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disability

Reduced ability or lack of ability of an individual to perform an activity in daily life. Examples: 1) feeds self with adaptive equipment, or is fed by another person 2) drives using adapted brakes 3) deafness 4) blindness Etiology: - diabetes mellitus increases risk of physical disability [1] - unhealthy behaviors (poor diet, lack of exercise, smoking) increases risk of physical disability [1] Epidemiology: - 90% of community-dwelling elderly with disabilites have care provided by a family member - increase in rates of disability in adults age 60-69 between 1988 & 2004, largely to increases in obesity in baby boomers [3,7] - decrease in diasbility rate between 1988 & 2004 in elderly > 80 years of age [3,9] Clinical manifestations: - ambulatory disability* has the highest prevalence rate in adults > 65 years (22%) > hearing inpairment (14%), living independence (14%), cognitive impairment (9%), self-care impairment (8%), visual impairment (6%) [3] * climbing stairs most common need for assistance from caregiver [3] Management: - many elderly persons with disabilties use assistive technology only, with no hands on care [3] - caregivers most likely to have need to assist with climbing stairs [1] - physical activity guidelines are for everybody - >= 150 minutes of moderate-intensity aerobic activity every week - ask about physical activity - discuss barriers to physical activity - physical barriers - feeling self-conscious at the gym - personalize fitness program - handcrank bicycles - water aerobics - refer patients to outside resources & programs - ask about Physical Activity

Related

handicap work-related injury (workers' compensation)

General

functional impairment

References

  1. Wong E et al Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. The Lancet Diabetes & Endocrinology, July 24 2013 PMID: 24622316 http://www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70046-9/abstract - Artaud F et al Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study BMJ 2013;347:f4240 PMID: 23881930 http://www.bmj.com/content/347/bmj.f4240
  2. Pearson, V. In: Assessing Older Persons, Kane & Kane (eds), Oxford University Press, 2000
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Seidel D, Brayne C, Jagger C. Limitations in physical functioning among older people as a predictor of subsequent disability in instrumental activities of daily living. Age Ageing. 2011 Jul;40(4):463-9. PMID: 21609999
  5. Marsh AP, Rejeski WJ, Espeland MA et al Muscle strength and BMI as predictors of major mobility disability in the Lifestyle Interventions and Independence for Elders pilot (LIFE-P). J Gerontol A Biol Sci Med Sci. 2011 Dec;66(12):1376-83. PMID: 21975090
  6. Carroll DD et al. Centers for Disease Control and Prevention. Vital Signs: Disability and Physical Activity - United States, 2009 - 2012 MMWR. May 6, 2014 / 63(Early Release);1-7 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0506a1.htm - Centers for Disease Control and Prevention. Disability and Health. Increasing Physical Activity among Adults with Disabilities http://www.cdc.gov/ncbddd/disabilityandhealth/pa.html
  7. Doshi JA, Polsky D, Chang VW. Prevalence and trends in obesity among aged and disabled U.S. Medicare beneficiaries, 1997-2002. Health Aff (Millwood). 2007 Jul-Aug;26(4):1111-7. PMID: 17630454
  8. Manton KG. Recent declines in chronic disability in the elderly U.S. population: risk factors and future dynamics. Annu Rev Public Health. 2008;29:91-113. Review. PMID: 18031222
  9. Seeman TE, Merkin SS, Crimmins EM Disability trends among older Americans: National Health And Nutrition Examination Surveys, 1988-1994 and 1999-2004. Am J Public Health. 2010 Jan;100(1):100-7. PMID: 19910350
  10. Song PH, Hilligoss B, Gleeson S How a Pediatric ACO Coordinates Care for Children with Disabilities. NEJM Catalyst. Case Study. July 28, 2016 http://catalyst.nejm.org/pediatric-aco-coordinates-care-children-disabilities/