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PubMed2000

Healthy ageing is associated with reduced and delayed disability.

OBJECTIVE: to identify subgroups within the population with reduced or delayed disability during healthy ageing. DESIGN: a longitudinal, community-based study. SETTING: Dubbo, New South Wales, Australia. PARTICIPANTS: 2805 men and women 60 years and older, first examined in 1988-89. OUTCOME MEASURES: activities of daily living assessed serially every 2 years over 8 years (scored in the range 0-6, least to most impaired); scores related to subsequent hospital admissions and to demographic, clinical and psychosocial characteristics at baseline. RESULTS: 1973 men and women provided complete follow-up data. Mean disability score at entry was low at 0.18 and increased to 0.69 by the final survey. Those having three or more hospital admissions (40% of the sample) had minimum disability (disability score approximately 0.3) around 5 years earlier than those with fewer admissions. Those with dementia or other mental illness had the most severe disability (mean disability scores of 3.15 and 2.13 respectively), but their numbers were very small. Those with a stroke or respiratory illness were more numerous and they had major physical disability (mean disability scores of 1.44 and 1.32 respectively). In a regression model, the statistically significant baseline predictors of disability at the final survey were age, body mass index, use of anti-hypertensive medication, history of stroke, depression score, peak expiratory flow and physical disability. CONCLUSIONS: the findings confirm reduced or delayed disability in older citizens requiring little or no hospitalization. Age, impaired peak expiratory flow and physical disability at study entry were most strongly predictive of disability, while stroke and respiratory illness were relatively common causes of severe disability.

Aged↗

PubMed1995

Physical disability in older runners: prevalence, risk factors, and progression with age.

BACKGROUND: Concern exists that certain types of exercise, particularly vigorous activity, may increase physical disability among older individuals. We investigated the prevalence of, and risk factors for, physical disability in active older persons (runners), and examined factors influencing the progression of physical disability with age. METHODS: Physical disability, measured using the Health Assessment Questionnaire Disability Index, was assessed prospectively in 454 runners, age 50 or greater, over five to seven years by annual mailed questionnaires. Baseline sociodemographic, clinical, and life-style characteristics associated with the presence of any disability over the course of the study were determined and contrasted with those in 292 older non-runners who had been similarly followed. RESULTS: Two hundred twenty-two runners (49%) reported some physical disability during the study. The presence of arthritis symptoms at baseline was the most important risk factor for physical disability; older age, greater body mass index, strenuous work-related physical activity, and the use of more medications were also associated with a greater likelihood of physical disability. Among the non-runners, 224 (77%) reported some physical disability, and the presence of arthritis symptoms was also the most important risk factor for physical disability in this group. Age-related changes in physical disability differed between those with and without arthritis symptoms in both the runner and non-runner groups. CONCLUSIONS: The presence of arthritis symptoms was an important risk factor for physical disability among both older runners and non-runners, and also identified subgroups of individuals with different progressions of disability with age.

Age Factors↗

PubMed2000

Disabled people and professionals differ in their perceptions of rehabilitation needs.

BACKGROUND: This study set out to explore whether there are systematic differences in unmet needs for rehabilitation services and resources as identified by disabled people and nominated key professionals. METHODS: A cross-sectional interview survey of 87 pairs of community-dwelling disabled people (aged 16-65) and their nominated key professionals was conducted in southern England. The Southampton Needs Assessment Questionnaire (SNAQ) was used to examine unmet needs and the Office of Population Censuses and Surveys (OPCS) Disability and Severity Scale to examine level of disability. RESULTS: Eighty-seven pairs of disabled people and their nominated key professionals participated. People were severely disabled (median OPCS score 8; interquartile range 6-9). Disabled participants reported significantly more unmet needs than did professionals. There was zero concordance on identified unmet needs between disabled participants and professionals in 56 per cent of cases. Concordance between disabled participants and professionals was significantly better if the disabled participant had reported more unmet needs. There was a trend for general practitioners to be poorer at reporting disabled participants' needs than other professionals. There was fair agreement between disabled participants and professionals in five areas of unmet need only (in descending order): adaptations, physiotherapy, equipment, assistance with 'non-care' activities and the use of a day centre. In all the other areas of unmet need the agreement was poor. CONCLUSIONS: Needs for rehabilitation services and resources (for disabled people) are perceived differently by disabled people and professionals. Until we know who is right about rehabilitation needs, it is important to determine both users' and providers' views when planning and commissioning services.

Adolescent↗

PubMed2003

Familial disability patterns in individuals with chronic work-related spine injury/illness.

STUDY DESIGN: A case control study of familial disability patterns and other potential risk factors identified in a group of individuals with work-related spine injury/illness. OBJECTIVES: The objective of the present study is to provide information on the relationship between a disabled family member and work-related spine injuries or illnesses leading to disability among another family member. SUMMARY OF BACKGROUND DATA: Extensive studies have been conducted to identify the medical and nonmedical factors associated with prolonged disability after work-related spine injury/illness. Many of the relevant nonmedical factors are psychosocial and are dependent to some degree on family of origin environment and experience. Although similar recurring pain behaviors have been described in certain families, no recent study has been conducted of coexisting family disabilities in individuals with work-related spine injury/illness. METHODS: A case-control investigation examining nine potential risk factors, including familial disability patterns, for the development of disability following work-related spine injury/illness was conducted. The case group (n = 88) consisted of individuals disabled from any and all gainful employment, whereas the controlled group (n = 40) continued working in spite of their spine complaints. RESULTS: In this study, gender, number of spinal areas involved, current injury considerations/severity, and having a primary family member or spouse similarly disabled were found to be significant predictors of disability following work-related spine injury/illness. However, further analysis revealed that having an associated family disability was the greatest predictor of disability in the study group. CONCLUSIONS: These data suggest that the presence of a primary family member or spouse with a work-related spine disability may be a risk factor for the development of disability in individuals sustaining a work-related spine injury.

Adult↗

PubMed2006

Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample.

STUDY DESIGN: Prospective, population-based cohort study. OBJECTIVES: To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability. SUMMARY OF BACKGROUND DATA: Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively. METHODS: Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers' Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained. RESULTS: At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6-13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5-6.5) were significant independent predictors. CONCLUSIONS: Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.

Adolescent↗

PubMed2000

The protective effect of emotional vitality on adverse health outcomes in disabled older women.

OBJECTIVE: Although the adverse physical health consequences of negative emotions have been studied extensively, much less is known about the potential impact of positive emotions. This study examines whether emotional vitality protects against progression of disability and mortality in disabled older women. DESIGN: A community-based study, The Women's Health and Aging Study. PARTICIPANTS: A total of 1002 moderately to severely disabled women aged 65 years and older living in the community. MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. The onset of new disability was determined by semiannual assessments of disability in performing activities of daily living (ADLs), walking across a room, walking 1/4 mile, and lifting/carrying 10 pounds. Mortality status was determined by proxy interviews and linkage with death certificates. Survival analyses with time to onset of specific disabilities (among those not disabled at baseline) and time to mortality were performed and adjusted for age, baseline level of difficulty, physical performance, and chronic conditions. RESULTS: Three hundred fifty-one of the 1002 older disabled women studied were emotionally vital. Among women without the specific disability at baseline, emotional vitality was associated with a significantly decreased risk for incident disability performing ADLs (RR = 0.81, 95% CI = 0.66-0.99), for incident disability walking one-quarter mile (RR = 0.73, 95% CI = 0.59-0.92), and for incident disability lifting/carrying 10 pounds (RR = 0.77, 95% CI = 0.63-0.95). Emotional vitality was also associated with a lower risk of dying (RR = 0.56, 95% CI = 0.39-0.80). These results were not simply caused by the absence of depression since protective health effects remained when emotionally vital women were compared with 334 women who were not emotionally vital and not depressed. CONCLUSIONS: Emotional vitality in older disabled women reduces the risk for subsequent new disability and mortality. Our findings suggest that positive emotions can protect older persons against adverse health outcomes.

Activities of Daily Living↗

PubMed2002

Tobacco use among adults with disabilities in Massachusetts.

OBJECTIVES: To examine the characteristics of smoking among adults with disabilities in Massachusetts. DESIGN: Data were obtained from the 1996-1999 Massachusetts Behavioral Risk Factor Surveillance System, a random digit dial telephone survey. Respondents reporting use of special equipment or a limitation caused by impairment or health problem were classified as having a disability. Adults with disabilities were further classified by level, based on need for assistance, and type of disability. Logistic regression models were used to assess the association between disability status and smoking. SETTING AND PARTICIPANTS: Random sample of non-institutionalised Massachusetts adults, 18 and older, with disabilities (n = 2985) and without disabilities (n = 14 395). MAIN OUTCOME MEASURES: Smoking status, intensity, and factors related to quitting. RESULTS: Compared to those without disabilities, adults with disabilities were more likely to have ever smoked (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.25 to 1.61) and to be current smokers (OR 1.52, 95% CI 1.32 to 1.76). Smoking rates varied by type of disability. Among current smokers, adults with disabilities smoked more cigarettes per day (OR 1.65, 95% CI 1.31 to 2.16), sooner after waking (OR 1.50, 95% CI 1.13 to 1.99), and were more likely to be advised by a doctor to quit (OR 2.07, 95% CI 1.60 to 2.69). Adults with disabilities who needed assistance were more likely to be planning to quit (OR 1.50, 95% CI 0.99 to 2.26). CONCLUSIONS: There are disparities in smoking rates between adults with and without disabilities. Smoking cessation programmes targeted to the disabled community are needed.

Adolescent↗

PubMed1995

Methodological issues in a disablement prevalence study: Mitchells Plain, South Africa.

The Mitchells Plain Disability Survey was undertaken primarily to expand a community-based rehabilitation programme in an underprivileged South African urban community. This descriptive survey used a proportional stratified random cluster sampling strategy (sample size 2424), with stratification by suburb and clusters consisting of 15 adjacent plots. A household screening questionnaire (based on the WHO disability questionnaire), identified people who reported health problems affecting their functional ability, while a second follow-up interview confirmed disablement status and obtained a medical, disablement and demographic profile of the disabled and ascertained their needs. This paper discusses different methodological issues related to the survey design and emphasizes the need for standardization of methods in the disablement field. Sampling issues include sample loss in a multi-staged data collection strategy as well as the non-independence of observations when sampling entire house- holds. The trade-off between studying disability across diagnostic, disablement and age categories, and wide confidence intervals for specific prevalence rates, is discussed. Because of the prohibitive costs validation of disablement status is often omitted in a low-budget project (as this one was), weakening the design of such studies. Even if the 'disabled' are correctly identified, the criteria for identifying respondents determine what type of disablement prevalence will be obtained, Different diagnoses reported on screening yielded different positive predictive values of disability--the most debilitating conditions yielding the highest proportion of disabled people. The quality of the data--evaluated through comparisons of initial and repeat screening interviews, and proxy and self-reporting--is described. There is a need for disability research to continue developing suitable methods for a wide range of purposes. One such is a 'good-enough' survey design which can be implemented rapidly, at relatively low cost, to yield useful results at local level.

Activities of Daily Living↗

PubMed2002

[Competitiveness in sports activities of the psychiatrically disabled].

In 2002, psychiatrically disabled athletes joined an historic first open game of volleyball at the national sports games for the disabled. Compared to the competitive sports and Paralympic Games that physically and intellectually disabled athletes have participated in, activities for the psychiatrically disabled have not been well-organized. In this paper, we examine a number of problems that have arisen when the psychiatrically disabled joined competitive sports games. We identify two major characteristics of the psychiatrically disabled of particular relevance when organizing competitive sports activities. First, all psychiatrically disabled athletes need treatment of their individual diseases. For example, psychiatric symptoms fluctuate markedly over time, unlike physical or intellectual disabilities, whose symptoms are much more stable. Exacerbations of psychiatric illness are also likely to occur due to the stresses of competitiveness. Second, psychiatric disabilities are manifestations of disorders in the central nervous system, which makes the classification of psychiatric disabilities less straightforward than classification of the physically disabled. These two characteristics require special attention when organizing competitive athletic challenges that include the psychiatrically disabled. However, promoting sports activities that include the psychiatrically disabled would be expected to reduce the prejudice toward and subsequent social disadvantages experienced by psychiatric patients. Thus, with careful planning to successfully integrate psychiatrically disabled athletes, we expect increased promotion of such sports activities in the future.

Competitive Behavior↗

PubMed1991

The demographics of disability.

In this article, I have attempted to clarify some of the disparate estimates and ways of measuring disability that have been used in different surveys. The definitional issue has implications for the size of the population that will be covered by the ADA. I have reviewed several perspectives, including that of researchers, disability advocates, and individual self-perceptions, which need to be considered in understanding the meaning of disability. Disability involves limitations in actions and activities because of mental and physical impairments. Comparison of these different perspectives reveals that the differences lie in the range of activities that are considered. At least 36 million persons, over 14 percent of the U.S. population, are limited in selected activities. Depending on what are considered to be major life activities, the population covered by the ADA could vastly exceed that figure. Little information is available about the extent to which persons with disabilities, however defined, are affected by discrimination and unequal treatment. Limited data are available from one survey conducted by the International Center for the Disabled, which indicate that as many as 66 percent of persons with activity limitations who are not working would like a job. On the other hand, many persons with activity limitations indicate that their limitations are an important cause of their unemployment. About a quarter of persons with activity limitations due to impairments have experienced discrimination in some form. The impact of the ADA will likely vary by impairment. Because the prevalence of chronic diseases is far greater than the prevalence of physical and sensory impairments, chronic diseases are more frequently the cause of disability. The risk of disability is highest for impairments with low prevalence. Because states and local areas differ in the prevalence of disability, the impact of the ADA will also be likely to vary by geographic area. For some states, the rate of work disability is more than twice the rate of other states. Yet, research indicates that much of the variation is due to socioeconomic characteristics of areas. This reflects, at the macroeconomic level, that persons with disabilities are more likely to be poor and less educated than persons without disabilities. Because of differences in understanding what disability is and insufficient knowledge about the extent of the problem of discrimination toward persons with disabilities, assessment of the potential impact of the ADA is challenging.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗

PubMed1998

The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients.

OBJECTIVE: Work disability is a common outcome of rheumatoid arthritis (RA). Yet there have been no longitudinal, longterm, prospective studies of work disability in this illness. This 18 year longitudinal study investigates the rate of work disability, its concomitants, and its predictors, using a large series of clinical, laboratory, and self-report measures. METHODS: In 1974, a computerized database was developed for the contemporaneous entry of all patient visits. Data included clinical, laboratory, and self-report information. Patients were also assessed by mailed questionnaires at 6 month intervals. In 1994, patients with RA were interviewed in detail about lifetime work status and work disability. RESULTS: Work disability was estimated to occur in 25% at 6.4 years and 50% at 20.9 years after disease onset, and most disability occurred late in the course of disease. Work disability was predicted by almost every demographic and clinical variable. Education level, body mass index (BMI), erythrocyte sedimentation rate, rheumatoid factor, pain, Health Assessment Questionnaire (HAQ) disability, and physical demands of the job were independently associated with disability. Over the course of their illness, the work disabled had a 35% reduction in family income, and had more abnormal scores for joint counts, grip strength, sedimentation rate, pain, global severity, HAQ disability, and anxiety and depression. Except for BMI, the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year. CONCLUSION: Work disability can be predicted by patient and work characteristics present at the first clinic visit, but it is persistent abnormalities of sedimentation rate, HAQ disability, and pain, which may be detected in longitudinal followup, that best predict work disability after work and demographic characteristics are accounted for.

Adult↗

PubMed1992

Neuropsychological and socio-emotional correlates of specific-arithmetic disability.

Neuropsychological and socio-emotional factors associated with specific-arithmetic disability were investigated in an unselected sample of New Zealand children. Subjects were 17 specific-arithmetic disabled, 27 specific-reading disabled, 63 generally disabled, and 50 nondisabled 13 year olds. Evidence was sought for an association between specific-arithmetic disability and the neuropsychological and socio-emotional correlates of Nonverbal Learning Disability syndrome (NLD). NLD is characterized by a pattern of nonverbal and verbal neuropsychological strengths and weaknesses, and appears to place individuals at greater risk for internalizing psychopathology, than other learning disabilities. Only specific-arithmetic disabled subjects were found to show a neuropsychological profile reminiscent of NLD. Evidence of poor socio-emotional adjustment was found across all three learning-disabled groups, and was greatest among generally disabled subjects. We found that the specific-arithmetic-disabled subjects exhibited the greatest degree of overlap between internalizing psychopathology and a NLD neuropsychological profile. The results are interpreted as providing some support for the idea that specific-arithmetic-disabled individuals may be at greater risk for the NLD syndrome than either generally disabled or specific-reading-disabled individuals.

Journal Article↗

PubMed2004

[Disability due to mental and behavioural disorders in Iceland.].

AIMS: To determine the prevalence of disability in Iceland on December 1st 2002 due to mental and behavioural disorders according to gender, place of residence and marital status and main subcategories. MATERIAL AND METHODS: The disability register of the State Social Security Institute was used to obtain information on the number, gender, age, place of residence, marital status and main diagnosis of recipients of disability pension. From Statistics Iceland the same information was obtained for the Icelandic population between the age of 16 and 66. RESULTS: The prevalence of disability due to mental and behavioural disorders was 2.32% for females and 1.98% for males. For males receiving disability pension the proportion having mental disorders as the main cause of disability was larger than for females. Among females the most common cause of disability was mood disorders whereas among males it was schizophrenia, schizotypal and delusional disorders. Most of those with schizophrenia, schizotypal and delusional disorders in Iceland receive full disability pension. The prevalence of disability due to mental and behavioural disorders was significantly higher in the capital region than in the rest of the country. Marriage and registered co-habitation was considerably less common among recipients of disability pension due to mental and behavioural disorders than among the nation in general. CONCLUSION: The prevalence of disability due to mental and behavioural disorders in the capital region is in excess of what is to be expected from the prevalence of these disorders and from disability in general in Iceland. The relatively high prevalence of disability due to mental and behavioural disorders among males is in line with epidemiological data. The prevalence of disability due to mental and behavioural disorders in Iceland has been rising. This needs to be addressed by improving vocational rehabilitation programs for those suffering from these disorders.

English Abstract↗

PubMed2001

[Educational level, occupation and income of those who became disability pensioners in Iceland in the year 1997.].

INTRODUCTION: All claims for disability benefits in Iceland are managed by the State Social Security Institute of Iceland. The decision to grant a claimant disability benefits was until September 1999 mainly based on medical certificates but social and economic factors were also taken into consideration. As information on social and economic conditions in medical certificates is limited it was decided to investigate these factors particularly. In this paper a comparison of educational level, employment, and income is made between new recipients of disability benefits and a random sample of the Icelandic nation. MATERIAL AND METHODS: All new recipients of disability benefits (full disability pension, partial disability pension and rehabilitation pension) in 1997 were contacted by phone and asked to answer a questionnaire. Their answers were compared with those obtained in a national survey carried out by the Institute of Social Sciences at the University of Iceland in 1996 and 1997 with a sample representing accurately the Icelandic population in terms of gender, age and place of residence. Information about average income of disability pensioners was obtained and compared to that of people in employment. RESULTS: Educational level of those receiving disability benefits was considerably lower than expected in comparison with the population and unskilled workers were overrepresented. Contrary to what might be expected a larger proportion of the recently disabled have been employed at some time than is the case for the national sample, even though 63.6% of the new disability pensioners were women. Considerable number of those receiving disability benefits were still in employment, particularly those with partial disability pension. Mean monthly income of Icelanders participating in the labour market was almost twice that received by those on disability benefits. CONCLUSIONS: Since lower educational level and more restricted employment opportunities characterize disability pensioners as compared to the nation, it seems likely that more varied occupational rehabilitation and educational opportunities could improve the situation of those who have had to leave the labour market because of ill health, lack of education and poor working conditions.

English Abstract↗

PubMedDate not supplied

Overestimation of chronic disability among elderly persons.

BACKGROUND: Although there is no generally accepted definition for the term short-term disability, chronic disability has been defined as disability lasting or expected to last at least 90 days according to a protocol that was established by the National Long-Term Care Survey. We evaluated the validity of the established protocol and determined the accuracy of prevalence estimates of chronic disability among elderly persons in the United States. METHODS: Chronic disability was ascertained during a comprehensive assessment using the established protocol. Participants were subsequently classified as having chronic disability (the gold standard) based on the presence of disability during consecutive monthly interviews immediately before or after the comprehensive assessment. RESULTS: Of the 552 participants, 120 (21.7%) met criteria for chronic disability according to the established protocol. Of these, 30 (25.0%) and 39 (32.5%) did not meet criteria according to the gold standard under assumptions that were favorable and unfavorable (ie, stringent) to the established protocol, respectively. Conversely, of the 95 participants (17.2%) who met the gold standard criteria for chronic disability according to the favorable strategy and the 89 (16.1%) who met the criteria according to the stringent strategy, 5 (5.3%) and 8 (9.0%), respectively, did not meet criteria for chronic disability according to the established protocol. Relative to the established estimate of 7.0 million, our projections yielded about 2.0 million fewer chronically disabled elderly Americans in 1999. CONCLUSION: Our results threaten the validity of the currently established protocol for ascertaining chronic disability and suggest that the burden of chronic disability among elderly Americans has been substantially overestimated.

Activities of Daily Living↗

PubMed2004

Effects of illness and disability on job separation.

Effects of illness and disability on job separation result from both voluntary and involuntary processes. Voluntary processes range from the reasoned actions of workers who weigh illness and disability in their decision-making, to reactive stress-avoidance responses. Involuntary processes include employer discrimination against ill or disabled workers. Analyses of the effects of illness and disability that differentiate reasons for job separation can illuminate the processes involved. This paper reports on an evaluation of effects of illness and disability on job separation predicted by theories of reasoned action, stress, and employer discrimination against ill and disabled workers. Effects of four illness/disability conditions on the rate of job separation for 12 reasons are estimated using data from a longitudinal study of a representative sample of the Canadian population-the Survey of Labour and Income Dynamics (SLID). Two of the four effects that are statistically significant (under conservative Bayesian criteria for statistical significance) are consistent with the idea that workers weigh illness and disability as costs, and calculate the costs and benefits of continuing to work with an illness or disability: (1) disabling illness increases the hazard of leaving a job in order to engage in caregiving, and (2) work-related disability increases the hazard of leaving a job due to poor pay. The other two significant effects indicate that: (3) disabling illness decreases the hazard of layoff, and (4) non-work disability increases the hazard of leaving one job to take a different job. This last effect is consistent with a stress-interruption process. Other effects are statistically significant under conventional criteria for statistical significance, and most of these effects are also consistent with cost-benefit and stress theories. Some effects of illness and disability are sex and age-specific, and reasons for the specificity of these effects are discussed.

Adolescent↗

PubMed1998

Chronic conditions and disabilities among seniors: an analysis of population-based health and activity limitation surveys.

PURPOSE: To describe the prevalence of disabilities and the medical conditions and risk factors associated with mobility and agility disabilities among seniors. METHODS: In the 1986 and 1991 Canadian Census, every fifth person answered a screening question about activity limitation and disabilities. A probability sample of both those reporting and not reporting disability was selected to complete the Health and Activity Limitations Surveys (HALS) in 1986 and 1991. These two cross-sectional surveys conducted five years apart collected detailed activity limitation information about persons over 15 years of age. The current analysis was based on only respondents aged 65 years and older. The sample size for 65 years and older was 38518 in 1986 and 5106 in 1991. A computer link with the Census data provided household income and additional socio-demographic data for all respondents. RESULTS: Over 40% of Canadian seniors reported at least one disability, and approximately a quarter of disabled seniors were classified as severely disabled. Mobility and agility disabilities accounted for over 80% of all disabilities reported by seniors, and senior women were more likely than men to report having a mobility or agility disability. Arthritis/rheumatism was reported as the cause of over 30% of all mobility and agility disabilities. CONCLUSIONS: The continued monitoring of disabilities through surveys such as HALS will help determine the prevalence as well as aid in the identification of the causes of disabilities. Such information may be used to guide the implementation of appropriate public health interventions that will meet the changing health care needs of seniors.

Activities of Daily Living↗

PubMed2002

[Comparison of expertises between long-term care insurance (SGB XI) and the law on ambulatory care for disabled individuals in Berlin (HPG)].

A long-term care insurance (SGB XI) was established in Germany in 1995. Previously, care for predominantly disabled and disabled elderly people in Berlin was regulated by a law enforced by the Berlin government (HPG). The objective of this study was to investigate the differences in age, sex, diagnosis and care of the disabled individuals at home. In a cross-sectional study, the social medicine certificates of 3.916 disabled individuals were evaluated. The certificate assesses the grade of disability and the care needed for a person entitled to benefit from either the HPG or later from SGB XI. Disabled females benefiting from the HPG and SGB XI regulations are in the majority. The male: female ratio for HPG was 1:2.215 and for SGB XI 1:2.759. The differences between male and female as well as between HPG and SGB XI are statistically significant. The even higher proportion of females for those benefiting from SGB XI is due to the demographic change over time. The results of the study also show that the certificates differ in diagnosis, in the care needed at home, and in the grades of disability. By logistic regression analysis, the univariate method shows the amount of care needed at home to be greater for the HPG than for the long-term care insurance. The collective of disabled persons benefiting from HPG were derived from the ambulatory and the stationary sector. In this study, those individuals who were investigated and supported by SGB XI originated from the ambulatory sector, although the law also supports those under hospital care. By calculating analysis of multivariate logistic regression with grades of disability taken as dependent and disability of a given person as independent variables related to the grades of disability when applying SGB XI were compared to HPG. The independent variables have different hierarchies for both laws and need to be divided into more specific subgroups. Interestingly, age and sex did not influence the grading of disability. Diseases leading to disability differ between male and females. Males suffer mostly from neurologic and psychiatric and females from orthopaedic diseases. The criteria for the particular grades are too broad and a better specification is suggested, in that the grades should be increased from three to five. For exceptional cases, a more flexible procedure should be allowed, which is possible under the present SGB XI regulations.

Adolescent↗