gender differences in disability and personal care assistance among older adults with and without...
TRANSCRIPT
e5Abstracts / Disability and Health Journal 2 (2009) e1ee15
homelessness, immigrant status and poverty in US and UK newspapers
since 1996.
Results: The merged dataset included 159 individuals who self- or proxy
identified as having dementia. Around 5% had experienced homelessness.
The rapid evidence review produced 48 publications with virtually no
intervention studies. US media reports focused primarily on loss of services
for illegal immigrants, drug benefit coverage, caregiver strains. UK media
discussed economic burden, community support, abuse in nursing care, and
dignity in the care of impoverished older adults with dementia.
Conclusion: Dementia care for socially marginalised groups is a highly
under-researched area. The evidence base is lacking for culturally
sensitive care environments. Interventions are critically lacking that
consider the compound needs of this heterogeneous clinical population.
Application of technology in the management of spinal cord injury:
Findings from a systematic literature review
Thilo Kroll, PhD, School of Nursing & Midwifery, University of Dundee,
Dundee, United Kingdom
Matthew Kehn, BA, National Rehabilitation Hospital, Washington, DC
Objective: Determine scope and use of technological applications to
promote quality-of-life after spinal cord injury (SCI).
Background: Rehabilitative improvements have stemmed from technological
enhancements. Studying rehabilitative outcomes is incomplete without
considering quality-of-life issues. Overlap between quality of life and
technology is unclear. This study seeks to determine scope and use of
technological applications to promote quality-of-life after SCI.
Methods/Design: Systematic search of multiple electronic databases
including MEDLINE, CINAHL, EMBASE and PSYCINFO. Searches
limited to humans, English, and time period: January 1996-September
2007. No additional limits (study design, research) were applied.
Keywords and expert searches were combined.
Results: 824 abstracts were identified after removal of duplicates.
Publications focused on technology have steadily increased over the past
decade. Quality-of-life is mostly undefined and rarely involves consumer
views. Most identified publications were commentaries or discussion
papers. None of the studies exceeded Phase I trial levels. Technological
applications were mostly discussed in terms of acute and rehabilitative
medical management (drug, pain, respiratory, bladder management). Few
publications focused on technology in advancing psychological coping,
adjustment and community integration. Some publications emphasized
potential of technology for supporting social development, health
promotion, and healthy aging. Little cross-disciplinary research was found.
Conclusion: The evidence base for technological applications in SCI
rehabilitation is scarce. There is tremendous scope to expand research into
the role and use of technology in community-based rehabilitation settings
aimed at enhancing quality-of-life. While community-based RCTs may be
difficult to implement, feasible, well-operationalized pre-trial research
studies (Mixed-Method studies; multiple baseline case studies) are needed.
Health Utilty among Community Dwelling Visually Impaired
Individuals
Kevin D. Frick, PhD, Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD
Christine Spencer, ScD, School of Public Affairs, University of Baltimore,
Baltimore, MD
Emily W. Gower, PhD, Dana Center, Johns Hopkins University, Baltimore,
MD
Jennifer L. Wolff, PhD, Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
John H. Kempen, MD,MHS, MPH, PhD, Center for Preventive
Ophthalmology and Biostatistics, University of Pennsylvania,
Philadelphia, PA
Objectives: To determine whether visual impairment and blindness have
independent relationships with health utility as measured by a visual
analog scale (VAS) or if the relationship is mediated by specific health
domains.
Methods: Between 2000 and 2003, Medical Expenditure Panel Survey
respondents aged 18 and older were asked the EuroQOL (EQ-5D)
questions, including the VAS. Respondents also were asked to report
visual impairment or blindness. The analysis included only those aged 40
and over due to the low prevalence of blindness at younger ages.
Regression analyses assessed the relationship between visual impairment
and the VAS, visual impairment and the five EQ-5D domains, the domains
and the VAS response, and the change in the relationship between visual
impairment and the VAS when controlling for the domains.
Results: Blindness and visual impairment were significantly related to the
VAS response when controlling for demographics (B 5 -5.20, SE 5 1.32,
p 5 0.0001 and B 5 -4.64, SE 5 0.33, p!0.0001 respectively). Visual
impairment and blindness were significantly related to each EQ-5D
domain (mobility, pain, usual activities, self-care, and anxiety). Each EQ-
5D domain was significantly related to the VAS response. When
controlling for domains, the relationship between blindness and VAS was
completely mediated (B5-0.39, SE 5 1.00, p 5 0.70) while the visual
impairment relationship was partially mediated (B5-1.77, SE 5 0.28,
p!0.0001).
Conclusion: While there may be a large health utility upon incident visual
impairment, those living with the condition over time may adapt to the
condition and have a relatively small loss of utility due to the visual
impairment itself rather than the effects of visual impairment.
Gender differences in disability and personal care assistance among
older adults with and without diabetes in Mexico
Flavia Andrade, PhD, Department of Kinesiology and Community Health,
University of Illinois at Urbana-Champaign, Champaign, IL
Data from a nationally representative sample of Mexicans is used to
examine the gender differences in disability among older adults with and
without diabetes and to explore the effects of gender on personal care
assistance in Mexico. Disability was measured using three measures:
Activities of Daily Living (ADL), Instrumental Activities of Daily Living
(IADL) and Nagi functional limitations. Results show that Mexican men
at age 50, regardless of their diabetic status, are expected to live about
3 years with at least one ADL. Disability-free life expectancy among men
aged 50 reaches 19.7 years and 28.4 years for diabetic and nondiabetic,
respectively. Women aged 50 are expected to live, on average, 5 years
with at least one ADL regardless of their diabetic status. Disability-free
life expectancy among women aged 50 reaches 21 and 29.2 years for
diabetic and nondiabetic, respectively. Therefore, differences in total life
expectancy among diabetics and nondiabetics are largely due to
differences in disability-free life expectancy. Results from Mexico
contrast with findings from Canada and the United States where effects of
diabetes on total life expectancy and disability-free are more remarkable
among women. However, this study confirms that women face higher
disability burden than men regardless of their diabetic status and they
require personal care assistance for a greater number of years. Finally, the
paper analyzes the extent to which gender differences in personal care
assistance can be explained by the differential social and economic
characteristics of older women and men.
Role of assistance dogs as supportive care providers for disabled
individuals
Viki Hansen, MPH, Health, West Chester University, West Chester, PA
Lynn Carson, PhD, CHES, Health Department College of Health Science,
West Chester University, West Chester, PA