Self-concept,sexual knowledge and attitudes,and parental support in the sexual adjustment of women with early- and late-onset physical disability

Three groups of college women were compared on the following dimensions: sexual experiences, sexual satisfaction, self-concept, sexual attitudes and knowledge, and parental support for sexual development. Groups were composed of women with late-onset physical disability, early-onset physical disability, and no disability. Measures utilized included an extension of the Sexual Interaction Inventory, the Tennessee Self-Concept Inventory, the Sexual Knowledge and Attitude Test, and questionnaires developed for this study. The early-onset group reported fewer current sexual experiences than did the nondisabled group. The early-onset group was dissatisfied with the frequency of sexual behavior to a greater degree than the nondisabled group. Also, both disabled groups believed that they could enjoy sexual experiences more than they did at present in contrast to the nondisabled group. There were no group differences for self-concept, though several aspects of self-concept contributed significantly to sexual adjustment for the disabled groups. No group differences were found for sexual knowledge and attitudes or parental support for sexual development, nor did these variables relate to sexual adjustment. Group differences in sexual adjustment are discussed in terms of functional, emotional, and social implications. Recommendations for further research include following the social development of women with lateonset conditions, comparing the social skills and cognitions of the two disabled groups, and assessing men who have established intimate relationships with disabled women.     

中国听力残疾老年人生活自理能力影响因素分析

目的分析中国听力残疾老年人生活自理能力现状及其影响因素。方法运用2006年第二次全国残疾人抽样调查数据,以≥60岁单纯听力残疾者为研究对象,对听力残疾的老年人基础性生活自理能力现状进行描述性分析,运用多因素logistics回归对听力残疾的老年人生活自理能力相关因素进行分析。结果中国≥60岁听力残疾老年人生活不能自理率为23.62%。多因素logistics回归分析结果显示,年龄越高听力障碍残疾等级越高(极重度OR=2.97,95%CI=2.68~3.29)、家庭人均户收入低于等于国家平均水平听力障碍老年人发生生活不能自理的风险越高(OR=1.17,95%CI=1.08~1.28);居住在农村(OR=0.86,95%CI=0.79~0.95)、所在地为东部(OR=0.59,95%CI=0.55~0.63)、受教育程度高(高中及以上OR=0.62,95%CI=0.53~0.72)听力障碍老年人发生生活不能自理的风险越低。结论个体因素和环境因素构成的情境因素与听力残疾老年人活动受限密切相关,影响其日常生活功能。     

Parks/sports facilities in local communities and the onset of functional disability among older adults in Japan: The J-shaped spatial spillover effects

We examined the associations between parks/sports facilities in local communities and the onset of functional disability among Japanese older adults. We further investigated the spatial spillover effects of parks/sports facilities in 1st-, 2nd-, and 3rd-degree neighboring communities. Data on the onset of functional disability, including date of onset, sex, age, and address (school district) of all older adults aged 65 years and older living in Kobe City were obtained from the public long-term care insurance database (163,348 men [190,831 person-year] and 200,443 women [230,464 person-year]). Multilevel proportional hazard regression analyses showed that the number of parks and sports facilities were negatively associated with the onset of functional disability among men. In particular, these associations were stronger for the adjacent district than for individuals’ living districts. Our results imply that involving multiple neighboring communities as the intervention unit is effective when utilizing community built environments for long-term care prevention in men.     

Self-esteem as mediator and moderator of the relationship between stigma perception and social alienation of Chinese adults with disability

BackgroundSeveral studies show the relationship between self-esteem and stigma perception and also between self-esteem and social alienation, but none sufficiently analyze the relationship between stigma perception and social alienation of people with disability.Objective/hypothesisThe primary aim of this paper is to investigate the mediator and moderator effects of self-esteem on the relationship between stigma perception and social alienation of people with disability.MethodsThe participants were 129 adults with disability (80 males and 49 females) from eight communities in China. Data was collected by using the stigma perception scale, self-esteem scale, social avoidance scale, social anxiety subscale of the self-consciousness scale, and loneliness scale. Each item is rated on a 5-point scale (1 = “strongly disagree” to 5 = “strongly agree”).ResultsStigma perception was positively correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), and loneliness (p < 0.001). Self-esteem was inversely correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), loneliness (p < 0.001), and stigma perception (p < 0.001).ConclusionsSelf-esteem partially mediated the relationship between stigma perception and social avoidance, social anxiety and loneliness. Moreover, self-esteem moderated the relationship between stigma perception and social avoidance, but not on social anxiety and loneliness.     

Preparing young adults with disability for employment

Young people with disabilities are often excluded from the labour market. The present paper describes an evaluation of an innovative 2‐year pilot initiative called Vocational Opportunities in Training for Employment (VOTE) implemented in Northern Ireland to provide employment training and support for vulnerable young adults with a wide range of disabilities. The principal aims of the study were to assess the impact of the new service in the extent to which: (1) it had created and developed training and employment opportunities for young people; and (2) promoted inclusive working partnerships. Documentary analysis was used as a basis for describing and assessing the project objectives in combination with face‐ to‐face interviews with a small number of key stakeholders. A total of 122 young people participated in the initiative in the pilot period, during which time 160 qualifications were obtained. Key stakeholders expressed positive views about the initiative, and in particular, its therapeutic benefits and the extent of interagency working and shared learning. The VOTE initiative achieved considerable success in enabling a significant proportion of young adults to engage in society by developing social and employment skills, and by improving their employment opportunities and prospects. Factors critical to the continued success of this and similar initiatives include: the close involvement of parents; addressing the concerns of local employers; the sympathetic treatment of workplace issues; and effective partnership working.     

Supporting young adults with hemiplegia: services and costs

This paper lays out the service and cost consequences of supporting a nationally representative sample of young adults with hemiplegic cerebral palsy. The total costs burden and the additional costs that accrue to the public and independent sector due to their disabilities are calculated. Most of the young adults live at home. Many lead "ordinary" lives and attend further or higher education establishments or go to work. A small number of study members, however, make intensive use of expensive, often segregated facilities such as residential homes or schools and make considerable use of other support services. In total, this group of 81 people cost just over 1 million pounds to support during the year prior to interview, 43% of which was related to their impairments. When the sample is divided into two groups, people with a combination of associated conditions are found to have hemiplegia-associated costs almost 50 times greater than those with simple hemiplegia.     

Pain intensity is associated with both performance-based disability and self-reported disability in a sample of older adults attending primary health care centers

BackgroundOlder adults' function level can be used as a predictor of future detrimental events, such as disability, reliance on others, risk of institutionalization and likelihood of death. The assessment of function at the primary health care centers using self-reported and/or performance based measures is of prime importance.ObjectiveTo determine whether personal factors, pain, depression and physical activity are associated with self-reported and performance based disability for older adults aged ≥60 years attending primary health care centers, as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and Short Physical Performance Battery (SPPB), respectively.MethodsParticipants (196 females and 55 males; mean age ± SD = 70.87 ± 7.76) had their pain, self-reported disability, performance, physical activity levels and depressive symptoms assessed. Regression analyses were performed with self-reported and performance-based disability as the dependent variable and age, sex, education, chronic conditions, depression, physical activity and pain characteristics as dependent variables.ResultsMean (SD) results for SPPB were 8.45 (2.86) and 20.06 (8.21) for WHODAS. Pain intensity, depression, pain frequency, number of chronic conditions and level of physical activity explained 44% of the self-reported disability variance. Pain intensity, age, level of physical activity, years of formal education and chronic conditions explained 37% of the performance variance. Pain intensity alone explained 27% and 18% of the self-reported and performance based disability, respectively.ConclusionFindings indicate that primary health care interventions should target pain intensity, depressive symptoms and physical activity as a means to preventing or decreasing both self-reported and performance based disability.     

我国老年视力残疾人服务需求满足度现状及关联因素分析

目的 了解老年视力残疾人服务需求满足度的现状及关联因素.方法 基于2006年全国残疾人抽样调查数据获得老年视力残疾人样本24 017例,研究人口、健康、社会、经济4个变量与健康服务需求(第Ⅰ类)、基本生存服务需求(第Ⅱ类)、环境支持性服务需求(第Ⅲ类)满足之间的关系.结果 老年视力残疾人第Ⅰ、Ⅱ、Ⅲ类服务需求满足度分别为35.1％、9.3％和4.3％.参加养老保险(OR=1.64)、居住在城市(OR=1.54)、家庭人均年收入≥5 000元(OR=1.46)是老年视力残疾人第Ⅰ类需求获得满足的有利因素;年龄在≥80岁(OR=0.90)和男性(OR=0.93)是第Ⅰ类需求获得满足的不利因素.男性(OR=1.43)、居住在城市(OR=1.15)、鉴定为二级(OR=1.36)和一级(OR=1.70)残疾是第Ⅱ类需求获得满足的有利因素;年龄在15～59岁(OR=0.57)和≥60岁(OR=0.45)、家庭人均年收入在1 000～1 999元(OR=0.77)、2 000 ～4 999元(OR=0.58)和≥5 000元(OR=0.39)是第Ⅱ类需求获得满足的不利因素.居住在城市(OR=1.23)、鉴定为二级(OR=1.38)和一级(OR=1.34)残疾、参加养老保险(OR=1.62)和家庭人均年收入≥5 000元(OR=1.42)是第Ⅲ类需求获得满足的有利因素.结论 老年视力残疾人的满足程度普遍偏低,家庭收入水平、社会保险参与状况、年龄、残疾发现年龄、居住地、性别、残疾等级、婚姻、受教育程度是服务需求获得满足的重要关联因素.     

Factors influencing participation among adults aging with long-term physical disability

BackgroundPeople aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD.ObjectiveThis study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions.MethodsA cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45–65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD.ResultsA total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation.ConclusionsPeople AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.     

How adults with a profound intellectual disability engage others in interaction

Using video records of everyday life in a residential home, we report on what interactional practices are used by people with severe and profound intellectual disabilities to initiate encounters. There were very few initiations, and all presented difficulties to the interlocutor (support staff; the recording researcher); one (which we call ‘blank recipiency’) gave the interlocutor virtually no information at all on which to base a response. Only when the initiation was of a new phase in an interaction already under way (for example, the initiation of an alternative trajectory of a proposed physical move) was it likely to be successfully sustained. We show how interlocutors responded to initiations verbally, as if to neuro‐typical speakers – but inappropriately for people unable to comprehend, or to produce well‐fitted next turns. This mis‐reliance on ordinary speakers’ conversational practices was one factor that contributed to residents abandoning the interaction in almost all cases. We discuss the dilemma confronting care workers.     

A cost function analysis of residential services for adults with a learning disability

Successive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost. The paper presents the results of a cost function analysis of a random stratified sample of staffed community facilities in England excluding London. Both costs and quality of care were found to vary greatly amongst community residential facilities. The most important factors explaining differences in cost were case-mix factors relating to client age, dependency and length of stay. Facility characteristics such as the type of building, the internal layout and the structural quality were not significant. Quality of service measures such as the extent to which care-regimes were client orientated and made use of local community services were positively and significantly associated with costs. Type of provider had no impact on costs independent of differences in case-mix and quality of care with the exception of the private for profit sector which appeared less expensive than other agencies. The shortcomings of the methods and implications of these findings for policy makers are discussed.     

ask for it: development of a health advocacy intervention for adults with intellectual disability and their general practitioners

Two per cent of people in Australia have intellectual disability and the adults in this population often have poor health status. This poor health can be partly attributed to communication difficulties encountered by people with intellectual disability and also health professionals in consultation settings. The design and development processes of an educational intervention to improve communication between patients, general practitioners (GPs) and also advocates in a population of adults with intellectual disability are described. The design process was collaborative and involved adults with intellectual disability, GPs, parents, support workers and other professionals. It was a nine-step development process and led to the final communication tool package, the ask (advocacy skills kit) 5-year health diary and educational session. As a result of the collaborative design and development processes, this diary included qualities not found in most other medical record keeping systems: visual appeal, advice on how to be a health advocate, utility for a range of users, privacy, portability and sufficient capacity to record personal patient information which enhanced communication between doctor, patient and advocate. It is proving to be very popular. Clear implications were found for applying established criteria and incorporating the needs of users in the design of educational interventions in the intellectually disabled population. Health promotion tools aiming to improve the current poor health status of adults with intellectual disability should be developed further.     

Activities of daily living in persons with intellectual disability: Strengths and limitations in specific motor and process skills

As there is a wide range of abilities among clients with intellectual disability, occupational therapists should use assessments of activities of daily living that specify clients' strengths and limitations to guide and target interventions. The aim of the present study was to examine if activities of daily living performance skills differ between adults with mild and moderate intellectual disability. Three hundred and forty-eight participants with either mild intellectual disability ( n  = 178) or moderate intellectual disability ( n  = 170) were assessed using the Assessment of Motor and Process Skills to examine the quality of their activities of daily living skills. The overall activities of daily living motor and activities of daily living process hierarchies of skill item difficulties remained stable between groups. Although participants with moderate intellectual disability had more difficulty overall with activities of daily living motor and activities of daily living process skills, they were able to carry out some of these activities equally as well as participants with mild intellectual disability. The findings are discussed in relation to the planning of specific interventions to improve the ability of clients with intellectual disability to carry out activities of daily living.     

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain

Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.     

The difference between disability and impairment: A distinction worth making

American employers pay far too much for workplace disability. In part, disability expenditures continue to increase because key decision-makers in work organizations do not understand the difference between impairment and disability. Impairment is a medical issue. Disability is a non-medical concept; a vocational issue. Disability can be managed like any other vocational problem. Managing disability in the workplace is a function of employer commitment and planned team effort. Managing disability can save employers substantial costs.     

Declines in late-life disability: the role of early- and mid-life factors

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.     

Role of weight history on functional limitations and disability in late adulthood: the ARIC study

OBJECTIVE: To examine associations of weight history with functional limitations and disability in white and African-American men and women. RESEARCH METHODS AND PROCEDURES: Data were from the Atherosclerosis Risk in Communities study (n = 11,177). Associations of recalled weight status at age 25 and weight change from age 25 to ages 45 to 64 with functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at follow-up (ages 52 to 75) were examined using logistic regression. RESULTS: Obesity (BMI > or = 30 kg/m2) at age 25 was associated with functional limitations and ADL and IADL impairment at follow-up in white and African-American men and women. For example, obese compared with normal weight (BMI, 18.5 to 24.9 kg/m(2)) white women had higher odds of mild [odds ratio (95% confidence interval), 1.97 (1.18 to 3.29)] and severe [9.81 (5.92 to 16.27)] functional limitations and ADL [3.48 (2.36 to 5.13)] and IADL [2.95 (2.00 to 4.33)] impairment. In African-American women, obesity was associated with higher odds of mild [2.71 (1.14 to 6.41)] and severe [6.01 (2.53 to 14.26)] functional limitations and ADL [1.82 (1.10 to 3.00)] and IADL [2.39 (1.47 to 3.90)] impairment. Similar associations were found in men. Compared with weight maintenance (+/-10 lbs), large weight gain (>30 lbs) from age 25 to ages 45 to 64 was also associated with functional limitations and ADL and IADL impairment in white and African-American men and women. DISCUSSION: Maintenance of a healthy body weight throughout adulthood may play a role in preventing or delaying the onset of functional limitations and disability, resulting in increased quality of life and decreased health care costs.