE items were regrouped to reflect Diagnostic and Statistical Manual III criteria for depression and dysphoria. More than 26% were found to have a major depression or dysphoria. These affective disorders were strongly correlated with physical health status. Without physical health complications, the rate was 5.5%. A number of socioeconomic, health behavior, and family variables were related to affective state. Treatment for affective disorder appeared to be very poor for this population. J Am Geriatr Soc 35:920–926, 1987

Depression and life satisfaction in aging polio survivors versus age-matched controls: Relation to postpolio syndrome, family functioning, and attitude toward disability

OBJECTIVE To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables. DESIGN A planned medical, functional, and psychosocial study with multivariate analyses. SETTING A large, urban rehabilitation center. PARTICIPANTS A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds. MAIN OUTCOMES Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale. RESULTS The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community. CONCLUSIONS Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.