Severity, timing, and structure of disability

Summary Objectives: Severity and timing are key aspects of disability experience for individuals. They also generate a populations disability structure (prevalence, counts, patterns). We study links among severity, duration, and structure for community-dwelling adults in the US.Methods: The data source is the National Health Interview Survey Disability Supplement. Disabilities in personal care (ADL), household management (IADL), and physical functions (PLIM) are analyzed.Results: Many combinations of disabilities are possible, but just a few are frequent; the top-10 patterns cover 70% of ADL, 89% of IADL, and 47% of PLIM disabled adults. Hierarchical patterns are common for ADLs and IADLs. People with many disabilities also have more-severe ones, and their disabilities often started at the same time.Conclusions: Disability structure reflects severity and timing of specific disabilities, sometimes strongly, and other times weakly due to exit processes from the community. Assumptions that disability occurs in hard tasks first and easy ones last, and that hard-and-early connotes mild disability whereas easy-and-late connotes severe, need direct empirical testing.     

Impact of the timing, type and severity of disability on the subjective well-being of individuals with disabilities

Despite the existence of a large volume of literature on subjective well-being (SWB) of the general population, very few studies have focused on individuals with disabilities. The present study uses data on 24,036 Canadians with disabilities to investigate factors affecting their SWB. It found that SWB, measured here by level of happiness, decreases with severity of disability but is independent of the type of physical disability. Those born with a disability are likely to be happier as compared to those disabled later on in life. Per capita family income has no effect on happiness. However, unemployment decreases happiness. Happiness is found to be U shaped in age, bottoming out around 40 years of age. Some of these results vary when the sample is split according to the timing, type or severity of disability.     

Loss, stress and readjustment: the structure of coping with bereavement and disability

On the basis of recent developments in the study of readjustment, a comprehensive formal theoretical framework was suggested, predicting the factors enhancing and impeding readjustment after a traumatic irrevocable loss (bereavement and disability) and empirically supported. Empirical investigation and application of multivariate techniques of data analysis revealed an identical structure of the content universe of readjustment for three groups: war widows, bereaved parents and disabled army veterans. The structure ascertained the hypothesized predominance of individual resources--and particularly those which facilitate affective interaction relationship--as well as of primary groups' emotional support in enhancing readjustment, compared to the limited efficacy of formal rehabilitation agencies. In the realm of instrumental coping assistance, data ascertained the efficacy of 'resource enhancing' support (e.g. vocational training) in advancing readjustment. Data also ascertained that the weight of individual resources and primary group support in facilitating readjustment is greater than the effect of the severity of the disability, and plays a greater role in readjustment than lapse of time since the loss. The significance of the study is in the development and empirical verification of a formal comprehensive and testable framework of readjustment to change following a traumatic loss. Though the universal validity of the framework needs further proof, there seems to be sufficient basis for assuming such validity until empirically verified. It is suggested to view this study as a first step toward a general model of readjustment. The study seems particularly contributing to the body of knowledge in the realm of stress and coping in light of the difficulties in arriving at a valid empirical verification of the stressful life events leads to coping leads to homeostasis relationship.     

Definitions,concepts, and measures of disability

The term “disability” is a shorthand expression or as explained in the International Classification of Functioning, Disability and Health an umbrella term. It has been used to identify the impairments that result from disease and injury, the physical, and mental or emotional functional limitations or difficulties a person has as a result of the impairments, as well as the participation restriction they experience when the environment is not supportive. Thus the term disability has been used to represent almost any of the conceptual components associated along the ability continuum that impacts the person, but it also includes the environmental effects that create a limiting impact from the context outside the person. This paper examines those concepts and definitions to provide insight into the measurement process to represent this important element of health and participation.     

Long-term care and births timing,

Due to the aging process, the provision of long-term care (LTC) to the dependent elderly has become a major challenge of our epoch. But our societies are also characterized, since the 1970s, by a postponement of births, which, by raising the intergenerational age gap, can affect the provision of LTC by children. In order to examine the impact of those demographic trends on the optimal policy, we develop a four-period OLG model where individuals, who receive children's informal LTC at the old age, must choose, when being young, how to allocate births along their life cycle. It is shown that, in line with empirical evidence, early children provide more LTC to their elderly parents than do late children, because they face a lower opportunity cost of providing LTC. When comparing the laissez-faire with the long-run social optimum, it appears that individuals have, at the laissez-faire, too few early births, and too many late births. We then study, in first-best and second-best settings, how the social optimum can be decentralized by encouraging early births, in such a way as to reduce the social burden of LTC provision.     

Technology, selfhood and physical disability

Much has been written in recent times of the interface between technologies and the human body. The vast majority of this literature, however, focuses on a body that is assumed to be free of physical disability. This article seeks to address this lacuna by presenting findings from an exploratory study using in-depth interviews with fifteen people with physical disabilities living in the Australian city of Adelaide. The dominant research question was to explore the ways in which technologies contribute to the meanings and experiences of the lived body/self with disabilities. The data showed that the interviewees identified several technologies that they used as highly beneficial to allowing them to transcend some aspects of their disabilities. However, the interviewees also identified significant negative aspects to the use of some technologies. They noted that such technologies could serve to mark out people with disabilities as 'different' or 'lacking', acting as a barrier to the achievement and presentation of their preferred body/self.     

Adolescence, chronic illness and disability

The prevalence of chronic illness or disability in adolescence has increased in recent years. In the past, children with certain chronic diseases did not reach adolescence, but over the last decade the survival rate has increased manyfold. The old morbidity (infectious disease, poor housing, poverty, lack of immunisation) has been exchanged with a new morbidity of adolescence, where a longer life expectancy is followed by an increase in lifelong disability. This review discusses issues concerned with the definition of disability in adolescence, reviews prevalence studies in several countries, the causes of disability, disparities, access and expenditure of health care, psychosocial aspects, and how to promote better outcomes.     

Mortality, disability, and falls in older persons: the role of underlying disease and disability.

BACKGROUND. Falls are prevalent in older persons and can have serious consequences. METHODS. Data from the Longitudinal Study on Aging were analyzed to study the relationship between falls and both mortality and functional status in 4270 respondents age 70 and over. The effects of demographic traits, chronic conditions, and disability present at baseline were controlled for by means of multivariable analyses. RESULTS. Risk of death within 2 years was greater for both single fallers (crude odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0) and multiple fallers (crude OR, 2.2; 95% CI, 1.7-2.8). This excess risk was dissipated when selected covariates were added to the model. No crude or adjusted association was evident between single falls and functional impairment; however, multiple falls were an independent risk factor (adjusted OR, 1.6; 95% CI, 1.2-2.0). CONCLUSIONS. Multiple falls in older persons increase risk of functional impairment and may indicate underlying conditions that increase risk of death.     

Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood.

Undernutrition in infancy and early childhood is thought to adversely affect cognitive development, although evidence of lasting effects is not well established. With the use of data from the Cebu Longitudinal Health and Nutrition Study, we assesshere the relationship between stunting in the first 2 y of life and later cognitive development, focusing on the significance of severity, timing and persistence of early stunting. The sample included > 2000 Filipino children administered a cognitive ability test at ages 8 and 11 y. Stunting status was determined on the basis of anthropometric data collected prospectively between birth and age 2 y. Children stunted between birth and age 2 y had significantly lower test scores than nonstunted children, especially when stunting was severe. The shortfall in test scores among children stunted in the first 2 y was strongly related to reduced schooling, which was the result of a substantial delay in initial enrollment as well as higher absenteeism and repetition of school years among stunted children. Interactions between stunting and schooling were not significant, indicating that stunted and nonstunted children benefitted similarly from additional schooling. After multivariate adjustment, severe stunting at age 2 y remained significantly associated with later deficits in cognitive ability. The timing of stunting was also related to test performance, largely because children stunted very early also tended to be severely stunted (chi(2) P = 0.000). Deficits in children's scores were smaller at age 11 y than at age 8 y, suggesting that adverse effects may decline over time. Results emphasize the need to prevent early stunting and to provide adequate schooling to disadvantaged children.     

Trends in the level and structure of disability in the Republic of Tatarstan

Analysis of changes in the disability rates in the Tatarstan Republic showed that the number of subjects acknowledged by the Medical Labor Expert Evaluation Committees disabled decreased by 2.1%, while the number of patients acknowledged disabled for the first time increased by 22.5%. The level of primary disability increased from 67.0 to 80.1% per 10,000. Cardiovascular diseases rank first among the causes of primary disability (35.9-40.1%); they are followed by malignant tumors (12.0-13.1%), diseases of the nervous system and organs of senses (9.1-10.4%), mental disorders (8.5-9.4%), injuries and poisoning (7.9-0.2%).     

Illness,disability and sex in aging

Age needs to be considered a significant factor to avoid abusive generalizations about sexuality in the elderly. Contributory factors include physiological change, the social environment of the elderly, their living conditions and companionship opportunities. Growing old does not necessarily discontinue a healthy sexual life, but it does call for redefining its expression. This paper discusses the multidimensionality of sexuality in the elderly, emphasizing the impacts of illness and disability. Analysis of 80 semi-structured interviews and life histories reveals some elements of the conjugal and sexual life of persons of that cohort.     

Sexuality, fertility and contraception in disability

In this review the authors describe ways in which particular disabilities may affect sexual performance, fertility, menstruation and pregnancy. The special contraceptive needs of people with various physical and mental disabilities are discussed, with each method of contraception being discussed together with its indications for use by people with various disabilities. The authors conclude that if family planning services are to be improved for people with disabilities, those providing the services must increase their awareness and acceptance of sexuality in disabled people.