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PubMedDate not supplied

Snow skiing injuries in physically disabled skiers.

This study, through retrospective review, examines the injury rate of selected disable skiing populations in general and as compared to able-bodied skiers in areas where comparison was possible. Data on disabled skiers gathered from instructional programs at multiple sites indicate that the disabled skier had a very low rate of injury occurrence. Where comparison could be make, it was found that there was no significant difference in overall injury rates between able-bodied and physically disabled skiers. Disabled skiers appear to sustain less severe injuries, and they do not show the trend in increasing injury rates that able-bodied skiers in this study show. In addition, the uphill transport of skiers with a disability who use sit- or mono-skis was examined in one large program and found to be efficient and exceedingly safe, with no injuries reported. A major limitation of this study is the inconsistency in methods of data collection and reporting. There is a need for further prospective studies in the general able-bodied and disabled skiing populations with direct comparisons of rate, location and severity of injury, type of disability, and experience level of the skier. We hope that this study will stimulate more ski areas to allow disabled skiers on their slopes, even it limited to participation in supervised, instructional programs.

Athletic Injuries↗

PubMed2005

The relation between childhood adverse experiences and disability due to mental health problems in a community sample of women.

OBJECTIVE: The objective of this study was to examine the association between selected childhood adverse experiences and disability due to mental health problems in a community sample of women. Variables of interest included childhood physical and sexual abuse, parental psychiatric and substance abuse history, and sociodemographic factors. METHOD: Girls and women (aged 15 to 64 years) from a province-wide community sample (n = 4239) were asked about disability and most childhood adverse experiences through interview; a self-administered questionnaire inquired about child abuse. Logistic regression (crude and adjusted odds ratios) was used to test the associations between childhood adversity and disability due to mental health problems. RESULTS: Approximately 3% of the women had a disability due to mental health problems. Among women with a disability, about 50% had been abused while growing up. After controlling for income and age, we found that disability showed the strongest association with childhood sexual abuse, physical abuse, and parental psychiatric disorder. CONCLUSION: Disability due to mental health problems was experienced by women with and without exposure to abuse in childhood. However, childhood sexual abuse and physical abuse were important correlates of disability. Disability creates suffering and loss for the individual and society; this issue merits more research in relation to child abuse.

Adolescent↗

PubMed1995

Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder.

This paper provides an overview of current conceptualizations of learning disabilities and ADHD, a conceptual framework critical for defining and classifying each disorder and for distinguishing each disorder from the other and from other, less common problems of childhood. At a most basic level, reading disability or dyslexia (the most common and best defined of the learning disabilities) and ADHD represent two distinct disorders that may frequently cooccur in the same unfortunate child but that can be clearly distinguished from one another. Reading disability represents a disorder of cognitive functioning. In contrast, ADHD is defined by the child's behavior as perceived by the child's parents and teachers; ADHD thus refers to a disorder affecting primarily the behavioral domain. Within the last decade, considerable progress has been made in our understanding of reading and reading disability. Converging evidence from several lines of investigation now indicates that reading ability conforms to a normal distribution model, so that there is a continuum of reading ability and reading disability. Children along this continuum differ by degree but not in kind. Cutoff points may be instituted to segment this continuous distribution, but these will be arbitrary and will not reflect any natural joints in nature; there is no second mode or "hump" in the distribution of reading ability. The normal model of reading and reading disability indicates that reading disability is related to normal reading ability, that there is a seamless transition from good to poor reading ability. Awareness of this relationship is critical to our approach to understanding the basis of reading disability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Race and ethnic variation in the disablement process.

OBJECTIVES: This analysis examines ethnoracial group differences in the transition from health to disability. METHODS: Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability. RESULTS: Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences. DISCUSSION: The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

Activities of Daily Living↗

PubMed1982

Survival experience of semi-skilled disability pensioners in Denmark.

The purpose of this study was to estimate the survival prognosis of semi-skilled disability pensioners. The survival experience of 1353 invalid male members of the Danish Semiskilled Workers Union (SID) awarded disability pensions in 1975 was compared with a control group of members of the same union, matched geographically and by age. The two groups were followed until Nov. 30, 1978. For the follow-up period as a whole, the mortality risk among disability pensioners was estimated to be 6.8 times as high as that of controls. The relative risk of mortality was higher at the period's inception than at the end. A very high mortality level was found among disability pensioners awarded the highest level of disability pension, but no differences in mortality were found between disability pensioners awarded the lower levels of disability pension and the corresponding control group. The significance of medical and social factors in reducing the ability to work is discussed, as it relates to grounds for the awarding of disability pensions. The prognosis of one category of disability pensioners is very poor, while the survival prognosis of another is not significantly worsened, despite a considerable deterioration in the ability to work.

Adult↗

PubMed2006

The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging.

BACKGROUND: For older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II). METHODS: Participants included 559 US adults (232 males and 327 females) >or= 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). RESULTS: Multivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67-0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78-0.97) compared to those people who were disability free. CONCLUSION: Older adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.

Activities of Daily Living↗

PubMed2005

The association between cognitive impairment and physical disability in multiple sclerosis.

BACKGROUND: The association between cognitive impairment and physical disability was examined in a larger, more representative sample of patients with multiple sclerosis (MS) than in previous studies. METHOD: Two hundred and fifty-three patients attending an MS clinic were assessed with respect to physical disability using the Expanded Disability Status Scale and cognitive impairment using a battery of neuropsychological tests. RESULTS: Physical disability correlated with duration of disease; cognitive impairment did not. Virtually all measures derived from the cognitive battery were significantly correlated with physical disability. Three measures of speeded information processing and one involving delayed recall of verbal material were unique predictors of disability status. The relationship between cognitive impairment and physical disability was equivalent for patients with shorter (< 3 years) versus longer (> 10 years) disease duration. Cognitive impairment correlated with the rate of disability progression as reflected by the progression index. CONCLUSION: Cognitive impairment is more closely associated with physical disability than most previous studies indicate. This relationship appears to be stable throughout the duration of MS, although this conclusion is qualified by the cross-sectional design of the study. Further attention should be paid to cognitive impairment as a possible predictor of the rate of patients' physical decline.

Adult↗

PubMedDate not supplied

Child disability and mothers' tubal sterilization.

CONTEXT: The needs of children with disability can be substantial, leading some parents to consider contraceptive sterilization to prevent additional births. METHODS: Matched records from the 1993 National Health Interview Survey and the 1995 National Survey of Family Growth were used to investigate the relationship between child disability and mothers' sterilization. Data included the birth records of 8,711 children, information on older children in the household, and the mothers' background and reproductive characteristics. Logistic and Cox regression models were used to estimate the effect of the birth of a child with a disability on the risk of mothers' sterilization. RESULTS: The birth of a child with disability has no effect on the likelihood that a mother will undergo sterilization within the next month; however, women who have an older child with severe disability are more likely than those whose older children are nondisabled to undergo sterilization within a month after the birth of another child (odds ratio, 2.6). Severe disability in a newborn significantly increases the risk of sterilization 1-36 months after birth (risk ratio, 1.7); severe disability among older children also appears to increase the risk of sterilization 1-36 months after birth (1.5), although this result was only marginally significant. CONCLUSIONS: Women often respond to the birth of children with disabilities by changing their fertility plans, although usually not immediately unless they have older children with severe disability. These findings are consistent with parents'desire to have a nondisabled child and with their need to care for an exceptional child by forgoing additional births.

Adolescent↗

PubMedDate not supplied

Qualitative profiles of disability.

This study identified profiles of functional disability (FD) paralleled by increasing levels of disability. We assessed 96 subjects using the World Health Organization Disability Assessment Schedule II (WHODAS II). Clustering Based on Rules (ClBR) (a hybrid technique of Statistics and Artificial Intelligence) was used in the analysis. Four groups of subjects with different profiles of FD were ordered according to an increasing degree of disability: "Low," self-dependent subjects with no physical or emotional problems; "Intermediate I," subjects with low or moderate physical and emotional disability, with high perception of disability; "Intermediate II," subjects with moderate or severe disability concerning only physical problems related to self-dependency, without emotional problems; and "High," subjects with the highest degree of disability, both physical and emotional. The order of the four classes is paralleled by a significant difference (<0.001) in the WHODAS II standardized global score. In this paper, a new ontology for the knowledge of FD, based on the use of ClBR, is proposed. The definition of four classes, qualitatively different and with an increasing degree of FD, helps to appropriately place each patient in a group of individuals with a similar profile of disability and to propose standardized treatments for these groups.

Disability Evaluation↗

PubMed2005

State and metropolitan-area estimates of disability in the United States, 2001.

OBJECTIVES: We sought to provide estimates of disability prevalence for states and metropolitan areas in the United States. METHODS: We analyzed Behavioral Risk Factor Surveillance System data from 2001 for all 50 states and the District of Columbia and 103 metropolitan areas. We performed stratified analyses by demographics for 20 metropolitan areas with the highest prevalence of disability. RESULTS: State disability estimates ranged from 10.5% in Hawaii to 25.9% in Arizona. Metropolitan disability estimates ranged from 10.2% in Honolulu, Hawaii to 27.1% in Tucson, Ariz. Regional metropolitan medians for disability (range, 17.0-19.7%) were similar across the Northeast, Midwest, and South and were highest in the West. In the 20 metropolitan areas with the highest disability estimates, the prevalence of disability generally increased with age and was higher for women and those with a high-school education or less. CONCLUSIONS: State and metropolitan-area estimates may be used to guide state and local efforts to prevent, delay, or reduce disability and secondary conditions in persons with disabilities.

Adolescent↗

PubMed1992

Functional limitations and disability among elders in the Framingham Study.

BACKGROUND: The measurement of physical disability as an indication of the impact of disease is commonly seen in research. However, these measures often do not clearly differentiate between functional limitations and daily performance of an activity. METHODS: We measured the differences between self-reported disability and observed functional limitations in six activities of daily living tasks among community-dwelling elders. The value of functional limitations vs disability measures in determining risk factors for disablement was ascertained. RESULTS: Systematic differences were found among the 1453 participants. At least 89% of the time when a difference was identified, the subjects ranked disability greater than the functional limitations observed. For those who were cognitively impaired, discrepancies occurred up to 11% of the time. In determining risk factors for disablement, we found that neurological impairments were associated with both functional limitations and disability, while sociocultural factors were associated with disability only. CONCLUSIONS: Our findings suggest that physical functional limitations and disability in the elderly are two distinct concepts and that the measure of choice should be determined by research objectives and the type of population being studied.

Activities of Daily Living↗

PubMed1994

Disability determinations for adults with mental disorders: Social Security Administration vs independent judgments.

OBJECTIVES: Disability determinations made by the Disability Determination Service for Social Security Administration (SSA) disability claims due to mental impairment were compared with the independent judgments of a team of mental health workers. The decisions of the Service and the team's agreement with those decisions were predicted from a set of explanatory variables. METHODS: One hundred fifty-eight adult applicants for or beneficiaries of SSA benefit programs participated. The team used SSA disability criteria to judge disability based on in-depth interviews. RESULTS: Team members voted yes, no, or maybe regarding approval for disability. Of the cases approved by the team, 89% were actually allowed by the Disability Determination Service. However, the team could not reach a yes or no decision for almost half of the subjects, contributing to a total agreement with the Service on only 40% of the cases. CONCLUSIONS: Sufficient evidence exists to question the reliability of SSA disability determinations for mental disorders. Although the Disability Determination Service decision for mental impairments can be predicted above chance, a direct test of the reliability of such determinations should be conducted, with particular attention to the effect of the quality of the medical information.

Adolescent↗

PubMed2000

Injuries to athletes with disabilities: identifying injury patterns.

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.

Athletic Injuries↗

PubMed2001

Looking inward: introspectiveness, physical disability, and depression across the life course.

This study investigates the interrelationships among age, physical disability, introspectiveness, and depression. Using data from a community sample of disabled and non-disabled adults (N = 1,567), this study tests: 1) if there are age variations in introspectiveness; 2) if age variations in introspectiveness differ by physical disability status; 3) if introspectiveness mediates the association between age and depression; 4) if introspectiveness and disability status have synergistic effects on depression; and if so, 5) if subjective health differences between disabled and nondisabled account for the joint impact of introspectiveness and disability status on depression. Results show that older people report less introspectiveness than younger people do--which explains part of the negative association between age and depression. Additionally, the negative association between age and introspectiveness is significantly stronger among nondisabled respondents. Adjustment for less introspectiveness among older adults accounts for about 24 percent of the negative association between age and depression. Disabled respondents experience a more positive relationship between introspectiveness and depression; however, disabled respondents' poorer global health explains most of that pattern.

Adult↗

PubMed2004

Disability forecasts and future Medicare costs.

The traditional focus of disability research has been on the elderly, with good reason. Chronic disability is much more prevalent among the elderly, and it has a more direct impact on the demand for medical care. It is also important to understand trends in disability among the young, however, particularly if these trends diverge from those among the elderly. These trends could have serious implications for future health care spending because more disability at younger ages almost certainly translates into more disability among tomorrow's elderly, and disability is a key predictor of health care spending. Using data from the Medicare Current Beneficiary Survey (MCBS) and the National Health Interview Study (NHIS), we forecast that per-capita Medicare costs will decline for the next fifteen to twenty years, in accordance with recent projections of declining disability among the elderly. By 2020, however, the trend reverses. Per-capita costs begin to rise due to growth in disability among the younger elderly. Total costs may well remain relatively flat until 2010 and then begin to rise because per-capita costs will cease to decline rapidly enough to offset the influx of new elderly people. Overall, cost forecasts for the elderly that incorporate information about disability among today's younger generations yield more pessimistic scenarios than those based solely on elderly data sets, and this information should be incorporated into official Medicare forecasts.

Adult↗

PubMed2002

Diabetes and incidence of functional disability in older women.

OBJECTIVE: To examine the relationship between diabetes and the incidence of functional disability and to determine the predictors of functional disability among older women with diabetes. RESEARCH DESIGN AND METHODS: We analyzed data from 8,344 women enrolled in the Study of Osteoporotic Fractures, a prospective cohort of women aged > or =65 years. Diabetes (n = 527, 6.3% prevalence) and comorbidities (coronary heart disease, stroke, arthritis, depression, and visual impairment) were assessed by questionnaire and physical examination. Incident disability, defined as onset of inability to do one or more major functional tasks (walking 0.25 mile, climbing 10 steps, performing household chores, shopping, and cooking meals), was assessed by questionnaire over 12 years. RESULTS: The yearly incidence of any functional disability was 9.8% among women with diabetes and 4.8% among women without diabetes. The age-adjusted hazard rate ratio (HRR) of disability for specific tasks associated with diabetes ranged from 2.12 (1.82-2.48) for doing housework to 2.50 (2.05-3.04) for walking two to three blocks. After adjustment for potential confounders at baseline (BMI, physical activity, estrogen use, baseline functional status, visual impairment, and marital status) and comorbidities (heart disease, stroke, depression, and arthritis), diabetes remained associated with a 42% increased risk of any incident disability and a 53-98% increased risk of disability for specific tasks. Among women with diabetes, older age, higher BMI, coronary heart disease, arthritis, physical inactivity, and severe visual impairment at baseline were each independently associated with disability. CONCLUSIONS: Diabetes is associated with an increased incidence of functional disability, which is likely to further erode health status and quality of life.

Age of Onset↗

PubMed2002

Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study.

OBJECTIVE: To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women's Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures. RESULTS: Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree. CONCLUSIONS: Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

Age of Onset↗

PubMed1996

An estimation of the functional disability burden in elderly Chinese age 70 years and over.

A cross-sectional survey of functional status among elderly Hong Kong Chinese aged 70 years and over was carried out to estimate the current burden of disability. Two thousand and thirty-two subjects (999 men, 1033 women) were recruited by random sampling of the old age and disability allowance schemes covering over 90% of the elderly population, stratified by sex and 5-year age groups. Functional ability was administered using the Barthel Index. The duration of disability, if any, was also noted. The prevalence of disability for different activities of daily living varied from 0.8% to 26% (lowest for feeding and highest for climbing stairs and bathing). The prevalence was higher for women than men, and higher in the older age group for both sexes. Men in the 80+ age group had shorter duration of disability compared with those in the 70-79 age group, and compared with women. Using disability years (estimated number of elderly with disability in the population x median duration of disability) as an estimate of disability burden, the number ranges from approximately 19,000 (inability to feed) to 100,000 (inability to climb stairs). This estimate may be useful in the planning of service provisions for the formal and informal care sector.

Activities of Daily Living↗