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Objectives: To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI)., Design: Cross-sectional survey., Setting: General community, international., Participants: Volunteers (N=352) with SCI for more than 20 years., Interventions: Not applicable., Main Outcome Measure: The need for more help with ADLs., Results: The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI., Conclusions: People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.

The purpose of this study was to explore the use of narrative as a tool to understand the experience of chronic illness. The study is phenomenological in nature, using elements of grounded theory and social constructionism to consider the data collected. As examples of the issues raised using the narrative approach, the paper describes four themes that were pervasive in the first-person accounts of these individuals: 1. Emotional reaction to the diagnosis--Because of both the form and content in the narratives, these are described as 'peak experiences'; 2. Impact of stress--As a precipitator of symptoms or illness, as an ongoing aggravator of the chronic illness, or as a factor in overall coping with the chronic illness; 3. View of death--Named by all four individuals as it relates to their view of life; 4. Illness meaning--Coined by two of the individuals as 'philosophy of life.' These themes were interpreted in terms of their implications for therapeutic relationships with people with disabilities and chronic illnesses.