As more individuals with spinal cord injuries survive into the later decades of life, they are faced with a variety of potential secondary conditions that limit their physical independence and affect community integration. This article describes, body system by body system, the various health issues that people with spinal cord injuries are likely to encounter as they age. Changes also occur in one’s community participation and integration, which may result in changed perceived quality of life. Possible interventions to delay or minimize the effects of aging in this unique population are described, based on the emerging literature and on clinical experience.