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PubMed2001

Potential risks and prevention, Part 2: Drug-induced permanent disabilities.

Potential risk factors for and the preventability of drug-induced permanent disabilities were studied. Case reports of adverse drug events (ADEs) published in Clin-Alert during 1978-97 were the source of information on drug-induced permanent disabilities. Patient, drug, and event variables were identified, and the causality, predictability, and preventability of each case were assessed. Data were entered into a relational database for analysis. The data indicated 227 cases of drug-induced permanent disabilities. Twenty-three percent of the cases were assessed as definite, 47% as probable, and 30% as possible. Twenty-nine percent of the patients were less than 10 years old, and 36% were considered healthy. The drug categories most commonly associated with a drug-induced permanent disability were antimicrobials, vaccines, central-nervous-system agents, and antineoplastics. About half of the patients received more than the usual dosage. The most common permanent disabilities were brain damage, blindness, tardive dyskinesia, deafness, quadriplegia, and hearing loss. Event types were distributed as medication errors (55%), adverse drug reactions (43%), and drug interactions (2%). Eighty-four percent of the drug-induced permanent disabilities were judged to have been preventable; of these, a pharmacist could have prevented 40%. Litigation was reported for 56% of the cases of drug-induced permanent disability; judgments and settlements averaged $4.3 million. A review of published case reports of ADEs for 1978-97 yielded information on possible risk factors for drug-induced permanent disabilities and on which events may have been preventable.

Adverse Drug Reaction Reporting Systems↗

PubMed2003

Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process.

Prognosis of multiple sclerosis is highly variable. Clinical variables have been identified that are assessable early in the disease and are predictors of the time from the disease onset to the onset of irreversible disability. Our objective was to determine if these clinical variables still have an effect after the first stages of disability have been reached. We determined the dates of disease onset and assignment of scores of irreversible disability in 1844 patients with multiple sclerosis. We used three scores on the Kurtzke Disability Status Scale as benchmarks of disability accumulation: 4 (limited walking but without aid); 6 (walking with unilateral aid); and 7 (wheelchair bound). We used Kaplan-Meier analyses and Cox regression models to determine the influence of the clinical variables on the time to disability onset. Median times from onset of multiple sclerosis to assignment of a score of 4, 6 and 7 were significantly influenced by gender, age, symptoms and course (relapsing-remitting or progressive) at onset of the disease, degree of recovery from the first relapse, time to a second neurological episode, and the number of relapses in the first 5 years of the disease. Similarly, times from onset of multiple sclerosis to a score of 6 and 7 were influenced by time to a score of 4. In contrast, none of the variables substantially affected the time from a score of 4 to a score of 6 or 7, or from a score of 6 to a score of 7. Early assessable clinical variables significantly influence the time from the onset of multiple sclerosis to the assignment of a disability score of 4, but not the subsequent progression of irreversible disability.

Adolescent↗

PubMed2006

Age at disability milestones in multiple sclerosis.

Many efforts have been devoted to the description of the prognosis of multiple sclerosis and its possible influential factors in terms of time to reach disability milestones. By contrast, the age at which patients with multiple sclerosis reach these milestones has not yet stirred much interest. We have tested the hypothesis whether the prognosis of multiple sclerosis depends on the current age of patients and the initial course of the disease. We have assessed disease onset and course, and assignment of scores of irreversible disability in 1844 patients with multiple sclerosis. We have used three scores on the Kurtzke Disability Status Scale as benchmarks of disability accumulation: DSS 4 (limited walking but without aid), DSS 6 (walking with unilateral aid) and DSS 7 (wheelchair-bound). We used Kaplan-Meier analyses to estimate the age of the patients at assignment of disability milestones. The possible influence of the initial course of multiple sclerosis and of other clinical variables early assessable in the disease on these outcome measures was also studied, using the Kaplan-Meier curves for univariate analyses and Cox models for multivariate analyses. For the 1844 patients, median ages at time of assignment of irreversible disability were 44.3 years (95% CI 43.3-45.2) for a score of DSS 4, 54.7 years (95% CI 53.5-55.8) for DSS 6 and 63.1 years (95% CI 61.0-65.1) for DSS 7. These results were essentially similar whether the initial course of multiple sclerosis was exacerbating-remitting or progressive, and whatever the initial symptomatology. Females reached disability milestones at an older age than males. The most influential clinical factor was age at clinical onset of multiple sclerosis: the younger the onset, the younger the age at assignment of disability milestones. Therefore, prognosis in multiple sclerosis appears, at least to some extent, as age-dependent and not substantially affected by the initial course, be it exacerbating-remitting or progressive. Aside acute focal recurrent inflammation and diffuse chronic neurodegeneration, accelerated ageing-related mechanisms may operate in the central nervous system of multiple sclerosis patients.

Adult↗

PubMed1997

Gender differences in the comparison of self-reported disability and performance measures.

BACKGROUND: Gender differences in functioning among older adults have been well documented. Differential reporting of functional problems by men and women may contribute to this observed difference. The purpose of this study was to examine the gender differences in functional ability by comparing self-reported function to observed performance of physical tasks. METHODS: In 1988, 1,458 men and women ages 71 and older from the New Haven site of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) self-reported activities of daily living (ADL) disability and functional limitations. Subjects' ability to perform 7 tasks was observed. Gender differentials in "accurate" and "inaccurate" reporting were determined by examining comparable self-reports and performance measures. Logistic regression determined how much of the gender differential in self-reported function was explained by performance ability. RESULTS: More women than men reported disability and functional limitation, and women had poorer performance scores for every task. Compared to similar performance items, self-reports of function were accurate for the majority of men and women. However, among those who inaccurately reported function, more men than women underreported disability and more women than men overreported disability. Overall performance explains all of the gender difference in ADL disability and most of the difference in functional limitation. CONCLUSIONS: These results suggest that both men and women generally report their disability accurately, and women's higher prevalence of reported functional problems is probably a reflection of true disability for most disability measures.

Activities of Daily Living↗

PubMed1998

Interrelationships among disablement concepts.

BACKGROUND: Understanding interrelationships among disablement concepts is critical to the design of future disability treatment and prevention interventions. METHODS: This study uses cross-sectional data to examine the relationships among physiologic impairments, functional limitations, and disability in a moderately disabled sample of 207 community-dwelling older adults. RESULTS: As hypothesized, the data revealed statistically significant curvilinear relationships of upper and lower extremity strength and balance with mobility in this older sample. Multivariate analyses further clarified the hypothesized causal mechanism among the disablement concepts by demonstrating that most of the association of muscle strength and balance with disability was through the intermediary role of mobility limitations. CONCLUSIONS: The findings from this study highlight the value of clinical trials that focus on prevention or treatment of mobility limitations as a means of preventing disability; our findings underscore the need for future research that examines the effects of other variables believed to influence disablement in late life.

Aged↗

PubMed2005

Expanding the disablement process model among older Mexican Americans.

BACKGROUND: Very few studies have examined how disability develops among older Mexican Americans. To determine how disability develops, we explored the Disablement Process model, which posits that impairment, measured by muscle strength, leads to functional limitations, which lead to disability, which ultimately is associated with health-related quality of life (HRQOL). METHODS: A structural equation model approach was used (AMOS 4) with data collected on 622 Mexican Americans aged 71 or older residing in the Southwest. RESULTS: Our results show preliminary support for the Disablement Process model. Impairment is significantly associated with functional limitation (beta =.36, z value = 7.2), which is significantly associated with disability (beta = -.53, z value = 16.1). Finally, disability is significantly related to both physical and mental components of HRQOL (beta = -.69, z value = 23.4; beta = -.26, z value = 6.5, respectively). CONCLUSIONS: Muscle strength as a measure of impairment and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score as a measure of HRQOL are important factors in understanding disability in older Mexican Americans.

Activities of Daily Living↗

PubMed2006

Bathing disability and the risk of long-term admission to a nursing home.

BACKGROUND: The prevalence of disability in bathing and the likelihood of a long-term nursing home admission increase substantially with age. We performed a prospective study to determine whether the occurrence of persistent disability in bathing is associated with the risk of a long-term nursing home admission, independent of potential confounders, including persistent disability in other essential activities of daily living. METHODS: We studied 754 community-living persons, 70 years old or older, who were nondisabled in four essential activities of daily living. Participants were followed with monthly telephone interviews for a median of 75 months to determine the occurrence of persistent (i.e., present for at least 2 consecutive months) disability in bathing and the time to the first long-term nursing home admission, defined as longer than 3 months. RESULTS: One hundred thirteen (15.0%) participants had a long-term nursing home admission. At least one episode of persistent bathing disability occurred among 59 (52.2%) participants with a long-term nursing home admission and 210 (32.8%) without a long-term admission (p <.001). In a proportional hazards model that was fully adjusted for potential confounders, the occurrence of persistent bathing disability increased the risk of a long-term nursing home admission by 77% (hazard ratio 1.77, 95% confidence interval 1.05 to 2.98), but had no effect on the risk of a short-term nursing home admission (hazard ratio 0.87, 95% confidence interval 0.51 to 1.49). CONCLUSIONS: Among community-living older persons, the occurrence of persistent disability in bathing is independently associated with the risk of a long-term nursing home admission, but has no effect on short-term admissions. Interventions directed at the prevention and remediation of bathing disability have the potential to reduce the burden and expense of long-term care services.

Activities of Daily Living↗

PubMed2006

Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability.

BACKGROUND: It is unclear how well self-reports and clinician ratings of performance in the instrumental activities of daily living (IADLs; household maintenance tasks) correspond and why they may differ. METHODS: We assessed clinician-rated IADL performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). AMPS and self-rated IADL disability were compared in two groups of nondemented elderly persons without ADL limitation: a group with functional limitation only (self-reported difficulty in some area of upper or lower body function, n = 139) and a group that reported functional limitation plus IADL disability (difficulty in at least one IADL task, n = 49). Occupational therapists were blind to self-reports, and all assessments were conducted in respondent homes. RESULTS: Self-rated IADL disability was significantly associated with the AMPS motor skill score (r = -.34, p <.001), but the motor skill score was only moderately sensitive (61%) and specific (67%) in identifying self-rated disability. In adjusted logistic regression models, clinician-rated performance and self-rated IADL disability shared some physical predictors, but only clinician-rated performance was related to cognitive status. AMPS process skill scores did not relate to self-rated IADL disability or physical or cognitive status. CONCLUSIONS: In this sample of older adults without dementia or ADL disability, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical deficits appear to be more salient in self-ratings than is cognitive ability, because cognitive ability (in particular, verbal fluency) was associated only with clinician-rated IADL performance.

Activities of Daily Living↗

PubMed1997

Further evidence on recent trends in the prevalence and incidence of disability among older Americans from two sources: the LSOA and the NHIS.

The Longitudinal Study on Aging (LSOA) and the National Health Interview Survey (NHIS) are used to examine change in the prevalence of disability from 1982 through 1993 for persons 70 years of age and over. Changes in the likelihood of becoming disabled and the likelihood of recovering from disability also are investigated with the LSOA. There is some evidence for improving disability status among the old. The prevalence of disability is somewhat lower in more recent years in the NHIS; also, the incidence of disability is lower, and the rate of recovery higher during 1988-90 than in the 1984-86 interval. On the other hand, the prevalence of disability increases at some dates after 1984 in the LSOA sample. In both datasets, there is fluctuation rather than a clear trend in the prevalence of disability. Continued steady improvement in rates of onset and recovery and a consistent trend toward improving prevalence is needed before concluding that we are witnessing the beginning of an ongoing trend toward improving health among the older population.

Age Factors↗

PubMed2000

Disability trends among elderly persons and implications for the future.

OBJECTIVES: This article used a new data source to examine the issue of disability trends among elderly persons and examined the potential implications of these trends on future health and long-term care needs. METHODS: We used the 1992-1996 Medicare Current Beneficiary Survey to examine time trends in rates of activities of daily living and instrumental activities of daily living disability and physical limitation among Medicare beneficiaries aged 65 and over. We used multinomial logit and least squares regression techniques to produce trend estimates that held the age, sex, race, and educational distributions constant and projected these trends into the future. Finally, we estimated the potential impact of disability decline on per capita Medicare spending on elderly persons. RESULTS: We found that disability among elderly persons is declining and that the trend toward a more educated elderly cohort explains some, but not all, of this decline. In the absence of downward disability trends, per capita Medicare expenditures would have grown even faster than they have. DISCUSSION: Although the decline in disability prevalence in recent years appears real, whether it continues has enormous implications for the size of the disabled population in the future and for the ability of the society to care for its disabled elderly members.

Activities of Daily Living↗

PubMed1993

The relationship of visual and hearing impairments to disability: an analysis using the longitudinal study of aging.

BACKGROUND: Little is known about the relationships of visual impairment and hearing impairments to physical disability. The purpose of this work is to determine if persons 70 years of age and over with these impairments are at risk for increased disability in basic physical activities of daily living (ADLs) compared to persons without these impairments. METHODS: We used as our data source the baseline (1984) and the 1988 reinterview from the Longitudinal Study of Aging, a nationally representative survey of noninstitutionalized persons 70 years of age and older. To determine the relationships of visual impairment and hearing impairment to future four-year disability, we used multiple variable modeling, controlling for demographic variables, selected chronic conditions, and baseline disability. RESULTS: Persons with visual impairment were 1.37 (95% CI:1.20-1.57) times more likely to have increased disability in ADLs than those without visual impairment. Hearing impairment was not independently related to increased ADL disability. CONCLUSIONS: Visual impairment by itself is an independent risk factor for future ADL disability. In light of the enlarging older population, maneuvers to ameliorate visual impairment may help to minimize the increase in numbers of disabled persons.

Activities of Daily Living↗

PubMed1999

Identifying disability: comparing house-to-house survey and rapid rural appraisal.

This study compared house-to-house survey and rapid rural appraisal as methods used to identify people with disabilities in a sample rural population in South India. The research showed that by using these methods, two distinctly different populations were identified. The factors that influenced the identification processes were: local perceptions and definitions of disability; social dynamics, particularly those of gender and age; relationships within the rapid rural appraisal groups and between the health auxiliary and the respondents in the house-to-house survey; and the type of disability and the associated social implications and stigma of that disability. While a few more people were identified through the house-to-house survey, the rapid rural appraisal was a better approach for identifying disability in the community because of the greater community participation. The researchers believe that this community participation provided a greater understanding of the complex contextual dynamics influencing the identification of disability, thereby increasing the validity of the study findings. Another advantage of the rapid rural appraisal was the methodological and analytical simplicity. Both methods, however, failed to identify some individuals with disabilities who were later identified on the follow-up verification visits. Taking into account the factors discussed above, the researchers conclude that no single method could be used to comprehensively identify people with disability in a community. They suggest that a judicious combination of methods which takes into account local perceptions and priorities, includes more specific screening techniques, and facilitates informed voluntary referrals, would be the most effective approach.

Adolescent↗

PubMed2000

Rhetoric or reality? The participation of disabled people in NGO planning.

User involvement in planning is now well established in the fields of both health and development. This study looks at one particular client group, namely disabled people, and addresses the question: How do selected European-based international non-governmental organizations (INGOs) facilitate the participation of disabled people in their planning process? The study was exploratory in nature, using both quantitative and qualitative methods to answer the research question. Data were collected using a self-administered questionnaire with 18 INGOs, which was supported by five semi-structured interviews and 20 'e-mail dialogues' with key informants. The findings indicate that the INGOs involve disabled people's organizations (DPOs) in their planning of services and projects in a variety of ways. Most commonly this is through sharing information with them, but consulting them, including them in decision-making or supporting action initiated by them are other less frequent methods of involvement. INGOs with a specific disability focus involve disabled people in the ways described above more frequently than other INGOs. Although most INGOs regularly provide information and consult DPOs, if there is no assurance that ideas raised will be implemented, then there is no guarantee of DPOs' participation in the planning process of these INGOs. The focus of an INGO and the nature of its projects affect how disabled people are involved in planning, whereas the size of an INGO has little effect. INGOs thus far have failed to match their expressed intentions about participation, but as they help to strengthen DPOs, encourage their formation and move to make disability an issue that cuts across sectoral boundaries, INGOs are changing. There is still a lot of rhetoric about participation, but the participation of disabled people in the planning process of INGOs is a growing reality.

Community Participation↗

PubMed2003

Measuring health in a vacuum: examining the disability weight of the DALY.

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Australia↗

PubMed2003

Rethinking quality in the context of persons with disability.

OBJECTIVE: To review the current health services literature related to quality of care for persons with disabilities and to highlight the need for a unique framework for conceptualizing quality and patient safety issues for this population. DESIGN: Drawing on quality measurement theory, we formulate a multi-dimensional model of quality of care for persons with disability. This model is then used to identify and summarize findings from existing health services research that relate to the quality, of care for persons with disability. STUDY SELECTION: We searched MEDLINE and other databases for primary research and review articles containing the phrases 'quality of care', 'patient safety', 'access', 'patient experience', and 'coordination of care' in conjunction with the words 'disability' or 'impairment'. RESULTS: A review of health services research suggests several potential issues in the areas of clinical quality, access, client experience, and coordination. Physical barriers, transportation, communication difficulties, and client and provider attitudes present barriers to receiving appropriate client-centered care. Communication difficulties between provider and client may increase risk for accidental injury and decrease the quality of the client experience. Frequent contact with the health care system and the complexity of an individual's situation also increase the risk of accidental injury. Coordination, the 'lubricant' that facilitates links for all areas of quality for a person with disability, presents the most significant opportunity for improvement, because multiple medical and social providers are typically involved in the care of individuals with disabling conditions. CONCLUSION: Health care providers need to embrace a multi-disciplinary approach to quality to meet the needs of persons with disabilities. Funders and purchasers need to provide flexibility in funding to enable a comprehensive primary care approach, while health service researchers need to adopt a broad view of quality to capture issues of importance for persons with disabilities.

Communication Barriers↗

PubMed2003

Quality of life of adolescents with perceived disabilities.

OBJECTIVE: To compare the self-perceived quality of life (QoL) of adolescents with and without disabilities. METHOD: A school-based survey was conducted with 2801 7th to 12th grade students in a rural area of the United States. The Youth Quality of Life Instrument-Surveillance Module and the Youth Quality of Life Group-Disability Screener were completed. RESULTS: Twenty-one percent of all students surveyed reported having one or more physical, emotional, or learning disabilities. Adolescents with disabilities reported lower QoL than adolescent without disabilities. However, self-rated health, depressive symptoms, and contextual variables were significant covariates in the relationship between disability and QoL. CONCLUSIONS: These findings suggest channels to improve the QoL of adolescents with disabilities. Specifically, reducing social and environmental barriers to promote inclusion of adolescents with disabilities in school, family, and community activities is one practical avenue for reducing disparities in QoL.

Adolescent↗

PubMed2007

Employment status and frequent mental distress among adults with disabilities.

BACKGROUND: It has been postulated that poor mental health can lead to disability and disability can lead to unemployment. However, the association between poor mental health and employment status among adults with disabilities has not been well characterized in population-based studies. AIM: To examine the association between employment status and frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days) among adults with disabilities. METHODS: Cross-sectional data were analysed for 47,377 community-dwelling US adults aged 25-64 years with disabilities that participated in the 2001 and 2003 Behavioural Risk Factor Surveillance System. Logistic regression analysis was applied. RESULTS: Among adults with disabilities, the unadjusted prevalence of FMD was 18% (SE 0.4) among those employed, 40% (SE 1.3) among those unemployed and 44% (SE 0.8) among those unable to work. After adjustments were made for age, sex and race/ethnicity, the results indicated that adults with disabilities who were unemployed or unable to work were significantly more likely than those employed to have FMD (adjusted prevalence: 39 and 45%, respectively, versus 18%; P < 0.001). These associations persisted after further adjusting for education, marital status, health risk behaviours, body mass index, health care coverage and self-rated general health (34 and 36%, respectively, versus 19%; P < 0.001). CONCLUSION: These findings demonstrate the need for research and development of public health interventions to reduce the toll of mental distress among all adults with disabilities.

Adult↗

PubMed1983

Lateral dominance in children with learning disabilities.

The purpose of the study was to investigate the occurrence of lateral dominance problems in a sample of children with learning disabilities. Ninety-one children (62 boys, 29 girls) who attended a school for children with learning disabilities were selected for the study. The Harris tests of lateral dominance were administered individually, and the children were rated as having right, left, or mixed dominance for hand, eye, and foot. When compared with normative data on dominance in children, the results showed that the occurrence of mixed hand dominance was no more frequent, the occurrence of mixed eye dominance was less frequent, and the occurrence of mixed foot dominance was more frequent in the children with learning disabilities. Results also showed that the occurrence of mixed and crossed eye-hand dominance was significantly different in children with learning disabilities when compared with children without learning disabilities. However, the occurrence of mixed eye-hand dominance was found to be significantly greater in children without learning disabilities than in learning disabled children. Age and sex were not found to affect the occurrence of lateral dominance problems in children with learning disabilities.

Child↗