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The effect of rehabilitation service use on coping patterns over time among older adults with age-related vision loss.

OBJECTIVE: To enhance our understanding of coping and rehabilitation in the context of adaptation to disability by examining how coping may change over a two-year time period, and how different vision rehabilitation services may affect coping over time. DESIGN: Longitudinal two-wave study (baseline and two-year follow-up). SETTING: Vision rehabilitation agency. SUBJECTS: Older adults with visual impairment. METHOD: In-person interviews using structured assessments of functional vision loss and functional disability, rehabilitation service use and coping strategies. RESULTS: Ninety-five people participated in both study waves. Findings showed change in patterns of coping over the two-year period of the study, as participants adjusted to living with age-related vision loss. Although instrumental coping was the only coping mode with evidence for average change (a decrease), affective and escape/distraction strategies showed individual variation in change over time. Rehabilitation use explained variance in coping at time 2 over and above impairment status and coping at time 1. Those who used a greater number of assistive aids between time points were likely to report more instrumental coping at time 2, and those who used counselling between time points were likely to report more affective coping at the two-year follow-up. Finally, those who used more optical aids were likely to report more escape/distraction coping at time 2, whereas those who saw a low vision specialist tended to report less of this type of coping over time. CONCLUSIONS: Findings suggest that rehabilitation interventions can affect coping patterns over time, and that direction and magnitude of such an effect may depend on the type of rehabilitation received.

Adaptation, Psychological↗

Risk of cataract and history of severe diarrheal disease in southern India.

A case-control study was carried out in the state of Tamil Nadu, southern India, to examine the association between the risk of visually disabling cataract and a lifetime history of severe diarrhea (including cholera). A series of 421 subjects, aged 35 to 65 years, meeting case (n = 181) and control (n = 240) eligibility criteria were enrolled from 19 rural cataract-screening camps. Ninety case-control pairs were postmatched for (reported) age (+/- 2 years), sex, and area of residence. A history of diarrhea was obtained by using an algorithm developed by other investigators in India who have reported a strong association between cataract and diarrhea. An odds ratio of 0.8 (95% confidence limits: 0.0, 3.2) was obtained from matched pairs analysis, and an odds ratio of 1.3 (95% confidence limit: 0.6, 2.7) was obtained among all subjects (n = 392) from a logistic analysis that adjusted for age, sex, occupation, area of residence, and caste. Findings of this study do not support the hypothesis of an increased risk of visually disabling cataract in persons with a positive history of severe diarrhea.

Adult↗

Aromatherapy for deaf and deafblind people living in residential accommodation.

This article looks at ways in which aromatherapy and therapeutic massage have been found to be beneficial for a group of deaf and deafblind adults with special needs, living in residential accommodation. Our basic aim is to promote confidence and communication as well as enhancing a sense of well-being through the judicial use of aromatic plant materials and therapeutic massage. Aromatherapy sessions have become an accepted enjoyable and therapeutic part of the residents' lifestyle. It is our belief that this gentle, non-invasive therapy can benefit deaf and deafblind people, especially as their intact senses can be heightened. This paper explores both professional and caring issues related to the use of aromatherapy in this environment.

Adult↗

Audible pedestrian traffic signals: Part 1. Prevalence and impact.

A collaborative project between the San Diego Association of Governments and San Diego State University (5) evaluated the effectiveness of audible pedestrian traffic signals in aiding visually disabled and elderly persons to walk in their community with greater safety. Three aspects of audible pedestrian traffic signals were investigated: 1) the patterns of use and the impact of these signals on pedestrian traffic safety; 2) the physical characteristics of the sound emitted by the devices; and, 3) the detection of the emitted sounds in the presence of various traffic noise levels. This paper reports on the prevalence and impact of audible traffic signals were ascertained through seeking information from traffic engineers in 71 North American cities; soliciting opinions about these signals from various school officials, social agencies, and volunteer organizations that serve persons with vision impairments; and analyzing pedestrian accident rates at intersections before and after the installation of such signals. The other two aspects of the project are reported in accompanying articles (6,7) that appear in this issue of the Journal of Rehabilitation Research and Development.

Accidents, Traffic↗

Occupational injuries among workers with disabilities: the National Health Interview Survey, 1985-1994.

CONTEXT: As the baby boom generation ages, more people will be working with disabilities, but we have little information regarding how disabilities affect risk for occupational injury. OBJECTIVE: To test the hypothesis that work-limiting disabilities in general and hearing and visual impairments in particular are risk factors for occupational injuries. DESIGN: Retrospective cohort study. SETTING: The National Health Interview Survey (NHIS), 1985 to 1994. PARTICIPANTS: The 459827 participants in the NHIS from 1985 to 1994 who listed "working" as their primary activity, who were not farmers, and who were between 18 and 65 years of age. MAIN OUTCOME MEASURE: Occupational injuries in the year preceding the interview causing a residual impairment at the time of interview. RESULTS: After adjusting for occupation, self-employment, and age, occupational injury was associated with preceding work disability (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.19-1.56); blindness (OR, 3.21; 95% CI, 1.32-7.85); deafness (OR, 2.19; 95% CI, 1.17-4.12); hearing impairment (OR,1.55; 95% CI, 1.29-1.87); upper extremity impairment (OR, 1.46; 95% CI, 1.05-2.05); and arthritis (OR, 1.34; 95% CI, 1.07-1.68). Visual impairment was not associated with a significantly increased risk (OR, 1.37; 95% CI, 0.87-2.17). CONCLUSIONS: Workers with disabilities, especially sensory impairments, appear to have an elevated risk for occupational injury. Further research in the design and evaluation of improved workplace accommodations for workers with these disabilities is needed.

Accidents, Occupational↗

Vision and hearing impairment in aged care clients.

PURPOSE: To determine the frequency of sensory impairments among aged care clients. METHODS: We examined 188 persons aged 65-99 years being evaluated for aged care services at a geriatric assessment center, west of Sydney, Australia. Visual acuity was measured using a LogMAR chart. Visual impairment was defined in the better eye: mild < 20/40 to > or = 20/80, moderate < 20/80 to > or = 20/200, and severe < 20/200. Hearing function was assessed by portable pure-tone air-conduction audiometry. Hearing loss was defined using average hearing thresholds in the better ear: mild > 25 to < or = 40 decibels (dB), moderate > 40 to < or = 60dB, and severe > 60dB. RESULTS: Vision, hearing, or both were randomly tested in 96, 93, and 49 aged care clients, respectively. Vision impairment was found in 30.2% of clients. Distance vision could be improved with pinhole in 16.7% of 84 clients with presenting VA < 20/20. Moderate to severe hearing loss was present in 50.5%. Combined sensory impairment was detected in 22.5% of persons having both tests. The age-standardized proportions with vision impairment was 25.6%, higher than the rate (17.4%) found in the Blue Mountains Eye Study (BMES) community population, but lower than the 37.7% prevalence reported from the BMES nursing home sample. Hearing impairment was also more common in aged care clients (28.1% vs 17.5%). CONCLUSIONS: This study suggests a high prevalence of sensory impairment among older persons transitioning from independent community living to institutionalized care.

Aged↗

Recent trends in disability and functioning among older adults in the United States: a systematic review.

CONTEXT: Several well-publicized recent studies have suggested that disability among older Americans has declined in the last decade. OBJECTIVES: To assess the quality, quantity, and consistency of recent evidence on US trends in the prevalence of self-rated old age disability and physical, cognitive, and sensory limitations during the late 1980s and 1990s and to evaluate the evidence on trends in disparities by major demographic groups. DATA SOURCES: We searched MEDLINE and AGELINE for relevant articles published from January 1990 through May 2002 and reviewed reference lists in published articles. STUDY SELECTION: From more than 800 titles reviewed, we selected 16 articles based on 8 unique repeat cross-sectional and cohort surveys of US prevalence trends in disability or functioning among persons generally aged 65 or 70 years or older. DATA EXTRACTION: We evaluated survey quality according to 10 criteria, ranked the surveys as good, fair, or poor, and calculated for each outcome the average annual percent change. DATA SYNTHESIS: Among the 8 surveys, 2 were rated as good, 4 as fair, 1 as poor, and 1 as mixed (fair or poor, depending on the outcome) for assessing trends. Analyses of surveys rated fair or good showed consistency of declines in any disability (-1.55% to -0.92% per year), instrumental activities of daily living disability (-2.74% to -0.40% per year), and functional limitations. Surveys provided limited evidence on cognition and conflicting evidence on self-reported ADL (changes ranged from -1.38% to 1.53% per year) and vision trends. Evidence on trends in disparities by age, sex, race, and education was limited and mixed, with no consensus yet emerging. CONCLUSIONS: Several measures of old age disability and limitations have shown improvements in the last decade. Research into the causes of these improvements is needed to understand the implications for the future demand for medical care.

Activities of Daily Living↗

Patients' perception of visual impairment in glaucoma: a pilot study.

BACKGROUND/AIMS: There is a paucity of useful information on the level of visual disability suffered by glaucoma patients. The aims of this study were to determine and rank the frequency of self reported visual disability in daily tasks performed by glaucoma patients; to examine the interrelation between disabilities using factor analysis; to study the relation between perceived visual difficulty and a measure of the severity of visual field loss; to develop a glaucoma specific subgroup of questions; and examine the validity and reliability of this subgroup of questions. METHODS: 63 glaucoma patients completed a questionnaire containing 62 questions covering 10 broad aspects of daily life activities using a five point answer scale. Patients were classified into three groups as having mild, moderate, and severe field loss on the basis of the perimetric results. The relation between a measure of the severity of visual field loss and subjective visual disability in the three groups was examined. RESULTS: Using factor analysis, the most frequently reported problems were grouped into the following four categories: outdoor mobility, glare and lighting conditions and activities demanding functional peripheral vision, household tasks, and personal care. These four factors accounted for 72% of the variability in the patients' questionnaire responses. With increasing severity of binocular visual field loss there was an increase in the number of self reported visual problems. A loss of confidence in performing some routine daily tasks tended to precede self reported specific visual disabilities. The factor "glare and lighting and activities demanding functional peripheral vision" was found to have a significant relation with a measure of visual field loss and was used to create a glaucoma specific subset of questions. Cronbach's alpha showed a high degree of reliability and internal consistency (alpha =0.96) in this glaucoma specific subset of questions. Furthermore, the validity of this new subset of questions was shown to be significant (r=0.037, p<0.05) for the correlation between a measure of the severity of binocular visual field loss and the mean score of the variables used in the glaucoma specific subgroup of questions. CONCLUSIONS: Outcome measures and quality of life issues need to be addressed in glaucoma. This pilot study identified common problems encountered by patients which at the present time are not assessed in routine glaucoma care. It also identified a subgroup of questions that seems to be specific for glaucoma. Further research is required if a significant impact on the quality of life of glaucoma patients is to be achieved.

Aged↗

Continuation of benefit payments to certain individuals who are participating in a program of vocational rehabilitation services, employment services, or other support services. Final rule.

We are publishing final rules that amend the rules for the continuation of disability benefit payments under titles II and XVI of the Social Security Act (the Act) to certain individuals who recover medically while participating in an appropriate vocational rehabilitation (VR) program with a State vocational rehabilitation agency. We are amending these rules to conform with statutory amendments that extend eligibility for these continued benefit payments to certain individuals who recover medically while participating in an appropriate program of services. These include individuals participating in the Ticket to Work and Self-Sufficiency Program or another program of vocational rehabilitation services, employment services, or other support services approved by the Commissioner of Social Security. We are also extending eligibility for these continued benefit payments to students age 18 through 21 who recover medically, or whose disability is determined to have ended as a result of an age-18 redetermination, while participating in an individualized education program developed under the Individuals with Disabilities Education Act with an appropriate provider of services. Providers of services we may approve include a public or private organization with expertise in the delivery or coordination of vocational rehabilitation services, employment services, or other support services; or a public, private or parochial school that provides or coordinates a program of vocational rehabilitation services, employment services, or other support services carried out under an individualized program or plan.

Adolescent↗

Malocclusions and traumatic injuries in disabled schoolchildren and adolescents in Kuwait.

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special-needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3-20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51-3.52), those of increasing age (OR = 1.1; 95% CI = 1.01-1.10), and males (OR = 1.5; 95% CI = 1.05-2.07) had higher risk for the occurrence of severe malocclusion. Less than one-fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17-2.77) and increasing age (OR = 1.2; 95% CI = 1.13-1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.

Adolescent↗