CODI: Cornucopia of Disability Information

Aging Bodies... Changing Needs

Aging Bodies... Changing Needs

	You may have thought about the equipment changes -- the power
chair, the solid back, the van with the lift, the roll-in
shower -- but figured they were for those other people, not for you.
Yet, you can't deny the increases in fatigue, in pain, in weight. And you
can't deny the increased problems doing those things that used to be
second nature. As we age, our bodies change, as do other things
including energy level, situations, abilities, needs and helpers. It
may be time for equipment changes ...

	Recent research in spinal cord injury and aging has been
turning out some good news/bad news information. The good news? We're
alive, relatively healthy and can count on a pretty normal life
expectancy. The not-so-good news? Spinal cord injury isn't as totally
static as we had thought. Parts wear out, energy decreases, pain and
needs go up. Does this mean that those young guys, the ones who can't
imagine turning grey, are off the hook? In a word, no. Only some of
this is due to aging.

	Just as much of this not-so-good news has to do with the number
of years postinjury as it does with getting old. Sometimes it's a
question of high mileage and little or no maintenance. Common sense
and planning -- together with some equipment and lifestyle changes
 -- can go a long way in preserving health, energy, strength and
independence, and in the process, quality of life. Often times,
changes in equipment are the changes which do the most in allowing us
keep the function we have and maintain the quality of life we desire.
How we regard these changes can be as important as the changes
themselves.

	Adaptive equipment can be viewed as those devices which narrow
the gap between aspiration and ability, between what we want to do and
what we are able to comfortably or safely do. Capitalizing on
equipment can help to avoid pain, preserve energy and prevent future
problems. Utilizing equipment can save large amounts of time and
energy spent on such mundane things as dressing, bathing, getting from
place to place, or transferring in and out of a vehicle. While the
thought of more equipment is often equated with loss of independence,
incorporating new equipment into daily routines can preserve time and
energy, helping to enhance as well as maintain both independence and
quality of life.


OLD TIMERS ...

	Jack is an independent guy. Twenty years ago he sustained a
C-7 complete injury, but it didn't slow him down. He's worked full
time for the last 12 years. Single, he employs no help around his home
and does all his own self-care. An avid outdoorsman, he spends most
weekends in his boat, fishing with his friends. After ten years of
driving minivans, doing the highreach transfers necessary to get in,
and then hauling his wheelchair in behind him, he recently bought a
full-size van with a lift.

	"The last two years were murder. I found myself going fewer
places because I didn't want to make the transfers --  they were too
hard, they were too painful, and I didn't have the energy. My
shoulders hurt too much to clean off the snow so I've started parking
the van in the garage and leaving the boat outside. The next thing I
buy is a bath bench. I'm not real comfortable getting in the bottom of
the tub any more. If I hadn't waited so long, maybe I wouldn't have so
much pain every time I put on a shirt, or comb my hair or reach above
my head for something."

	Andy has used a wheel chair for over four decades. He resisted
the change of going to a power chair for several years, trotting out
all the usual reasons: too big, too clumsy, too prone to breakdown,
too ugly. Besides, he reasoned, if he didn't push every day, his
muscles would soon waste away. And, of course, the biggest reason of
all -- "Electric wheelchairs are for crippled people, not for folks
like me."

	What he found, however, was something quite different. He
speaks not only of more rested muscles and easier and better
transfers, but of a growing, expanding world. "It has changed my
life." He reports venturing out to galleries alone without the worry
of fatigue or the dependence of a companion; hiking on trails to be
with nature and wildlife; meeting and getting to know neighbors while
on "electric strolls." More important are his reports of internal
feelings: "I know I am not a failure. I'm just sensible. It is a
transition I should have made years ago."

JOHNNY-COME-LATELIES ...

	Relatively speaking, Jake is a newcomer to the world of
disability. He sustained an incomplete C-5 injury six years ago, at
age 42. Throughout several years of school and part-time work he
continued to work out for an hour or two a day, pushing hard to
maximize his independence and take full advantage of his return of
function. Recently Jake began working full time ... and making some
other changes as well.

	"I don't have as much energy to spend on exercise now that I'm
working. I don't go to the gym as much, but it's worth it because I
like the job. I have to wear my corset all the time at work because my
posture is pretty bad. I'm now looking for a lighter chair in order to
save energy. I'll lower the kitchen counters to make cooking easier.
With my function, I know I could do the car transfers, but the van is
so much easier and quicker, so what's the point?"

	Mort, who got hurt when he was 53, is also a newcomer.
Following rehab for his C-5 injury seven years ago, he returned to
work part time. He presently lives alone, and is adapting to changing
needs and desires. He recently did extensive remodeiing in his
bathroom in order to minimize his transfers and shoulder pain. Being
an avid gardener with a large yard, he bought a used power chair to
deal with getting across the lawn. He just switched to an ultralight
manual chair for work and recently treated himself to a new
convertible.

	"My financial situation is good enough that I can pay people
to do things for me: housekeeping, cooking, errands, shopping. When I
was married, my wife did those things. The power chair lets me have
fun with my gardens and the bathroom mods save me energy and time. I
don't mind using a transfer board because the car lets me look cool,
which is important to me at my age. My next vehicle will be a van, but
I've got to have some fun right now."


PROFESSIONAL OBSERVATIONS, AND SUGGESTIONS

	Physical and occupational therapists find that they can make
general predictions concerning their clients' changing equipment and
environmental needs. These changing needs are usually in response to:

	* lower strength and function

	* increased pain

	* decreased mobility

	* weight gain or loss

	* less activity

	* skin sores

	* posture problems

	* aging of the primary care givers.

	Another thing they find to predict equipment changes is
fatigue and pain experience by either the individual with spinal cord
injury or the non-disabled spouse or care giver. Fatigue is a
significant predictor of several future problems, including
depression, lower quality of life and in some survivors, the need for
both more durable medical equipment and help from others. Fatigue can
show up in ways other than just being tired. Lack of interest,
irritability, crabbiness or giving up of enjoyable activities can
indicate fatigue, and can also cover up the fear and depression that
some find go along with aging bodies unable to do what they once did.
Using new and different equipment is a logical way to maintain the
constantly changing ability-energy balance.

	Changes in equipment can include ultralight or power chairs
and chair accessories, such as solid backs; transfer aids such as
slide boards or transfer machines; bath equipment in the form of
benches; and types of transportation, including car-top chair carriers
to eliminate putting the chair in the car, or vans with lifts, which
eliminate the need to transfer. Changing environmental needs of their
clients often lead therapists to focus on bathroom modifications such
as extra grab bars or roll-in showers; lowered shelves and clothes
poles in closets; and lowered counters in kitchens. Other
accessibility and safety enhancing changes could include more gentle
ramps, non-carpeted floors, door openers or speaker phones. The point
is to be in charge of the environment rather than a prisoner of it.

	Too often therapists encounter aging clients who are giving up
things they enjoy - fishing, traveling, even working - because of
pain, fatigue, and other health issues. Yet these same clients
continue to muscle their chairs into the car in order to drive, do
difficult transfers and reject equipment or adaptations designed to
enhance posture, protect skin or preserve range of motion, strength
and energy. Reasons given have to do with personal appearance,
perceived image and independence, or infringement on schedules. Yet,
their likely appearances, schedules and independence five, ten,
fifteen years from now are hardly pretty pictures.


Changes -- In Response and Anticipation

	Following years of over-achieving, Jack responded to pain and
range of motion limitations by switching to a van with a lift. He
reports less pain, more energy and increased freedom with the
elimination of those tough transfers. Safety is also on his mind when
he speaks of the bath bench. And there's more than a bit of regret
when he speaks of waiting so long to make changes. "If I had treated
my shoulders better when I was 20, they'd probabiy be treating me lots
better now that I'm 40."

	Andy struggled with self-image and independence before
switching to the power chair. He also worried about fitness and
possible muscle atrophy. "I had a terrible feeling that unless I
pushed my muscles to their limit each day, they would soon waste
away." What he found were pleasant surprises. Not only does he now
have more energy, he also finds himself more active and less
dependent.

	Both Andy and Jack have lived with paralysis for many years.
Not knowing much of the long term effects of their conditions, they
waited, perhaps too long, before responding. Jake and Mort, on the
other hand, are fairly recent injuries, and both have done extensive
homework in finding out what to expect. As a result, they've been able
to make more informed choices and decisions relative to equipment and
environmental changes. Each of these individuals refers to quality of
life ancl independence when spealsing of changes.

	Because Jack and Andy have blazed the trail for Jake and Mort,
the latter two know a little better what to expect and can strive to
maintain quality of life clespite their injuries. While neither's
responses have been "perfect" and both have made trade-offs, various
home modifications ancl equilJmelit changes save them not only time
and energy but also insure them satety and life enjoyment.


LOOKING AT THE DONUT AND NOT THE HOLE

	Quality of life may be the prime consideration for changing
equipment needs. Often it is simply a question of how we want to spend
our time and what is truly important to us. Just as often, new
equipment is a matter of preventative maintenance.

	Quality of life and how we want to spend our time can
certainly work at cross purposes to the independence-at-any-price
approach. Is it truly more important to transfer to the bottom of the
tub for a bath or shower, or is getting clean, which can be done using
far less energy, as well as more quickly and safely from a bath bench,
the real issue? Is it more important to expend energy doing car
transfers, or is the energy better spent on the job and driving a van
there? If wearing a corset provides the trunk stability necessary to
make sit skiing fun rather than work, where's the concession or giving
up?

	We can only ask shoulders and arms to do the work of hips and
legs for so long before the bills come due. The bills can come in the
form of blown shoulders, bad wrists, skin problems, chronic pain,
excessive fatigue, disgruntled helpers. Adaptive equipment can be a
way around the bills, a form of creative financing, if you will.

	Each of us ages, and as we do our bodies change. Few of us can
do at 40 or 50 what we did at 20. Similarly, the more years we spend
post-injury, the more our bodies change. How we use our bodies in part
determines how they change. An important part of aging is using
accumulated wisdom from past experience, ours and others', to avoid
mistakes and future emotional and physical pain. Focusing on quality
of life is truly what wisdom is about.

=================

Contributed by The Rehabilitation Research and Training Center on
Aging With Spinal Cord Injury is a joint project of Craig Hospital and
the Department of Rehabilitation Medicine at the University of
Colorado Health Sciences Center.

This article appears in, and is reproduced with permission
of Life, a publication of
The National Spinal Cord Injury Association
545 Concord Avenue, Suite 29
Cambridge, Massachusetts 02138-1122