Showing papers on "Physical disability published in 1997"

Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk

Abstract: OBJECTIVES: This article synthesizes and assesses current evidence about the importance of physical disability to older adults It then considers the applications of research findings to clinical geriatrics practice RESULTS: Physical disability is a major adverse health outcome associated with aging Certain subgroups of older adults, including individuals with mobility difficulty, with preclinical functional changes, and persons who are hospitalized, are at particularly high risk of becoming disabled or experiencing disability progression The major underlying causes of physical disability are chronic diseases, including both acute events, such as hip fracture and stroke and slowly progressive diseases such as arthritis and heart disease These diseases appear to have task-specific effects; understanding this may assist in setting treatment and prevention goals Comorbidity, particularly certain combinations of chronic diseases, is a strong risk factor for disability in itself Recent trials indicate that clinical interventions may be able to prevent onset or progression of disability CONCLUSIONS: Available evidence now suggests clinical approaches to both treatment and prevention of disability and directions for defining optimal clinical care for the future

Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis

Abstract: Objectives: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke9s expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys9 (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex. Design: Cross sectional study. Setting: Clinical department of neurology, Edinburgh. Subjects: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. Main outcome measures: Scores on the SF-36; EuroQol; Kurtzke9s expanded disability status scale; the OPCS disability scale. Results: Patients and clinicians disagreed on which domains of health status were most important (χ 2 =21, df=7, P=0.003). Patients9 assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians9 assessment ( r =-0.87, P r =-0.90, P Conclusions: Patients with multiple sclerosis, and possibly those with other chronic diseases, are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment. Key messages Patients can accurately assess their own physical disability Physical disability may not always be the main determinant of overall health related quality of life Patients and clinicians differ in their assessments of the relative importance of different elements of health related quality of life The opinions of patients should be taken into account in the selection of outcome measures for clinical trials

The impact of psychiatric disorders on labor market outcomes

Abstract: Analyzing data on 2,225 men and 2,401 women from the National Comorbidity Survey, the authors examine the impact of psychiatric disorders on employment and, among those employed, work hours and income. They find that psychiatric disorders significantly reduced employment among both men and women. They also find evidence of small reductions in the conditional work hours of men and a substantial drop in the conditional income of men and women, although these findings are somewhat sensitive to the estimation methods and specification of the model. This study examines the impact of psychiatric disorders (both mental and substance use disorders) on employment rates, work hours, and personal income. Although physical disability is known to be an important determinant of labor market outcomes, less is known about the influence of mental and substance use disorders. Diagnosable psychiatric disorders are highly prevalent, affecting about 30% of the non-institutionalized U.S. population in any given year and almost 50% over the lifespan (Kessler et al. 1994). Many of these illnesses are chronic and cause severe impairment. Psychiatric disorders have been

Health trajectories : Long-term dynamics among Black and White adults

Abstract: Disability has long been identified as a predictor of self-assessed health, but some studies suggest the opposite causal direction. The aim of this study is to examine the dynamic relationships between physical disability and assessments of health among Black and White adults while simultaneously considering changing morbidity. Research questions include: Do more negative health assessments lead to greater morbidity and physical disability? Do negative health assessments lead to a cycle of health decline over time? These questions were addressed for Black and White respondents over 15 years using data from three waves of the National Health and Nutrition Examination Survey I: Epidemiologic Follow-Up Study. Results from structural equation modeling reveal that self-assessed health predicts subsequent change in health, suggesting a cycle between health problems and negative health assessments for both White and Black adults. In addition, self-assessed health among African Americans declined at a faster rate than was the case for White adults.

Psychosocial factors in fibromyalgia compared with rheumatoid arthritis : ii. sexual, physical, and emotional abuse and neglect

Abstract: Two recent reports have found associations between fibromyalgia and sexual victimization but had methodologic characteristics that limited their interpretation. The authors compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual physical and emotional victimization histories as well as dimensional self-report measures of victimization severity. Compared with the patients with rheumatoid arthritis those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization both adult and adulthood as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia particular forms of maltreatment (e.g. sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood however showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability psychiatric distress illness adjustment personality and quality of sleep in-patients with fibromyalgia but not in those with rheumatoid arthritis. Fibromyalgia seems to be associated with increased risk of victimization particularly adult physical abuse. Sexual physical and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients. (authors)

A Prediction Model for Functional Recovery in Stroke

Abstract: Background and Purpose Stroke-related physical disability can diminish quality of daily living, place care burden on families, and increase need for long-term institutionalization. We developed a prognostic index for use in research and with potential for adaptation to clinical practice that establishes the likelihood of an individual achieving a specific stage of functional recovery after stroke rehabilitation. Methods We constructed the index using logistic regression based on 3760 patient records from 96 rehabilitation facilities in 31 states. The stage, as measured by the Functional Independence Measure, includes achievement of the following: independence in eating, grooming, and dressing the upper body; continence in bowel and bladder; and transfer between a bed and chair with supervision only. Results This stage was achieved by 26.1% of patients functioning below it at rehabilitation admission. Disability onset of less than 60 days was associated with more than a 3-fold increase in the likelihood of...

Quality of life in elderly subjects with pain in the hip or knee.

Abstract: This study examines the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic pain in the hip or knee and of a reference group without pain (total n = 306) Firstly, it was hypothesized that the experienced QOL is lower in people with more chronic pain Secondly, the potential mediating and moderating roles of disability and of coping with problems in general on the relationship between pain chronicity and QOL were assessed A Visual Analogue Scale was used to assess global QOL Physical as well as psychosocial disability was assessed with the Sickness Impact Profile (SIP) Coping with problems in general was assessed with the Utrecht Coping List As expected, a significantly lower QOL was found in people with more chronic pain (p = 0045) The difference in QOL between the group with chronic pain and a reference group without pain was 10% A multivariate regression model showed that physical and especially psychosocial disability are mediators in the relationship between pain chronicity and QOL and that 'seeking social support' as a coping style is a more important predictor of the experienced QOL than either pain chronicity or physical disability No moderating role of the style of coping with problems was found

Assessing Physical Performance in Independent Older Adults: Issues and Guidelines

Abstract: With the projected growth in the older adult population, preventing or delaying physical disability in later years has become a national goal. Evidence suggests that physiological decline, especially that associated with physical inactivity, is modifiable through proper assessment and activity intervention. However, a major limitation in reducing loss of function in later years is the lack of suitable assessment tools. Especially lacking are tests that can measure physical performance on a continuum across the wide range of functioning in the independent, community-residing older adult population. Of special concern is the ability to assess underlying physical parameters associated with common activities of daily living. Additional tools are needed for measuring physical performance in older adults, especially tools that meet established guidelines in terms of reliability, validity, discrimination power, and performance evaluation standards.

Long-term effects of Ménière's disease on hearing and quality of life.

Abstract: Objective: To evaluate long-term hearing results and quality of life in patients with Meniere's disease. Study Design: Detailed audiometric evaluation and disease-specific as well as global health quality evaluation of patients with Meniere's disease. Setting: Ambulatory evaluation was conducted in a large multispecialty clinic. Patients: Meniere's disease in only one ear, were at least I year posttreatment, were <65 years of age, had no neurologic or psychologic disorders, and lived within driving distance of the ambulatory clinic. Main Outcome Measures: Audiometry, the Hearing Handicap Inventory, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and SF-36 Health Survey. Results: No statistically significant differences in long-term hearing results were detected from natural history in medically or surgically treated patients with Meniere's disease. A significant disease-specific symptom handicap was detected. The global health handicap was greater for emotional disability than for physical disability. Conclusions: Medical and surgical treatment does not significantly influence hearing results in Meniere's disease. Patients with Meniere's disease have a greater emotional disability than a physical disability.

Modifying attitudes of prospective educators toward students with disabilities and their integration into regular classrooms

Abstract: Prospective educators who completed an introductory special education course were participants in a study investigating whether attitudes toward students with disabilities and toward their integration into regular classrooms would be influenced by viewing videotapes that presented positive portrayals of persons with disabilities in regular settings and by the disability characteristics of the professor who taught the course. Results showed that those who viewed the videotapes expressed more favorable attitudes toward students with disabilities only when the course was taught by the professor with a visible physical disability. Attitudes toward the integration of students with disabilities into regular classrooms were not influenced by viewing the videotapes nor by the disability characteristics of the professor who taught the course. These results are discussed with reference to Yuker's (1988) comprehensive review of the research on the effects of personal contact on attitudes toward persons with...

Cost of community care for older people

Abstract: BACKGROUND There has been no published study that considers actual costs in a representative sample of people aged > or = 65 years. The present study describes the financial costs of formal community services for elderly people with dementia, depression, anxiety disorder or physical disability. METHOD Psychiatric morbidity, physical disability and services received were assessed by standardised questionnaire in randomly selected Islington enumeration districts. Subjects were interviewed at home (n = 700). RESULTS Dementia was the most expensive disorder per sufferer in terms of formal services. Those with depression were also high users of health services. Despite presenting to health services, 90% were not treated with appropriate drugs. In contrast, social services were received by people who were activity-limited or with dementia. The highest service cost for the population as a whole was for the physically disabled. In multivariate analysis the significant predictors of high service costs were living alone, being physically ill, depression, dementia and increasing age. CONCLUSIONS Failure to detect and treat depression and the anxiety disorders in older people, despite their presentation to medical services, may have major economic consequences as well as contributing to individual suffering.

Clinical correlates of sleep benefit in Parkinson's disease

Abstract: The phenomenon of sleep benefit, a period of lessened disability or feeling "on" upon awakening from sleep in the morning, has received scant attention in the literature on Parkinson's disease. We interviewed 162 consecutive patients regarding disease onset, medication history, and symptoms, evaluated them using the Unified Parkinson's Disease Rating Scale, and assessed them as to the presence or absence of sleep benefit. Thirty-three percent reported experiencing sleep benefit. Compared with patients not having sleep benefit, patients with sleep benefit tended to be younger at disease onset, have longer disease duration, take higher total daily doses of levodopa, have longer duration of levodopa treatment, and exhibit less cognitive and physical disability. The findings of this study suggest that sleep benefit is a common phenomenon that may be anticipated in a subgroup of patients with Parkinson's disease. The mechanisms underlying sleep benefit do not appear to be simple and may be multifactorial. Clinicians need to be aware of the authenticity of patients' reports of sleep benefit and consider the existence of this phenomenon when prescribing or adjusting patients' medication schedules.

The STEPS Project: participatory action research to reduce falls in public places among seniors and persons with disabilities.

Abstract: Through a process of participatory action research involving a telephone hotline, the STEPS project compiled data over a nine month period on the location and nature of 791 pedestrian slips, trips, falls and potential hazards in the Capital Regional District of British Columbia. Of the 533 people who reported a slip, trip or fall, the majority (80%) were female, and the average age was 65.27 years. Thirty-five percent (n=186) had some type of physical disability and many (n=106) reported using a mobility aide at the time of their accident. Most callers (75%) said they had suffered an injury, and of these 55% required medical attention. The most frequently reported fall locations were sidewalks and crosswalks. Major recommendations from the study include the need for municipal priority-setting for repairs with input from key user groups, including the elderly and people with disabilities.

Relationship between use of technology and employment rates for people with physical disabilities in Australia: Implications for education and training programmes

Abstract: This study examined the impact of computer and assistive device use on the employment status and vocational modes of people with physical disabilities in Australia. A survey was distributed to people over 15 years in age with physical disabilities living in the Brisbane area. Responses were received from 82 people, including those with spinal cord injuries, cerebral palsy and muscular dystrophy. Of respondents 46 were employed, 22 were unemployed, and 12 were either students or undertaking voluntary work. Three-quarters of respondents used a computer in their occupations, while 15 used assistive devices. Using logistic regression analysis it was found that gender, education, level of computer skill and computer training were significant predictors of employment outcomes. Neither the age of respondent nor use of assistive software were significant predictors. From information obtained in this study guidelines for a training programme designed to maximize the employability of people with physical disabilities were developed.

Psychological aspects of hemiplegia

Abstract: Do paediatricians think of childhood hemiplegia simply as a mild physical disability? Rightly or wrongly, parents often get that impression. This is unfortunate as children and families are easier to help when they know that their difficulties are not being underestimated. The disability does not seem mild to hemiplegic children who are always last on sports day, or self conscious about their body, or unable to carry out all manner of mundane two handed activities. Furthermore, hemiplegia is often more than a physical problem, being accompanied by a variety of ‘invisible’ psychological disabilities. Particularly in the school years, many parents and children are more concerned about the educational, behavioural, emotional, and social accompaniments of hemiplegia than about the physical disability itself. Some of these psychological accompaniments are understandable responses to disability; others are direct consequences of the brain damage itself; and many reflect the complex interplay of these reactive and organic pathways. Though approximately two thirds of children with hemiplegia are of normal intelligence, the mean IQ of the group is shifted downwards, most markedly for those with the greatest neurological involvement.1 2 Hemiplegias acquired between 1 and 60 months of age may be particularly liable to reduce overall intelligence, perhaps because this is a peak period for synaptic creation and remodelling.2 Many IQ tests distinguish between verbal IQ, based on tests of verbal …

Comorbidity with depression in older people: the Islington Study

Abstract: The coexistence of depression with other psychiatric disorders, which has been extensively studied in younger adults, has hardly been reported in older people. This study focuses primarily on comorbidity and other associations of depression in a community sample of older adults. A random sample of 700 older people in the inner London borough of Islington, and any other adults living with them, were interviewed at home using standardized instruments. Older people who were depressed were likely to have other comorbid physical and psychiatric pathology, namely general anxiety, phobic anxiety, physical disability, somatic symptoms, sleep disturbance and subjective memory impairment. The overwhelming majority of older people with depression were not receiving pharmacological treatment. Such lack of treatment may be because patients with physical or psychiatric comorbidity have presenting symptoms that obscure the diagnosis of depression. We conclude that while the majority of elderly people are psychiatrically...

Children's Attitudes toward Physical Disability in Nepal A Field Study

Abstract: Nepalese children's attitudes toward peers with visible physical disabilities were studied, using a picture-ranking interview, and compared to a Western standard. Nepalese children expressed a positive preference toward peers with obesity that departed from all prior Western findings. Children's attitudes and comments implied that body size was associated with wealth, power, and food availability. Males were more avoidant of physical disabilities that interfere with functional activities, whereas females expressed a lower preference for cosmetic disabilities (in this instance, a facial cleft). Disabilities that are physically threatening to daily functioning are reported as less common and are avoided, reflecting feelings of unfamiliarity and potential survival threat.

Shoulder, elbow and wrist movement impairment--predictors of disability in female patients with rheumatoid arthritis.

Abstract: To explore and describe how shoulder, elbow and wrist movement impairment and age, disease duration, disease activity and shoulder-upper arm pain are associated with disability in rheumatoid arthritis, these variables were investigated in 63 females. Multiple linear regression analysis indicated that limitations in functional shoulder-arm movement and in active wrist motion ranges explained 30-35% of the variation among the patients' results within each of the physical disability instruments used. The Ritchie index for the upper-extremity might be a predictor of disability, explaining 6-28% of the variation within different disability questionnaires, while shoulder tendalgia explained 24% of the variation in shoulder-arm disability. Altogether, however, our predicting variables only explained 11-30% of the variation in shoulder-arm disability and 25-50% of the variation in the other disability areas studied. Thus, other factors not studied here, e.g. muscle strength and hand grip function, and e.g. psychological and social factors are probably also of importance and remain to be elucidated.

Evaluating patient motivation in physical disabilities practice settings.

Abstract: OBJECTIVES Motivation is an important factor in and predictor of a person's recovery from illness, yet no information exists about how occupational therapists actually evaluate patient motivation in clinical practice. This article describes a pilot study of how occupational therapists in physical disabilities settings evaluate patient motivation. METHOD A sample of 150 fieldwork coordinators in physical disabilities treatment centers were surveyed about whether they evaluate patient motivation and about the methods they used to evaluate patient motivation. RESULTS Most respondents reported that they evaluate motivation informally and throughout treatment. Respondents evaluate motivation mostly via general discussion, observation of patient conduct and actions, and information from others. Less than one third discussed interests and goals with patients to evaluate motivation. Despite questionable methods of evaluation of motivation, a majority of respondents reported that their evaluation influences their treatment approaches and improves treatment outcomes. CONCLUSION Instruction about the definition and evaluation of motivation may increase the frequency of motivation evaluation in occupational therapy.

When People with Pre-existing Disabilities Age in Place:Implications for Social Work Practice

Abstract: We focus on a population of people with disabilities who are "aging in place," that is, individuals aging with pre-existing physical disabilities. We distinguish between those who experience prolonged aging and others who experience accelerated aging A brief overview of people aging with disabilities and selected background information on the increasing linkages between the aging and disability communities is provided. Four case examples illustrate the practice implications faced by social workers in partnering with people with pre-existing disabilities and in being sensitive to their desires concerning aging in place. Key words aging disability elderly people impairment self-determination Aging in place" is a concept with multiple meanings. It implies the aging of people within familiar environments and the accompanying changes that occur as they become older. It implies the physical aging of the home, the neighborhood, and the larger community, all of which are nested within one another. Thus, aging in place becomes the "fit" of the person within the residential setting as well as the accompanying goals and policies that guide the constellation of services developed to maintain that fit (Pynoos, 1990). Aging in place is a respected term in the gerontology literature because it is based on numerous assumptions about client self-determination, least restrictive environment, the value of home, and the quality of life. Referring to home, Tilson and Fahey (1990) stated, "It is a place of identity. It is a manifestation of one's power to choose, to exercise autonomy. This is as true for the very old as it is for the young, as true for the frail and disabled as it is for the well and independent" (p. xv). Theoretically, it may be somewhat comforting to talk about aging in place and its importance to most people. Practically, however, it is a difficult concept to understand because people are so diverse (Bass, Kutza, & Torres-Gil, 1990). In this article, we focus on a population of disabled people who are aging in place, that is, people who are aging with pre-existing physical disabilities, whom we categorize into two groups: One group will reach the threshold of chronological old age having already experienced a prolonged period of accommodation because of the pre-existing disabilities they have had for years. The manner in which they approach their disabilities may reflect different philosophies between the disability community and the aging community--before joining the community of older people, they were part of the community of people with disabilities. The second group comprises adults with pre-existing disabilities who are aging in place in what might be called an accelerated aging process. Physically, they are experiencing what others may not experience until reaching the point where they are viewed as "old-old" or "frail." This group may not reach a chronological age of 85 or 90 years, but they will undergo that process, although at a younger age. What both groups have in common is that they acquired their disabilities as children, adolescents, or adults, not prenatally and not as older people. Recognizing prolonged and accelerated aging as critical to understanding people with disabilities is the focus of this article. LINKING DISABILITIES AND AGING: REVIEW OF THE LITERATURE Attention in discussing disabilities and aging has focused heavily on people with developmental disabilities and their families, or on people who have acquired disabilities as they reached old age. Less attention has been given to people aging in place with pre-existing physical and sensory disabilities--people who have a great deal to teach and with whom social workers must be prepared to work. It is important to focus on people with pre-existing disabilities in the proper context. Therefore, we will summarize recent literature that demonstrates the increasing linking of disabilities with aging. …

22 outcome after severe head injury

Abstract: Much more attention tends to be paid to describing and classifying the initial diagnosis and severity of injury than to defining the outcome after various types of trauma. Yet when it is the brain that is injured the need for accurate assessment of outcome is all the more pressing, because many survivors are left with a combination of mental and neurological deficits that markedly affect the quality of life. Judging the medical efficacy and the cost-effectiveness of interventions both in the acute and rehabilitation phases depends on measuring and valuing the ultimate outcome. Apart from this the patient and his/her family are clearly concerned to be kept informed about the prospects of recovery as time passes and to be advised about how to plan for the likely, and then to deal with the actual, outcome. The combined effect of mental and physical disabilities results in a global disability that is often greater than the sum of these parts. This is because the mental impairments limit the capacity to cope with the physical disabilities, while for many patients the mental changes comprise the major and often the only persisting disability. For these reasons it is important not only to list the various components of medical and physical disability but also to make a global assessment of the patient’s state in terms of overall social consequences of his/her brain damage. Various terms previously used to describe outcome tended to reflect the viewpoint of different observers, some more optimistic than others. Optimistic assessments resulted from overemphasis on physical recovery and minimizing the mental impairments, and were apt to be taken by those who had dealt with the patient in the acute stage. For them the contrast with the previously comatose state is striking, while they naturally wish to justify their early therapeutic efforts by claiming a reasonable recovery. Terms such as practical, useful, reasonable, acceptable and worthwhile recovery usually prove to be euphemisms for severe disability. On the other hand, assessments that list every detectable neurological deficit, many of which do not constitute any disability or handicap, can appear too pessimistic. Nor can social measures such as return to home or to work be relied on to indicate the degree of recovery. Exceptional family efforts may enable some very disabled patients to return home. Return to work is an unsatisfactory guide for the many patients who were not previously in work, while failure to return to work may indicate a decision to retire early or, in times of high unemployment, the patient being laid off for economic rather than health reasons. Occasionally, return to work is to a much lower level of job, provided by a sympathetic employer. For these various reasons it is much better to rely on some standard scale for assessing outcome. Many of these exist for patients with stroke, but they tend to focus in great detail on aspects of physical capacity and the ability to undertake activities of daily living. Moreover, most apply to elderly patients whose quality of life has different dimensions and expectations from that of the predominantly young patients who suffer head injury. It was for these reasons that we developed the Glasgow Outcome Scale.

A study of major physical disorders among the elderly depressives.

Abstract: Psychiatric evaluation and assessment of common physical illnesses and disabilities was carried out in elderly depressives (aged 60 years and above). Correlation, if any, was seen between depression and physical problems. The 'patient group' comprised of 40 drawn from MHI, Cuttack, having a depressive disorder (ICD-10). The 'control group' of 20 was drawn from the general population with no psychiatric disorder. The presence of physical illness was looked for in both groups. The patient group had physical illnesses, 76% of which were previously undiagnosed. The control group had physical illnesses 71% of which were previously diagnosed. Undiagnosed physical illnesses are more common among elderly patients with depression than among matched control. The physical illnesses contributed in two thirds of the patients. So careful detection and management of physical illness is of equal importance in the management of depression.

Population-based, genetically informative sample for studies of physical frailty and aging: black elderly twin study.

Abstract: In this article 1 describe efforts to build a genetically informative, population-based sample of black twins to study physical frailty and aging in the United States. This project involves the use of governmental registries combined with sampling techniques developed to overcome limitations in the registry data. Two analytical approaches to measures of disability are included to illustrate the types of questions that can be addressed with this sample. These results suggest that physical disability in late life has both genetic and environmental determinants. Only with a genetically informative sample can evidence be collected indicating that frailty may be driven by fixed processes (i.e., disability resulting from activation of senescence genes), fluid processes (i.e., disability resulting from changes in the features of the environment), or a combination of both.