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PubMed2005

The definition of disabling fatigue in children and adolescents.

BACKGROUND: Disabling fatigue is the main illness related reason for prolonged absence from school. Although there are accepted criteria for diagnosing chronic fatigue in adults, it remains uncertain as to how best to define disabling fatigue and Chronic Fatigue Syndrome (CFS) in children and adolescents. In this population-based study, the aim was to identify children who had experienced an episode of disabling fatigue and examine the clinical and demographic differences between those individuals who fulfilled a narrow definition of disabling fatigue and those who fulfilled broader definitions of disabling fatigue. METHODS: Participants (aged 8-17 years) were identified from a population-based twin register. Parent report was used to identify children who had ever experienced a period of disabling fatigue. Standardised telephone interviews were then conducted with the parents of these affected children. Data on clinical and demographic characteristics, including age of onset, gender, days per week affected, hours per day spent resting, absence from school, comorbidity with depression and a global measure of impairment due to the fatigue, were examined. A narrow definition was defined as a minimum of 6 months disabling fatigue plus at least 4 associated symptoms, which is comparable to the operational criteria for CFS in adults. Broader definitions included those with at least 3 months of disabling fatigue and 4 or more of the associated symptoms and those with simply a minimum of 3 months of disabling fatigue. Groups were mutually exclusive. RESULTS: Questionnaires were returned by 1468 families (65% response rate) and telephone interviews were completed on 99 of the 129 participants (77%) who had experienced fatigue. There were no significant differences in demographic and clinical characteristics or levels of impairment between those who fulfilled the narrower definition and those who fulfilled the broader definitions. The only exception was the reported number of days per week that the child was affected by the fatigue. All groups demonstrated evidence of substantial impairment associated with the fatigue. CONCLUSION: Children and adolescents who do not fulfil the current narrow definition of CFS but do suffer from disabling fatigue show comparable and substantial impairment. In primary care settings, a broader definition of disabling fatigue would improve the identification of impaired children and adolescents who require support.

Adolescent↗

PubMed2004

Disability profile of MS did not change over 10 years in a population-based prevalence cohort.

OBJECTIVE: To assess whether the level of multiple sclerosis (MS) -related disability in the Olmsted County population has changed over a decade, and to evaluate how the rate of initial progression to moderate disability impacts further disability. METHODS: The Minimal Record of Disability (MRD) measured impairment, disability, and handicap for the 2000 (n = 201) prevalence cohort. The authors compared these results with the 1991 (n = 162) cohort; 115 patients were in both cohorts. The authors assessed retrospectively intervals at which Expanded Disability Status Scale (EDSS) scores of 3 (moderate disability), 6 (cane), and 8 (wheelchair) were reached. RESULTS: The distribution of the 2000 EDSS and MRD scores were not significantly different from the 1991 distribution. The median time from MS diagnosis, for the entire cohort, to EDSS scores of 3 and 6 was 17 and 24 years, respectively. At 20 years after onset, only 25% of those with relapsing-remitting MS had EDSS scores > or =3. The median time from diagnosis to EDSS score of 6 for the secondary and primary progressive groups was 10 and 3 years, respectively. Rate of progression from onset or diagnosis to EDSS score of 3 did not affect the rate of further disease progression. However, once an EDSS score of 3 was reached, progression of disability was more likely, and rate of progression increased. CONCLUSIONS: The distribution of multiple sclerosis disability in the Olmsted community has remained stable for 10 years. Progression of disability for patients with relapsing-remitting multiple sclerosis or secondary progressive multiple sclerosis may be more favorable than reported previously. Once a clinical threshold of disability is reached, rate of progression increased.

Adolescent↗

PubMed2000

Shakespeare on old age and disability.

The plays of William Shakespeare were reviewed for references to disabilities, aging and disability, and older characters with disabilities. Shakespeare's references draw from traditional cultural notions about older people with disabilities. These traditional notions include people with physical disabilities being evil, the entertainment value of disabilty, and those who were mentally ill being wild and animal-like. He viewed the aging process as disabling and old age as a time when individuals lost some abilities to function, particularly when it came to mental capacity and physical mobility. His writings show that he used disability as a literary tool to add dimension to characters and set them apart. Contemporary literature continues to share some of Shakespeare's view on aging and disability but also departs from them in important ways. For example, contemporary treatment of disabilities and aging places more emphasis on the human side of the affects of aging and disabilities. Disabilities and aging are not cast in the same negative terms as Shakespeare used.

Aging↗

PubMed2005

Factors associated with recovery of independence among newly disabled older persons.

BACKGROUND: Recent evidence indicates that most older persons who develop disability in their activities of daily living (ADLs) regain independent function, but many of these persons subsequently experience recurrent disability. The aims of this study were to identify independent predictors of time to and duration of recovery of independent ADL function among newly disabled community-dwelling older persons. METHODS: From a cohort of 754 persons 70 years or older, we studied the 420 participants who experienced at least 1 episode of disability involving 1 or more key ADLs (bathing, dressing, walking, or transferring) during a median follow-up of 53 months. Comprehensive evaluations at baseline and every 18 months included demographic, medical, cognitive, psychological, social, behavioral, and physical factors. Activities of daily living function and hospital admissions were assessed during monthly telephone interviews, with a completion rate of 99.4%. RESULTS: Of the 420 newly disabled participants, 342 (81.4%) recovered independent ADL function after a mean +/- SD of 4.9 +/- 0.5 months. In multivariable proportional hazards analysis, habitual physical activity, mild disability (1-2 ADLs) at onset, and hospitalization in the month of disability onset were independently associated with shorter time to recovery. Among participants who recovered, 251 (73.4%) experienced recurrent disability or death after a mean +/- SD of 7.3 +/- 8.5 months. Younger age, greater habitual physical activity, higher functional self-efficacy, and shorter duration of the prior disability episode were independently associated with longer duration of recovery. CONCLUSIONS: Habitual physical activity is an independent predictor of time to and duration of recovery of independent ADL function among newly disabled community-dwelling older persons. Because the other independent predictors for time to recovery differ from those for maintenance of recovery, different mechanisms may underlie these 2 recovery outcomes, suggesting that different interventions may be required to promote recovery than to maintain independent ADL function after recovery.

Activities of Daily Living↗

PubMed1998

A quantitative review of mortality and developmental disability in extremely premature newborns.

OBJECTIVES: To summarize the literature on mortality rates and prevalences of major neurodevelopmental disabilities and to examine trends of these outcomes over time in extremely premature neonates. DATA SOURCES: MEDLINE was used to search the English literature for studies published since 1970 reporting on both mortality and disability in infants born at or before 26 weeks' gestation (extremely immature [EI] cohort), with a birth weight of 800 g or less (extremely small [ES] cohort), or subgroups of these. STUDY SELECTION: Studies were included in the analysis if all of the following were reported: mortality; direct examination of 75% or more of the survivors; and the proportion of patients with at least 1 of the following disabilities: cerebral palsy, mental retardation, blindness, and deafness. Studies reporting cohorts included as a subset of cohorts in another study were excluded. Forty-two studies providing mortality and disability data for 20 cohorts of 4116 EI infants and 38 cohorts of 4345 ES infants born after 1972 met the inclusion criteria. DATA EXTRACTION: Data were abstracted from all studies that met these criteria by two of us (J.M.L. and D.E.W.), independently; the data were then cross-checked to ensure accuracy. RESULTS: Survival averaged 41% for EI infants and 30% for ES infants, and it increased significantly with time. In contrast to mortality, the prevalences of major neurodevelopmental disabilities among survivors have not changed over time. The most common major disability was mental retardation, found in 14% of EI and ES survivors. Cerebral palsy was found in 12% of EI survivors and 8% of ES survivors, blindness was found in 8% of EI and ES survivors, and deafness was found in 3% of EI and ES survivors. Overall, 22% of EI survivors and 24% of ES survivors were classified as having at least 1 major disability. Each 100 EI or ES livebirths yielded 7 children with major disabilities; this prevalence was correlated with survival across cohorts. CONCLUSIONS: The prevalence of disabilities had not changed among EI or ES survivors with increasing survival. However, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.

Birth Weight↗

PubMed2005

Passive coping is a risk factor for disabling neck or low back pain.

BACKGROUND: Despite evidence suggesting that coping is an important concept in the study of pain, its role in predicting the development of disabling pain has not been previously studied. To assess the relationship between coping and the development of disabling pain. METHODS: From a random sample of adults, we formed a cohort of individuals with non-disabling neck and/or low back pain (n=571). Participants were followed 6 and 12 months after the index survey. Coping was measured with the Vanderbilt Pain Management Inventory. The Chronic Pain Questionnaire was used to measure the presence of disabling neck and/or low back pain. We used Cox proportional hazards regression analyses to investigate the role of passive coping in the development of disabling pain while controlling for confounders. RESULTS: Passive coping was a strong, independent risk factor for disabling neck and/or back pain. Those using moderate to high levels of passive coping strategies were at an over five-fold increased risk of developing disabling pain (Moderate: HRR=5.19, 95% CI=1.78-15.1; High: HRR=6.80, 95% CI=2.36-19.6). Active coping was not found to be a significant risk factor for disabling neck and/or back pain. CONCLUSION: Passive coping is a strong and independent predictor of disabling neck and/or back pain. This strong relationship identifies passive coping as a marker for risk of disability and can allow for the identification of individuals at risk and in need of intervention to aid in improving their overall adjustment.

Adaptation, Psychological↗

PubMed2005

Impact of depression on disablement in late middle aged and older persons: results from the Longitudinal Aging Study Amsterdam.

The main pathway of the disablement process consists of four consecutive phases: Pathology (presence of disease/injury), Impairments (dysfunctions/structural abnormalities), Functional Limitations (restrictions in basic physical/mental actions), and Disability (difficulty doing activities of daily life, ADL). This study determines the presence of the main pathway of disablement in a cohort aged 55 years and older and examines whether progression of the main pathway of disablement is accelerated in the presence of depression. Based on baseline (T1) and two three-year follow-up interviews (T2 and T3) from the Longitudinal Aging Study Amsterdam (LASA) in a population-based cohort of 1110 Dutch persons, we first analysed the intermediate effect of the different consecutive phases of the disablement process by means of multiple regression, adjusted for covariates. Then, depression was used as interaction term in multiple regression analyses linking the consecutive phases of the disablement process. We found that Impairments mediated the association between Pathology and Functional Limitations, and that Functional Limitations mediated the association between Impairments and Disability. Depression significantly modified the associations between Pathology and subsequent Impairments, and between Functional Limitations and subsequent Disability. In sum, the main pathway of the disablement process was identified in our sample. In addition, we found an accelerating effect of depression, particularly in the early and late stages of the model. Reduction of depression may help slow down the process of disablement for persons who find themselves in those stages of the model.

Activities of Daily Living↗

PubMed2006

Incidence and risk factors of disability in the elderly: the Rotterdam Study.

BACKGROUND: This study analyzed the incidence of disability and its risk factors in multiple dimensions in community-dwelling women and men of older age, between 1990 and 1999, in Rotterdam, The Netherlands. METHODS: For this community-based prospective longitudinal study, data were obtained from the Rotterdam Study that comprised a cohort of 7983 elderly who are 55 and over. The study sample for incident disability consisted of 4258 subjects who were disability free at baseline and had complete outcome data at follow-up, 6 years later. Sociodemographic factors, lifestyle variables, health conditions and disability status were assessed at baseline and follow-up. Disability was defined as a Disability Index (DI) > or =0.50 according to the Health Assessment Questionnaire. RESULTS: Multivariate analyses, performed separately due to gender differences, revealed that age, self-rated health, overweight, depression, joint complaints, medication use were predictors of disability for both men and women. Stroke, falling and presence of comorbidities predicted disability in men only while having a partner, poor cognitive functioning, osteoarthritis and morning stiffness only predicted disability in women. CONCLUSION: Identified risk factors in this study are to some extent modifiable, enabling interventive strategies, reckoning with gender differences in risk profile, in order to prevent disability.

Age Factors↗

PubMed2002

The pediatric athlete with disabilities.

There have been increased opportunities and sports participation by athletes with disabilities during the past decades. Research on pediatric athletes with disabilities remains limited. Appropriate classification of athletes on the basis of their functional abilities is key to fair participation. Preparticipation evaluation of these athletes is based on similar principles as for able-bodied athletes. The prevalence, nature, evaluation, differential diagnosis, and treatment principles for injuries are similar for athletes with disability and for those without. There are few disability-specific medical and orthopedic issues to be considered in working with these athletes. Sport participation recommendations are based on the specific disability and demands of the sport. The vast majority of athletes with disabilities can participate safely in a number of sports if appropriately matched; such participation should be encouraged and facilitated at all levels because of well-recognized psychological and medical benefits. Significant progress has been made in increasing sports participation opportunities for persons with disabilities; this is especially true for adults and, to a lesser extent, for children and adolescents. Many barriers remain, however: inadequate facilities, exclusion of children with disabilities, medical professional overprotection, lack of trained personnel and volunteers to work with children with disabilities, lack of public knowledge about disabilities, and lack of financial support for sport and physical education in schools [9,12].

Adolescent↗

PubMed2003

Examining the disablement process among older Mexican American adults.

The Disablement Process model (Verbrugge and Jette, Social Science & Medicine 38 (1994) 1) describes a pathway leading from pathology to impairment to functional limitations, and, ultimately to disability. Components of this model have been examined among older White adults; however, very little research has examined the disablement process among older adults of other ethnic groups. Our goal in this research is to evaluate the Disablement Process model using Activities of Daily Living (ADL) disability as the outcome among a representative group of older Mexican American adults in the Southwestern United States. Respondents are from two waves of the Hispanic Established Populations Epidemiologic Study of the Elderly (EPESE) (n=2439). Structural equation models (LISREL 8.30) are utilized to examine the Disablement Process model. We also investigate aspects of the original model that have potentially important effects on the process of becoming disabled, such as cognitive impairment and perceived emotional support. Findings from structural equation models suggest that the main pathway from pathology to ADL disability is through functional limitations among older Mexican Americans. Risk factors, especially age and gender, have significant indirect effects on ADL disability. The main pathway in the Disablement Process model receives preliminary support among older Mexican Americans. We discuss implications of this model for future research.

Activities of Daily Living↗

PubMed1995

Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

BACKGROUND: Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. METHODS: This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. RESULTS: Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. CONCLUSIONS: Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.

Activities of Daily Living↗

PubMed1999

Disability in older adults. 1: Prevalence, causes, and consequences.

The effects of disability on an aging population's health and welfare are an important issue in gerontological research. The rapid growth of the elderly population and increases in longevity have led to an ongoing debate about whether longer lives can be matched by longer active lives that are free from disability. After a detailed review of current disability literature, the authors discuss the impact of disability in the elderly, defining disability and reviewing three classes of disability--physical, mental, and social. Both subjective and objective disability measures are described, and disability trends and prevalence rates are reviewed and compared cross culturally, by gender, by age, and over time. The path from chronic disease to disability is described and the consequences of living with disability are discussed in terms of family burdens and the increased need for medical care.

Activities of Daily Living↗

PubMed2005

Depression in adults with disabilities, in primary care.

PURPOSE: This research was design to answer the question: Does the prevalence of depression differ between adults with and without disability, in the same family medicine practice? METHOD: A retrospective cohort design was used, to study depression among adults, with and without primary disabling conditions, receiving primary care in either a university based urban or rural family practice setting. RESULTS: When we compared individuals with disability to those without disability, and controlled for individual characteristics, the relative risk for depression was significantly lower for individuals with autism (Relative Risk (RR) 0.20: 95% Confidence Interval (CI) 0.05-0.55), cerebral palsy with mental retardation (RR 0.40: 95% CI: 0.24-0.65), and MR (RR 0.56: 95% CI: 0.39-0.77). The risk for depression was significantly higher for those with cerebral vascular accidents/stroke (RR 2.18: 95% CI: 1.72-3.76) and traumatic brain injury (RR 2.55: 95% CI: 1.72-2.77). The earliest onset of depression was among individuals with traumatic disabilities and milt mental retardation. Our estimate of depression prevalence for the non-disabled and disabled primary care patients was 22.8% and 24.9% respectively, when patients with disabilities were grouped together (p = 0.008). CONCLUSION: It is important for physicians to recognize the higher prevalence of depression among patients with adult onset disabilities (e.g. stroke, traumatic brain injury). In addition, they should be aware of lower prevalence of depression among many individuals with lifelong disabilities, such as mental retardation, cerebral palsy, and autism.

Adult↗

PubMed2005

Road traffic accidents and disability: a cross-section study from Turkey.

PURPOSE: To investigate socio-demographic features, lesions which caused disabilities and the rate of disabilities caused by particular lesions and thus to reveal how disabilities are evaluated and general characteristics of disabilities due to road traffic accidents in Turkey. METHOD: In this study we retrospectively reviewed 563 victims of road traffic accidents evaluated by the Department of Forensic Medicine, Ankara University, between 1 July 1993 and 31 December 2002 to determine whether they had disabilities and to estimate the rate of disabilities. We collected data about age, gender, trials outcomes, affected body parts, surgical interventions, lesions taken into account in estimation of disabilities, the rate of disabilities. RESULTS: 64.7% of the cases were male and 35.3% were female. The mean age of the cases was 33.11 (SD:16.70) years. The most frequently affected body part was lower extremities and 73.6% of lesions taken into account in estimation of the rate of disability were located in the pelvis and lower extremities. CONCLUSIONS: In order to prevent these injuries, the mechanisms of the injuries should be determined and to this aim findings obtained at the scene, hospital records and findings obtained at the physical examination of the victims should be linked. Larger studies are needed to determine preventive measures for elimination of the causes of accidents, prevent permanent disabilities, plan education programs and make recommendations about the preventive measures.

Accident Prevention↗

PubMed2003

Duration of employment is not a predictor of disability of cleaners: a longitudinal study.

AIMS: Cleaning is a high-risk occupation for developing musculoskeletal disorders. Sickness absence is twice as high as in other occupations. Disability pensions for musculoskeletal disorders are twice as high in cleaners as in other employed women. However, a result from Norwegian and Danish studies shows that female cleaners do not report higher morbidity of musculoskeletal disorders than other women. The objective was to analyse whether female cleaners have a higher risk of obtaining a disability pension than women in other unskilled occupations and whether the length of employment influences the risk. METHODS: The material is from the National Census in 1980 and 1990 and supplemented with disability pensioning data from the National Insurance Administration and the Population registry. Women aged 20-49, working as cleaners, seamstresses, nursing, kitchen, or shop assistants in 1980 were followed until 1990 or until receiving disability pension. Female cleaners aged 30-59 years in 1990 were categorized into two cohorts by occupation in 1980. They were followed from 1991 to 1994, to the date they died, or received disability pension. Incidence rates and incidence rate ratio for disability pension and mortality was calculated by Poisson regression. Cox regression calculated the relative risk of obtaining disability pension. RESULTS: Disability pension rates were higher among cleaners than among other women in unskilled occupations (1.4 per 1,000 person years (CI 95% 1.35-1.46)), but the risk of obtaining disability pension did not increase with increasing exposure to cleaning (HR 0.8 (CI 95% 0.6-1.2)). CONCLUSIONS: The cleaning occupation has high disability rates compared with other unskilled occupations. A contribution factor to these high rates is a selection of women with poor health into the occupation.

Adult↗

PubMedDate not supplied

Prevention of childhood disability in the People's Republic of China.

With a dramatic decrease in infant mortality, an emerging challenge facing modern medicine in China is chronic disabling conditions in infants and young children. According to the results of a national sampling survey in 1987, it is estimated that there are over 51 million people of all ages with disabilities, which accounts for 4.9% of the total population. One out every five families in China has a member who is disabled. For children under 14 years of age, the overall prevalence rate of disability is 2.66%. The prevalence rate of mental retardation is 1.8% which accounts for 66% of all disabled children. Mental retardation is the most frequent childhood disability. Research on factors contributing to disability indicates the complexity of the problem. The etiology of 47% of cases is unknown, 21% of cases result from damage prenatally, 3% are due to perinatal factors, 29% are acquired during infancy and early childhood. Efforts to prevent developmental disabilities among children can be classified in terms of primary, secondary and tertiary activities. The most important primary prevention activities consist of genetic counselling, immunization programmes, improved prenatal, perinatal and postnatal health care, and legislation. On the secondary preventive level, focus is primarily on prenatal diagnosis and newborn screening. Tertiary preventive efforts include special education and comprehensive rehabilitation services. While these prevention efforts have been established, they are insufficient to meet the needs of disabled children and their families. In the context of the one child per family policy in China, much more is needed, much more can be done to reduce childhood disability. In addition to strengthening prevention efforts at all 3 levels, special emphasis should be placed on (a) integration of existing primary health care systems with early intervention programmes, (b) public education and information, (c) personnel preparation, and (d) research and evaluation.

Adolescent↗

PubMed2000

Longest held occupation in a lifetime and risk of disability in activities of daily living.

OBJECTIVES: To examine the association between the longest held occupation in a lifetime and risk of disability in activities of daily living (ADL) among elderly people (65 years and older) in northern Taiwan. METHODS: A case-control design was used nested within two cohorts of a total of 2198 elderly people who had been followed up either between 1993 and 1997 or between 1996 and 1997. Cases were 360 elderly people with ADL disability within the study period. For each case, two sex matched controls were randomly sampled from the pool of elderly people free from ADL disability. Occupational data were collected through interviews conducted in 1997. Performed job contents were classified into occupational categories and occupation based social classes. Unconditional logistic regression techniques were used to estimate relative risk and 95% confidence intervals (95% CIs) of ADL disability. RESULTS: Compared with people who were former legislators, government administrators, or business executives and managers, workers in agriculture, animal husbandry, forestry, or fishing (odds ratio (OR) 1.9, 95% CI 1.1 to 3.5) and workers in craft and related trades (OR 1.9, 95% CI 1.1 to 3.4) had significantly increased risks of subsequent ADL disability. Differential risks of ADL disability were found across social classes, with a significant dose-response trend in which unskilled blue collar workers had an 1.8 times higher risk of ADL disability than higher social classes of white collar workers. CONCLUSIONS: After adjustment for education, there was still an inverse relation between risk of ADL disability and social class. Although total control for all the known risk factors for ADL disability among elderly people was impossible, the results tend to suggest a potential for an effect of longest held occupation in a lifetime on risk of ADL disability.

Activities of Daily Living↗

PubMed2004

The contribution of dementia to the disablement process and modifying factors.

The objective of this study was to examine the impact of dementia on disability progression and mortality, and to analyze the modifying effect of risk factors and extra-individual factors. A sample of 3,403 participants in the PAQUID study was followed for 10 years. Disability was assessed on a 4-grade scale: no disability, disabled only on the Rosow-Breslau scale, disabled on the Rosow-Breslau scale and on instrumental activities of daily living (IADL) scales, and disabled on the Rosow-Breslau, IADL and activities of daily living (ADL) scales. A Markov model was used to estimate the effect of explanatory variables on disability and mortality. Controlling for age, gender, education, place of residence, medical care and informal support, dementia had a strong significant effect on progression to IADL and then to ADL disability. Dementia did not increase the risk of death, once disability was taken into account, except from the lowest disability grade.

Aged↗