Showing papers on "Physical disability published in 2009"

Social Outcomes in the Childhood Cancer Survivor Study Cohort

Abstract: Difficulties with negotiating and achieving desired social outcomes in life may be exacerbated by the experience of childhood cancer, including adverse effects from therapies used to achieve a cure. This review of previous publications from the Childhood Cancer Survivor Study (CCSS) and other relevant literature provides insight into the prevalence of, and risk factors for, poor educational attainment, less than optimal employment status, and interpersonal relationship issues among long-term survivors of childhood cancer. The impacts of emotional health and physical disability on social outcomes are also examined. Study results suggest that childhood cancer survivors generally have similar high school graduation rates, but are more likely to require special education services than sibling comparison groups. Survivors are slightly less likely than expected to attend college, and are more likely to be unemployed and not married as young adults. Cancers and treatments that result in impairment to the CNS, particularly brain tumors, or that impact sensory functioning, such as hearing loss, are associated with greater risk for undesirable social outcomes, as are emotional health problems and physical disability. This review of relevant data from CCSS and other studies provides information on risk factors for social problems into adulthood. A greater understanding of the long-term social impacts from the diagnosis and treatment of childhood cancer is critically important for developing targeted interventions to prevent or ameliorate adverse psychosocial effects.

Social support and intellectual disabilities : a comparison between social networks of adults with intellectual disability and those with physical disability

Abstract: Background Social support has been identified as a major protective factor in preventing mental health problems and also as a major contributor to quality of life. People with intellectual disabilities (ID) have been identified as having limited social support structures. Interventions have been focused on promoting their social presence and integration. However, previous studies have shown that this does not always lead to the formation of social relationships.To date few studies have looked at how having an ID leads to impoverished social networks.

Social support network structure in older people: underlying dimensions and association with psychological and physical health.

Abstract: Social networks have been associated with a wide variety of health outcomes in older people. We examined the dimensions underlying the Wenger social support network type assessment to identify dimensions associated with mental and physical health. We interviewed 1334 community-dwelling participants aged 65+. The Geriatric Mental State automated geriatric examination for computer-assisted taxonomy interview was used to rate psychiatric symptoms and quality of life. Cognitive impairment was defined as a score of <24 on the mini mental state examination. Clustering around latent variables identified two uncorrelated social support network domains: family (distance from and contact with relatives) and social engagement. Social engagement was associated with a lower age- and sex-adjusted prevalence of depression (odds ratio for a one-tertile increase 0.48), generalised anxiety disorder (OR 0.60), cognitive impairment (OR 0.68) and physical disability (OR 0.62) all p < 0.001. Adjusted for age, sex, depression, cognitive impairment and disability, the social engagement domain was also associated with better quality of life (OR 1.5) self-rated happiness (OR 1.3) and rating life as worth living (OR 1.4). The family domain, on the other hand, was not significantly associated with any health outcome. The results suggest that elective relationships and social engagement are the 'active ingredients' of social networks which promote health in later life.

Adult outcomes and lifespan issues for people with childhood‐onset physical disability

Abstract: This paper aimed to discuss functioning, quality of life, (QoL) and lifespan care issues of adolescents and young adults with childhood-onset physical disability from a clinical, scientific, and personal perspective. We present a resume of results of recently performed studies in rehabilitation-based samples of (young) adults with childhood-onset conditions such as cerebral palsy (CP) and spina bifida (SB), and different models of transition and lifespan care. The studies showed that many young adults with a childhood-onset disability experience health-related problems such as functional deterioration, pain or fatigue, and an inactive lifestyle. A significant number are restricted in participation in work, housing, and intimate relationships. They perceive a lower health-related and global QoL compared with a reference group. In some centres in the UK and the Netherlands specialized outpatient services are available or being developed. In conclusion, transition to adulthood is a critical phase for reaching autonomous participation in adult life. There is an international challenge to incorporate a lifespan perspective in paediatric, transition, and adult health care services for persons with a childhood-onset disability.

Disability and survival in Duchenne muscular dystrophy

Abstract: Background: Duchenne muscular dystrophy (DMD) leads to progressive impairment of muscle function, respiratory failure and premature death. Longitudinal data on the course of physical disability and respiratory function are sparse. Objectives: To assess prospectively physical impairment and disability, respiratory function and survival in patients with DMD over several years to describe the course of the disease with current care. Methods: In 43 patients with DMD, aged 5–35 years, yearly assessments of physical disability by the Duchenne muscular dystrophy physical Impairment and Dependence on care (DID) score, ranging from 9 (no disability) to 80 (complete dependence), and forced vital capacity (FVC), were obtained over a mean time interval of 5.4 (SD 2.1) years. Results: DID scores were correlated with age according to a hyperbolic function (f = 85.3×age/(10.05+age), R = 0.62, p Conclusions: Our detailed observations of the progression of physical disability, dependence on care and respiratory impairment in patients with DMD from childhood to adult life is valuable for predicting the clinical course with current medical care. Compared with historical data, survival has improved considerably.

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Abstract: Physical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatment-based risk factors include radiation and treatment with a combination of alkylating agents and anthracyclines. Musculoskeletal, neurologic, cardiac, pulmonary, sensory, and endocrine organ system dysfunction also increase the risk of developing a physical performance limitation. In summary, monitoring of physical performance limitations in an aging cohort of childhood cancer survivors is important and will help determine the impact of physical performance limitations on morbidity, mortality, and caregiver burden. In addition, in developing restorative and preventive interventions for childhood cancer survivors, we must take into account the special needs of survivors with physical disability to optimize their health and enhance participation in daily living activities.

Neighborhood Characteristics and Disability in Older Adults

Abstract: Objective. To characterize the infl uence of the residential neighborhood of older adults on the prevalence of disability. Methods. We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective effi cacy were added to these models to explore the impact of the social environment. Results. Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both “ physical ” disability and “ going outside the home ” disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective effi cacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term.

Living Alone and Depressive Symptoms: The Influence of Gender, Physical Disability, and Social Support Among Hispanic and Non-Hispanic Older Adults

Abstract: Background. Is living alone a risk factor for depression among older adults? Previous research is mixed and inconclusive, and it is unclear whether living alone infl uences psychological distress independently of other interrelated risk factors for depression. We reexamine this association and evaluate whether it is contingent on gender, physical disability, social support, and Hispanic ethnicity. Methods. We analyze data from a multiethnic sample of older disabled and nondisabled adults residing in MiamiDade County, Florida ( n = 947). We employ descriptive and multivariate analyses stratifi ed by Hispanic ethnicity to assess the relationship between living alone and depressive symptoms and evaluate whether any association is conditioned by gender, physical disability, and social support. Results. Living alone is associated with higher levels of depressive symptoms among Hispanics but not among nonHispanics. Variations in social support did not account for the higher overall levels of depression reported by Hispanics living alone relative to their counterparts living with a spouse, partner, or others. However, social support moderated the association between living alone and depression among both Hispanics and non-Hispanics. Conclusions. We discuss the implications of our fi ndings for future research, especially as they relate to observed ethnic differences in the relationship between living alone and depressive symptoms.

Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom.

Abstract: OBJECTIVES: Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits. DESIGN: Descriptive epidemiologic study and cost analysis. METHODS: The Department of Defense Medical Metrics (M2) database was queried for the hospital admissions and billing data of a previously published cohort of soldiers injured in Iraq and Afghanistan between October 2001 and January 2005 and identified from the Joint Theater Trauma Registry. The US Army Physical Disability Administration database was also queried for Physical Evaluation Board outcomes for these soldiers, allowing calculation of disability benefit cost. Primary body region injured was assigned using billing records that gave a primary diagnosis International Classification of Diseases Ninth Edition code, which was corroborated with Joint Theater Trauma Registry injury mechanisms and descriptions for accuracy. RESULTS: A total of 1333 soldiers had complete admission data and were included from 1566 battle injuries not returned to duty of 3102 total casualties. Extremity-injured patients had the longest average inpatient stay at 10.7 days, accounting for 65% of the $65.3-million total inpatient resource utilization, 64% of the 464 patients found "unfit for duty," and 64% of the $170-million total projected disability benefit costs. Extrapolation of data yields total disability costs for this conflict, approaching $2 billion. CONCLUSIONS: Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability benefit costs. This study highlights the need for continued or increased funding and support for military orthopaedic surgeons and extremity trauma research efforts. Language: en

Sexual Identity, Body Image and Life Satisfaction Among Women With and Without Physical Disability

Abstract: The current study examined the association between sexual identity, body image and life satisfaction among women with and without physical disability. Seventy women with physical disability (spinal cord injuries and injuries resulting from polio) and 64 women without disability completed the following questionnaires: Sexuality Scale, Body Image Scale and Quality of Life Questionnaire. The results demonstrated that women with physical disability had the same sexual needs and desires as women without disability, but their body image, sexual self-esteem, sexual satisfaction and life satisfaction were significantly lower. These differences were stronger among young adult women than among more mature women. It was also found that sexual satisfaction was a major factor in explaining the variance in life satisfaction in both groups, and the relationships between sexual satisfaction and life satisfaction were bidirectional. At the same time, different patterns of congruency and inconsistency between sexual satisfaction and life satisfaction were exposed in both groups. In addition, the research demonstrated a moderating effect of family status on links between sexual and life satisfaction.

Active avoidance but not activity pacing is associated with disability in fibromyalgia.

Abstract: Activity pacing has been suggested as a behavioural strategy that may protect patients with fibromyalgia (FM) against activity dysregulation and disability. The aim of the present study was to empirically test whether the construct of activity pacing is distinct from other behavioural strategies assessed with the Chronic Pain Coping Inventory (CPCI), such as guarding, resting, asking for assistance, relaxation, task persistence, exercise/stretch, seeking social support, and coping self-statements. The second objective was to test whether pacing was associated with physical disability when controlling for pain catastrophizing, pain severity and the other behavioural strategies as measured with CPCI. A random sample of patients with FM (N=409) completed the CPCI, the Pain Catastrophizing Scale (PCS), the Physical Index of the Fibromyalgia Impact Questionnaire (FIQ-PH) and the Pain Disability Index (PDI). The results demonstrated that the Dutch version of the CPCI including the pacing subscale has adequate internal consistency and construct validity. Moreover, guarding and asking for assistance, but not pacing, were associated with disability. These findings are in line with fear-avoidance models and suggest that specifically active avoidance behaviours are detrimental in FM. The authors recommend developing cognitive-behavioural and exposure-based interventions and challenge the idea that pacing as an intervention is essential in pain self-management programs.

Factors that promote or hinder young disabled people in work participation: a systematic review.

Abstract: Introduction The aim of this systematic review was to study factors which promote or hinder young dis- abled people entering the labor market. Methods We systematically searched PubMed (by means of MESH and text words), EMBASE, PsycINFO, Web of Science and CINAHL for studies regarding (1) disabled patients diag- nosed before the age of 18 years and (2) factors of work participation. Results Out of 1,268 retrieved studies and 28 extended studies from references and four from experts, ten articles were included. Promoting factors are male gender, high educational level, age at survey, low depression scores, high dispositional optimism and high psychosocial functioning. Female and low educational level gives high odds of unemployment just like low IQ, inpatient treatment during follow up, epilepsy, motor impairment, wheelchair dependency, functional limitations, co-morbidity, physical disability and chronic health conditions combined with mental retardation. High dose cranial radiotherapy, type of cancer, and age of diagnosis also interfered with employ- ment. Conclusions Of the promoting factors, education appeared to be important, and several physical obstructions were found to be hindering factors. The last mentioned factors can be influenced in contrast to for instance age and gender. However, to optimize work participation of this group of young disabled it is important to know the pro- moting or hindering influence for employment.

Living Arrangements, Social Integration, and Loneliness in Later Life: The Case of Physical Disability∗

Abstract: Despite the theoretical linkages between household composition and social integration, relatively limited research has considered how living arrangements affect risk for loneliness in later life. Prior work has also failed to consider whether physical disability moderates this potentially important relationship. Using data from a sample of older adults with and without a physical disability (N = 868), this study aims to (1) document variations in loneliness across living arrangements, (2) assess whether any observed association varies by physical disability status, and (3) evaluate the mediating role of social integration and social support. Results reveal that those living alone or with people other than a spouse (children, extended family members) report greater loneliness than those living with a spouse. However, the magnitude of these differences is greater for older adults with a physical disability. Measures of social integration and social support attenuated, but did not fully explain, inter-household variations in loneliness. These findings point to the independent significance of living arrangements for experiences of loneliness in later life among both disabled and nondisabled adults.

Participation of Students With Physical Disabilities in the School Environment

Abstract: OBJECTIVE. We investigated the factors that facilitate or hinder school participation of students with physical disabilities and explored the interaction of those factors. METHOD. The study used a mixed-methods design that used qualitative and quantitative data. Qualitative data were gathered on 49 participants: 14 students, 17 parents, and 18 teachers. Data analysis was based on grounded-theory procedures. Quantitative data were gathered on 32 students using the School Function Assessment. RESULTS. The characteristics of each school setting influenced students� participation. Some settings presented more challenges than others, particularly those with open spaces and limited structures such as the school playground and field trips. Possibilities of student participation decreased with increasing numbers of risk factors, but the interaction between factors was equally important. CONCLUSION. To promote school participation of students with disabilities, occupational therapists should consider a confluence of child, environmental, and task factors rather than focusing on individual aspects

The influence of religious coping on the mental health of disabled Iranian war veterans

Abstract: This study examined the contribution of religious coping alongside physical function, personal meaning, and social support on the mental health of Iranian veterans. In particular, it was hypothesized that religiosity in a Muslim sample would show associations with well-being independently of other psychological and social variables. A sample of disabled war veterans of the Iran–Iraq was studied (N = 78). Results showed that when physical function, social support, and personal meaning were controlled, religious coping had a significant contribution on mental health indicators including general mental health and PTSD above and beyond other predictors. Of the other predictors investigated only social support make an independent significant contribution to the mental health of veterans. Furthermore, the results demonstrated that participants used positive religious coping strategies more frequently than negative religious coping strategies in coping with their physical disability problems and traumatic experi...

Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA).

Abstract: Objectives: Depressive symptoms (DS) are very frequent in elderly individuals and are associated with negative outcomes. This study was undertaken to evaluate whether DS predict physical disability in this population. Methods: A prospective, community-based cohort study, this work included 5,632 individuals aged 65–84 years, who were recruited from the demographic registries of eight Italian municipalities in 1992. The complete data of 3,256 subjects were collected and analyzed. DS were assessed using the Geriatric Depression Scale with a score ≥10/30 indicating DS. All traditional risk factors for disability established by questionnaires and physical examinations were assessed at baseline. The outcomes were self-reported disability on the activities of daily living (ADL) test and the performance-based physical function assessment (Physical Performance Tests, PPT). The contribution of the predictive variables to the outcomes evaluated after a mean follow-up of 3.5 ± 0.4 years was assessed using hierarchical logistic nested models. Results: Baseline DS was associated with higher rates of ADL disability (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.12–2.66) and PPT disability (OR = 1.83, 95% CI 1.17–2.85) in men and with ADL disability (OR = 1.81, 95% CI 1.28–2.55) in women. The independent predictors of PPT disability in women were arthritis (OR = 2.13, 95% CI 1.28–3.53) and age (OR = 1.09; 95% CI 1.03–1.15). Conclusions: This study provides evidence that older persons who report DS are at higher risk of subsequent physical decline. In women, arthritis is a more powerful predictor of preclinical disability, as measured by PPT.

A descriptive investigation of dysphagia in adults with intellectual disabilities.

Abstract: Background Dysphagia has rarely been investigated in adults with intellectual disabilities (ID) despite being a serious condition affecting health and quality of life. Method This study collected information about 101 adults with ID, living in community settings, referred for an assessment of their eating and drinking. Ninety-nine people were classified as having dysphagia from clinical and videofluoroscopic assessments. This information was used to give an indication of the prevalence of dysphagia in adults with ID and identify the co-occurrence of physiological and anatomical indicators and associated negative health conditions. Results Details of the characteristics and conditions associated with dysphagia are provided. These include cerebral palsy, increased physical disability and cognitive impairment. A tentative indication of the current prevalence of dysphagia was found (8.15%). Conclusion Findings indicate that dysphagia is a significant issue for people with ID warranting further investigation. Practice implications detailed include increasing awareness of ‘at risk’ groups, changes in dysphagia with ageing, medication use and illness, and how findings can inform assessment and training.

Depressive symptoms in patients with chronic pain.

Abstract: Objective: To determine the nature of depressive symptoms in a sample of patients with chronic pain, and to examine the relationship between depressive symptoms and physical disability due to pain. Design, participants and setting: Cross-sectional study of 812 patients with complete datasets from a total of 2419 patients with pain who were referred to the Pain Management Research Institute at Royal North Shore Hospital, Sydney, between January 2000 and December 2007. Main outcome measures: Pain severity and distress, physical disability, depressive symptoms, pain self-efficacy, catastrophising, fear of movement/(re)injury, use of unhelpful self-management strategies, sense of control over life, and perceived support from significant others, assessed by the West Haven–Yale Multidimensional Pain Inventory, modified version of the Roland Morris Disability Questionnaire, the depression subscale of the Depression Anxiety Stress Scales, Pain Self-Efficacy Questionnaire, Pain-Related Self-Statements Scale, Tampa Scale of Kinesiophobia, and Pain Self-Management Checklist. Results: After controlling for the effects of age, sex and duration of pain, depressive symptoms were most strongly correlated with a combination of catastrophising, sense of control over life, physical disability, pain self-efficacy beliefs, higher use of unhelpful selfmanagement strategies and lower perceived social support. Depressive symptoms also correlated with physical disability, but to a lesser extent than other variables, including fear of re-injury, low self-efficacy for activity and pain severity. The depressive symptoms that were rated as most frequently experienced reflected sadness, lack of initiative and lack of ability to experience pleasure. Conclusions: In patients with chronic pain, depressive symptoms are correlated more strongly with cognitive variables than pain severity and pain distress, while physical disability is correlated more strongly with cognitive, behavioural and pain variables than depressive symptoms. Furthermore, depressive symptoms are characterised predominantly by mood-related symptoms, which suggests differences in the experience of depression in patients with chronic pain compared with those

Physical disability and suicidal ideation: a community-based study of risk/protective factors for suicidal thoughts.

Abstract: Although the significance of poor physical health for suicide risk is well established, the potential relevance of physical disability, as distinct from diseases and traumas that give rise to disability, has received little attention. Prior evidence suggests the possible utility of the stress process theoretical model for understanding variations in risk for suicide ideation and the contribution of physical disability to such risk. In this article, we examine the independent and joint explanatory significance of physical disability and components of the stress process model for risk of suicide ideation. Data from an ethnically diverse and representative sample of disabled and nondisabled adults (n = 1,768) reveal that physical disability is associated with a greater risk of lifetime suicidal ideation.

Siblings of children with disabilities: challenges and opportunities.

Abstract: Living with a child who has a disability can pose signifi-cant financial, emotional and lifestyle challenges for a fam-ily. Over the last 50 years, philosophies of service deliv-ery to children with a disability have changed consider-ably. More particularly, in the last few decades the focushas changed from medical and therapeutic needs only toan approach that includes the needs of the whole family.In the developed world, these changes have coincided withthe de-institutionalization of children with an intellectualdisability, legislation mandating a range of advocacy, edu-cational and intervention policies, and the increasing entryof these children into mainstream schools. For example, inthe 1970s in the United States, legislation was passed thatmandated early intervention programmes for families with achild who has a disability, recognizing the important role ofthefamilyinmaximizingthelifeoutcomesforthesechildren(1).Much of the research examining the effect on a familyhas focused on the mother. A consistent finding has beenthat mothers of children with a disability tend to experi-ence more stress and depressive symptoms than other fam-ily members (2–5). These symptoms are most likely to occurwhen the child also has behavioural problems or the familyfaces socio-economic or other challenges.Early studies of the effects of a disabled child on siblingsalmost exclusively reported negative psychological effects(6,7). More recent research has found little difference in arange of behavioural and social constructs between siblingswho do and do not have a brother or sister with an intel-lectual disability (8,9). Contemporary evidence is suggestingthat it is the overall family functioning that is more likely todetermine sibling adjustment although financial hardship isone of the social and economic determinants impacting onfamily functioning (10).Our studies of families with a Down or Rett syndromechild have demonstrated both positive and negative effectsfor siblings who have a brother or sister with an intellectualdisability (11). Some of these effects have been identifiedpreviously (12,13). Positive effects for siblings were relatedprimarily to personality characteristics, and included an in-creased tolerance and awareness of difference; a caring andcompassionatenature;increasedmaturitycomparedtotheirpeers;andanenhancedappreciationoftheirownhealthandabilities.Parents also reported several disadvantages. Spontaneousand planned recreational opportunities and ‘normal’ familyoutings were limited. Financial restraints limited family hol-iday opportunities, educational opportunities and materialgoods. The siblings experienced a sense of embarrassmentand ostracism by their peers. Some parents commented thattheir children did not have a ‘normal’ relationship with theirintellectually-disabled brother or sister. They also felt thatthere was an increased burden and sense of responsibility toassist with care of the disabled sibling.We also found that with an increasing number of chil-dren in the family and later birth order of the child withintellectual disability, the parents were less likely to reportdisadvantages for siblings. Perhaps the care of a child witha disability can be more easily shared within a larger family.Children from such families might also expect less ‘one-on-one’ time from parents, thus mitigating the negative impact.The impact seemed to vary slightly according to whetherthe child with intellectual disability had Down or Rett syn-drome, and it is likely that the nature of the impact will varyfor other conditions as well. For instance, the experience fora sibling of a child with autism who has severe behaviouralproblems may be different from that of a child whose siblinghas a severe physical disability.

Sibling relationship quality and social functioning of children and adolescents with intellectual disability.

Abstract: We examined sibling relationships for children and adolescents with intellectual disability and assessed implications for their social functioning. Targets (total N = 212) had either intellectual disability, a chronic illness/physical disability, or no disability. Nontarget siblings reported on relationship quality, sibling interactions were observed, and teachers reported on social adjustment. Group comparisons highlighted the asymmetrical hierarchy and low conflict unique to siblings and targets with intellectual disability. Sibling relationships characterized by high warmth/closeness, positive affect, and few negative behaviors were predictive of fewer behavior problems for the targets at school. Both high warmth/ closeness and high conflict predicted greater social competence for the targets with intellectual disability, though warmth, conflict, and sibling management had different implications depending on the sibling's gender.

Socioeconomic differences in physical disability at older age

Abstract: Background: This study aims to investigate the association between socioeconomic position (SEP) and physical disability at older age, using a framework that incorporates education, social class and wealth. Wave One data from the English Longitudinal Study of Ageing are used. Methods: Self-reported difficulties with activities of daily living, instrumental activities of daily living and motor skills were combined and categorised into “no disability”, “mild disability” and “severe disability”. The indicators of SEP used were wealth, education and social class. Multinomial regression was used to assess the associations between SEP and physical functioning reflecting the temporal relationship between education, social class and wealth. Results: Men and women who had the highest levels of wealth, education and social class also had the lowest disability rates. The association was stronger in younger age groups and in men. The association of education with disability, which was found to be significant in the unadjusted models, was attenuated when adjusted for other factors such as occupation or wealth. This supports a temporal model of education feeding into occupation and then wealth. The association of SEP with disability was stronger for men and for men and women in the younger age group. Conclusions: Socioeconomic circumstances affect the prevalence and scale of physical disability even at older ages. In particular, wealth appears more important as a socioeconomic factor for physical disability than social class or education. Socioeconomic gradients in physical disability are greater for men than for women and for those in the younger age groups.

Impact of COPD severity on physical disability and daily living activities: EDIP-EPOC I and EDIP-EPOC II studies.

Abstract: Summary Aims: The severity of chronic obstructive pulmonary disease (COPD) is associated to patients’ health-related quality of life (HRQL). Physical impairment increasingly affects daily activities creating economic, social and personal burden for patients and their families. This burden should be considered in the management of COPD patients; therefore, we intended to assess the impact of the disease severity on physical disability and daily activities. Methods: Two epidemiological observational cross-sectional descriptive studies were carried out in 1596 patients with moderate COPD and 2012 patients with severe or very severe COPD in the routine clinical practice. Demographic and basic clinical-epidemiological data were collected and patients completed questionnaires to assess their physical disability because of COPD [Medical Research Council (MRC)], COPD repercussion on daily activities [London Chest Activity of Daily Living (LCADL)], job, economy and family habits and their health status [EQ-5D visual analogue scale (VAS)]. Results: In all, 37% of severe/very severe COPD patients and 10% of moderate (p < 0.0001) had MRC grades 4 and 5. Mean global LCADL was significantly higher in severe/very severe than in moderate patients [29.6 (CI 95%: 28.91–30.25) vs. 21.4 (CI 95%: 20.8–21.9); p < 0.0001]. COPD job impact and economic and family habits repercussions were significantly higher and health status significantly worse in severe/very severe cases than in patients with moderate COPD. Conclusions: COPD severity is highly associated with physical disability by MRC grading, with functionality on daily activities and with impairment of other social and clinical activities. Moderate COPD patients show already a significant degree of impairment in all these parameters.

Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders

Abstract: NUMEROUS population-based aging studies have reported that depression is disabling (1–4). There is suggestion, however, that the effect of depression on disability may be less salient in older adults who are already disabled. For example, Mehta and colleagues (5) found that depressive symptoms have no significant effect on functional decline after controlling for cognitive impairment among older persons with dependence in activities of daily living (ADL) at baseline, although both depressive symptoms and cognitive impairment are risk factors for functional decline among those with no ADL dependence. Research has shown that depressive symptoms and cognitive impairment occur concomitantly (6), that cognitive dysfunction is a common symptomatic manifestation of late-life depression (7), and that poor cognitive functioning is a major risk factor for physical decline (8). Hence, it is possible that the observed effects of depression on disability are due to cognitive deficits, particularly among home care elders who are vulnerable to both depression and cognitive impairment (9,10). There is also evidence that emotional health and cognitive ability interact to influence physical function; for instance, Raji and colleagues (11) found that low depressive symptoms buffer the adverse impact of low cognition on subsequent decline of lower body function among older Mexican Americans. The purpose of this study is threefold. First, we investigate the effect of changes in depression status on physical disability among elderly persons receiving home care. Second, we examine whether such effect is independent of concomitant changes in cognitive status. Third, we test whether changes in depression and cognitive status interact to influence physical disability.

Use of Standardised Assessments and Outcome Measures among a Sample of Irish Occupational Therapists Working with Adults with Physical Disabilities

Abstract: This study was carried out to explore the current usage of standardised assessments and outcome measures by occupational therapists working with adults with physical disabilities. A survey research...