Browsing by Subject "Disabled Persons"
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Item Open Access Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older Singaporeans.(Asia-Pacific journal of public health, 2014-05) Whitson, Heather E; Malhotra, Rahul; Chan, Angelique; Matchar, David B; Østbye, TrulsThe objective of this study was to examine the prevalence and consequences of coexisting vision and cognitive impairments in an Asian population. Data were collected from 4508 community-dwelling Singaporeans aged 60 years and older. Cognition was assessed by the Short Portable Mental Status Questionnaire whereas vision, disability, and self-rated health (SRH) were determined by self-report. Vision impairment was present in 902 (18.5%) participants and cognitive impairment in 835 (13.6%), with 232 (3.5%) participants experiencing both impairments. Persons with the comorbidity experienced higher odds of disability than persons with either single impairment. The association of vision impairment with SRH was stronger among women (odds ratio [OR] = 6.79, 95% confidence interval [CI] = 4.64-9.92) than among men (OR = 1.71, 95% CI = 1.21-2.41). Concurrent cognitive and vision impairment is prevalent in older Singaporeans and is associated with high rates of disability. Gender differences in vision-dependent roles may affect the patient-perceived impact of this comorbidity.Item Open Access Comparison of Structural Disease Burden to Health-related Quality of Life Scores in 264 Adult Spinal Deformity Patients With 2-Year Follow-up: Novel Insights into Drivers of Disability.(Clinical spine surgery, 2017-03) Bakhsheshian, Joshua; Scheer, Justin K; Gum, Jeffrey L; Horner, Lance; Hostin, Richard; Lafage, Virginie; Bess, Shay; Protopsaltis, Themistocles S; Burton, Douglas C; Keefe, Malla; Hart, Robert A; Mundis, Gregory M; Shaffrey, Christopher I; Schwab, Frank; Smith, Justin S; Ames, Christopher P; International Spine Study Group (ISSG)Study design
This is a review of a prospective multicenter database.Objective
To investigate the relationship between preoperative disability and sagittal deformity in patients with high Oswestry Disability Index (ODI) and no sagittal malalignment, or low ODI and high sagittal malalignment.Summary of background data
The relationship between ODI and sagittal malalignment varies between each adult spinal deformity (ASD) patient.Methods
A prospective multicenter database of 365 patients with ASD undergoing surgical reconstruction was analyzed. Inclusion criteria entailed: age 18 years or above and the presence of spinal deformity as defined by a coronal Cobb angle≥20 degrees, sagittal vertical axis (SVA)≥5 cm, pelvic tilt (PT) angle≥25 degrees, or thoracic kyphosis≥60 degrees. Radiographic and health-related quality of life (HRQOL) variables were examined and compared, preoperatively and at 2-year postoperative follow-up. Group 1 (low disability high sagittal-LDHS) consisted of ODI<40 and SVA≥5 cm or PT≥25 degrees or pelvic incidence-lumbar lordosis≥11 degrees and group 2 (high disability low sagittal-HDLS) consisted of ODI>40 and SVA<5 cm and PT<25 degrees and pelvic incidence-lumbar lordosis<11 degrees.Results
Of 264 patients with follow-up, 58 (22.0%) patients were included in LDHS and 30 (11.4%) were included in HDLS. Both groups had similar demographics and preoperative coronal angles. HDLS had worse baseline HRQOL for all measures (P<0.05) except leg and back pain. HDLS had a higher rate of self-reported leg weakness, arthritis, depression and neurological disorder. Both groups had similar 2-year improvements in HRQOL (P>0.05), except only HDLS had a significant Scoliosis Research Society Mental improvement and a significantly higher rate of reaching minimal clinically important differences in Scoliosis Research Society Mental scores (P<0.05).Conclusions
There is an association of worse baseline HRQOL measures, weakness, arthritis, and mental disease in HDLS. Furthermore, HDLS patients demonstrated similar improvements to LDHS. However, HDLS had greater improvements in the mental domains, perhaps indicating the responsiveness of the mental disability to surgical treatment.Level of evidence
Level III.Item Open Access COVID-19 and the need for disability conscious medical education, training, and practice.(Journal of pediatric rehabilitation medicine, 2020-01) Doebrich, Adrienne; Quirici, Marion; Lunsford, ChristopherThe COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.Item Open Access Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States.(The journals of gerontology. Series B, Psychological sciences and social sciences, 2021-04) West, Jessica S; Lynch, Scott MObjectives
Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired.Method
We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50.Results
Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy.Discussion
Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.Item Open Access Development and Validation of the Disability Index Among Older Adults.(The journals of gerontology. Series A, Biological sciences and medical sciences, 2023-01) Zhang, Xuxi; Lin, Lizi; Sun, Xinying; Lei, Xiaoyan; Liu, Gordon G; Raat, Hein; Zeng, YiBackground
With the rapid population aging, the challenge to provide care for disabled older adults is becoming bigger. This study aims to develop the Disability Index (DI) to assess disability to indicate care needs, and we evaluated the reliability and validity of the DI among older adults aged 65-105.Methods
A total of 12 559 older adults (54.0% women; mean age = 84.3; SD = 11.2) from 22 provinces in China were investigated in 2017-2018. We developed the 21-item DI covering 4 subdomains, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), physical performance, and cognitive function. Cronbach's alpha was used to determine internal consistency. The convergent and divergent validity were assessed by Spearman rank order correlation coefficients and Pearson correlation coefficients. The known-group validity was assessed by Mann-Whitney U tests. The concurrent validity was assessed by the area under the receiver operating characteristic curve (AUC).Results
In the total sample, the internal consistency of the full DI and its subdomains were satisfactory with Cronbach's alpha ≥0.70; the convergent and divergent validity of the 4 subdomains were supported by all the alternative measures; the known-group validity of the full DI and its subdomains were supported by clear discriminative ability; and the concurrent validity of the full DI was supported with all the AUCs ≥0.70. The reliability and validity of the full DI and its subdomains were additionally supported by age subgroups and sex subgroups.Conclusions
The DI is a reliable and valid instrument to assess disability status among older adults.Item Open Access Do gender, disability, and morbidity affect aging rate in the LLFS? Application of indices of cumulative deficits.(Mech Ageing Dev, 2011-04) Kulminski, Alexander M; Arbeev, Konstantin G; Christensen, Kaare; Mayeux, Richard; Newman, Anne B; Province, Michael A; Hadley, Evan C; Rossi, Winifred; Perls, Thomas T; Elo, Irma T; Yashin, Anatoli IWe used an approach of cumulative deficits to evaluate the rate of aging in 4954 participants of the Long-Life Family Study (LLFS) recruited in the U.S. (Boston, New York, and Pittsburgh) and Denmark. We used an array of 85 health-related deficits covering major health dimensions including depression, cognition, morbidity, physical performance, and disability to construct several deficit indices (DIs) with overlapping and complementary sets of deficits to test robustness of the estimates. Our study shows that the DIs robustly characterize accelerated rates of aging irrespective of specific of deficits. When a wider spectrum of health dimensions is considered these rates are better approximated by quadratic law. Exponential rates are more characteristic for more severe health dimensions. The aging rates are the same for males and females. Individuals who contracted major diseases and those who were free of them exhibited the same aging rates as characterized by the DI constructed using mild deficits. Unlike health, disability can qualitatively alter the aging patterns of the LLFS participants. We report on systemic differences in health among the LLFS centenarians residing in New York and Boston. This study highlights importance of aggregated approaches to better understand systemic mechanisms of health deterioration in long-living individuals.Item Open Access Functional Limitations Due to Lumbar Stiffness in Adults With and Without Spinal Deformity.(Spine, 2015-10) Daniels, Alan H; Smith, Justin S; Hiratzka, Jayme; Ames, Christopher P; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; Klineberg, Eric O; Burton, Doug; Mundis, Greg M; Line, Breton; Hart, Robert A; International Spine Study Group (ISSG)Study design
Cross-sectional analysis.Objective
To compare Lumbar Stiffness Disability Index (LSDI) scores between asymptomatic adults and patients with spinal deformity.Summary of background data
The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. Baseline disability levels of patients with adult spinal deformity (ASD) are high as measured by multiple validated outcome tools. Baseline lumbar stiffness-related disability has not been assessed in adults with and without spinal deformity.Methods
The LSDI and Scoliosis Research Society-22r (SRS-22r) were submitted to a group of asymptomatic adult volunteers. Additionally, a multicenter cross-sectional cohort analysis of patients with ASD from 10 centers was conducted. Baseline LSDI and SRS-22r were completed for both operatively and nonoperatively treated patients with deformity.Results
The LSDI was completed by 176 asymptomatic volunteers and 693 patients with ASD. Mean LSDI score for asymptomatic volunteers was 3.4 +/- 6.3 out of a maximum score of 100, with significant correlation between increasing age and higher (worse) LSDI score (r = 0.30, P = 0.0001). Of the patients with spinal deformity undergoing analysis, 301 subsequently underwent surgery and 392 were subsequently treated nonoperatively. Operative patients had significantly higher preoperative LSDI scores than both nonoperative patients and asymptomatic volunteers (29.9 vs. 17.3 vs. 3.4, P < 0.0001 for both). For patients with ASD, significant correlations were found between LSDI and SRS-22 Pain and Function subscales (r = -0.75 and -0.76, respectively; P < 0.0001 for both).Conclusion
LSDI scores are low among asymptomatic volunteers, although stiffness-related disability increases with increasing age. Patients with ASD report substantial stiffness-related disability even prior to surgical fusion. Stiffness-related disability correlates with pain- and function-related disability measures among patients with spinal deformity.Item Open Access Gender-dependent association of body mass index and waist circumference with disability in the Chinese oldest old.(Obesity (Silver Spring), 2014-08) Yin, Zhaoxue; Shi, Xiaoming; Kraus, Virginia B; Brasher, Melanie Sereny; Chen, Huashuai; Liu, Yuzhi; Lv, Yuebin; Zeng, YiOBJECTIVES: To explore associations of BMI and waist circumference (WC) with disability among the Chinese oldest old. METHODS: The 5,495 oldest old in the sixth wave of Chinese Longitudinal Healthy Longevity Study conducted in 2011 were included in this study. Disability was assessed by activities of daily living (ADL); height and weight for BMI and WC were measured; information including socio-demographics, lifestyles, and health status was collected. RESULTS: Generalized additive models analysis showed that the association of BMI/WC with ADL disability was nonlinear. Among the males, logistic regression results supported a "J" shape association between ADL disability with BMI/WC-the highest tertile group in BMI or WC was significantly associated with an increased risk of ADL disability: odds ratio 1.78 (95% confidence interval (CI): 1.26-2.52) for BMI and 2.01 (95% CI: 1.44-2.82) for WC. Among females, an inverse "J" shape association was found, only the lowest tertile group before the cutoff point had an increased risk of ADL disability: odds ratio 1.42 (95%CI: 1.02-1.97) for BMI and 1.47 (95% CI:1.06-2.04) for WC. CONCLUSIONS: Associations of BMI and WC with ADL disability are significant even in the oldest old, but differ between the genders.Item Open Access Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016.(Occupational and environmental medicine, 2020-03) GBD 2016 Occupational Carcinogens CollaboratorsObjectives
This study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study.Methods
The burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs).Results
There were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens-3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 -79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (-10%) and DALYs (-15%) due to exposure to occupational carcinogens.Conclusions
Work-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.Item Open Access Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016.(Occupational and environmental medicine, 2020-03) GBD 2016 Occupational Risk Factors CollaboratorsOBJECTIVES:This study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study. METHODS:The GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors. RESULTS:In 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39-1.68) million deaths and 76.1 (66.3-86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs. CONCLUSIONS:Occupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.Item Open Access Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.(Lancet (London, England), 2018-11) GBD 2017 DALYs and HALE CollaboratorsBACKGROUND:How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. METHODS:We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. FINDINGS:Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). INTERPRETATION:With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. FUNDING:Bill & Melinda Gates Foundation.Item Open Access Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.(BMC health services research, 2018-11-22) Tyagi, Shilpa; Koh, Gerald Choon-Huat; Nan, Luo; Tan, Kelvin Bryan; Hoenig, Helen; Matchar, David B; Yoong, Joanne; Finkelstein, Eric A; Lee, Kim En; Venketasubramanian, N; Menon, Edward; Chan, Kin Ming; De Silva, Deidre Anne; Yap, Philip; Tan, Boon Yeow; Chew, Effie; Young, Sherry H; Ng, Yee Sien; Tu, Tian Ming; Ang, Yan Hoon; Kong, Keng Hee; Singh, Rajinder; Merchant, Reshma A; Chang, Hui Meng; Yeo, Tseng Tsai; Ning, Chou; Cheong, Angela; Ng, Yu Li; Tan, Chuen SengBackground
It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors.Methods
Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke.Results
Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter.Conclusion
Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.Item Open Access High-Impact Chronic Pain Transition in Lumbar Surgery Recipients.(Pain medicine (Malden, Mass.), 2023-03) Cook, Chad E; George, Steven Z; Lentz, Trevor; Park, Christine; Shaffrey, Christopher I; Goodwin, C Rory; Than, Khoi D; Gottfried, Oren NObjective
High-impact chronic pain (HICP) is a term that characterizes the presence of a severe and troubling pain-related condition. To date, the prevalence of HICP in lumbar spine surgery recipients and their HICP transitions from before to after surgery are unexplored. The purpose was to define HICP prevalence, transition types, and outcomes in lumbar spine surgery recipients and to identify predictors of HICP outcomes.Methods
In total, 43,536 lumbar surgery recipients were evaluated for HICP transition. Lumbar spine surgery recipients were categorized as having HICP preoperatively and at 3 months after surgery if they exhibited chronic and severe pain and at least one major activity limitation. Four HICP transition groups (Stable Low Pain, Transition from HICP, Transition to HICP, and Stable High Pain) were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization.Results
In this sample, 15.1% of individuals exhibited HICP preoperatively; this value declined to 5.1% at 3 months after surgery. Those with HICP at baseline and 3 months had more comorbidities and worse overall outcomes. Biological, psychological, and social factors predicted HICP transition or Stable High Pain; some of the strongest involved social factors of 2 or more to transition to HICP (OR = 1.43; 95% CI = 1.21-1.68), and baseline report of pain/disability (OR = 3.84; 95% CI = 3.20-4.61) and psychological comorbidity (OR = 1.78; 95% CI = 1.48-2.12) to Stable Stable High Pain.Conclusion
The percentage of individuals with HICP preoperatively (15.1%) was low, which further diminished over a 3-month period (5.1%). Postoperative HICP groups had higher levels of comorbidities and worse baseline outcomes scores. Transition to and maintenance of HICP status was predicted by biological, psychological, and social factors.Item Open Access Lessons from the 2015 earthquake(s) in Nepal: implication for rehabilitation.(Disabil Rehabil, 2016) Sheppard, Phillip S; Landry, Michel DPURPOSE: There has been an increase in the number of natural disasters in recent history, and the rate of disability is increasing among survivors. The most recent major natural disaster was the earthquake(s) that occurred in Nepal on 25 April 2015 and 12 May 2015. In total, more than 8500 people were killed and over 18,500 people were left injured. This article aims to demonstrate the role of rehabilitation professionals in post-disaster relief and beyond in Nepal. METHOD: This is an experiential account of physiotherapists present during the earthquake and participating in the post-disaster relief. RESULTS: Rehabilitation professionals played an important role in the acute phase post-disaster by providing essential services and equipment. However, discharge planning emerged as an important role for rehabilitation providers in the early days of post-disaster and signaled a relatively new and innovative function that facilitated the heavy imbalance between little supply and tremendous demand for care. In the coming years, rehabilitation will need to support local initiatives that focus on minimizing the long-term effects among people with a newly acquired disability. CONCLUSIONS: Rehabilitation serves an important role across the continuum in post-disaster relief from the initial stages to the months and years following an event. IMPLICATIONS FOR REHABILITATION: Driven by medical advances in acute field medicine, the relative proportion of casualties following natural disasters is decreasing, while relative rates of disability are rising among survivors. In post-disaster settings, the growing number of people with newly acquired disabilities will be added to the existing proportion of the population who lived with disabilities, creating a significant growth in the total number of people with disabilities (PWDs) in communities that are often ill prepared to provide necessary services. Rehabilitation interventions in the initial stages of emergency humanitarian response can minimize the long-term effects among people with newly acquired disabilities through early activation and prevention of secondary effects. Rehabilitation providers thus appear to have an important mediating effect on outcomes of disabilities in the early stages, but must also be strong partners with PWDs to advocate for social and political change in the long term.Item Open Access Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups.(Spine, 2014-08) Fu, Kai-Ming G; Bess, Shay; Shaffrey, Christopher I; Smith, Justin S; Lafage, Virginie; Schwab, Frank; Burton, Douglas C; Akbarnia, Behrooz A; Ames, Christopher P; Boachie-Adjei, Oheneba; Deverin, Vedat; Hart, Robert A; Hostin, Richard; Klineberg, Eric; Gupta, Munish; Kebaish, Khaled; Mundis, Gregory; Mummaneni, Praveen V; International Spine Study GroupStudy design
Multicenter, prospective analysis of consecutive patients with adult spinal deformity (ASD).Objective
Identify age-related radiographical parameters associated with poor health-related quality of life (HRQOL) and treatment preferences for ASD.Summary of background data
Patients with ASD report discrepant severities of disability. Understanding age-associated differences for reported disability and treatment preferences may improve ASD evaluation and treatment.Methods
Baseline demographic, radiographical, and HRQOL values were evaluated in a multicenter, prospective cohort of consecutive patients with ASD.Inclusion criteria
ASD, age more than 18 years, and no prior spine surgery. Patients were grouped into those treated operatively (OP) or nonoperatively (NON) and stratified into 3 age groups: G1, 50 years or less; G2, 50 to 65 years; G3, 65 years or more. HRQOL measures included Scoliosis Research Society-22r questionnaire, Oswestry Disability Index, and Short Form-36 Health Survey.Results
Four hundred ninety-seven patients (OP = 156, NON = 341) with a mean age of 50.4 years met inclusion criteria. The OP group was older (53.3 vs. 49.0 yr), had larger scoliosis (49.3° vs. 43.3°), larger sagittal vertical axis (SVA, 33.2 vs. 13.7 mm), greater pelvic incidence-lumbar lordosis mismatch (6.6°vs. 3.1°), and worse HRQOL scores than the NON group, respectively (P < 0.05). Age stratification demonstrated worsening of SVA, spinopelvic alignment (SPA), and HRQOL scores with increasing age (P < 0.05). Age/treatment stratification demonstrated that younger OP had greater scoliosis than NON (G1OP = 49.9°vs. G1NON = 42.2°; G2OP = 56°vs. G2NON = 47.2°; P < 0.05) but similar SPA as NON. Older OP had similar scoliosis, but larger SVA than NON (G3OP = 100.6 vs. G3NON = 66.4 mm; P < 0.05). OP in all age groups reported worse HRQOL than NON (P < 0.05).Conclusion
Poor HRQOL uniformly determined operative treatment for ASD. Spinal deformities differed between age groups. Younger OP had larger scoliosis but similar SPA and SVA than NON. Older OP had similar scoliosis but worse SVA than NON. Age-associated differences for poor HRQOL must be considered when evaluating patients with ASD.Level of evidence
2.Item Open Access Projecting the effects of long-term care policy on the labor market participation of primary informal family caregivers of elderly with disability: insights from a dynamic simulation model.(BMC geriatrics, 2016-03-23) Ansah, John P; Matchar, David B; Malhotra, Rahul; Love, Sean R; Liu, Chang; Do, YoungBackground
Using Singapore as a case study, this paper aims to understand the effects of the current long-term care policy and various alternative policy options on the labor market participation of primary informal family caregivers of elderly with disability.Methods
A model of the long-term care system in Singapore was developed using System Dynamics methodology.Results
Under the current long-term care policy, by 2030, 6.9 percent of primary informal family caregivers (0.34 percent of the domestic labor supply) are expected to withdraw from the labor market. Alternative policy options reduce primary informal family caregiver labor market withdrawal; however, the number of workers required to scale up long-term care services is greater than the number of caregivers who can be expected to return to the labor market.Conclusions
Policymakers may face a dilemma between admitting more foreign workers to provide long-term care services and depending on primary informal family caregivers.Item Open Access Sarcopenia Should Reflect the Contribution of Age-Associated Changes in Skeletal Muscle to Risk of Morbidity and Mortality in Elderly People.(J Am Med Dir Assoc, 2015-07-01) Evans, William JItem Open Access The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry.(BMC Public Health, 2014-03-26) Bettger, Janet Prvu; Zhao, Xin; Bushnell, Cheryl; Zimmer, Louise; Pan, Wenqin; Williams, Linda S; Peterson, Eric DBACKGROUND: Stroke is the leading cause of disability among adults in the United States. The association of patients' pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES--educational attainment, working status, and perceived adequacy of household income--with disability 3-months following an acute ischemic stroke. METHODS: We conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke--Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3-5 indicating activities of daily living limitations or constant care required). RESULTS: Overall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability. CONCLUSIONS: In this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.Item Open Access The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life.(Journal of aging and health, 2022-10) West, Jessica S; Kamis, ChristinaObjectives
We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood.Methods
Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 (n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status.Results
Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course.Discussion
Findings suggest that childhood disability has long-term implications for life course mental health.Item Open Access Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability.(Topics in stroke rehabilitation, 2018-05) Malhotra, Rahul; Chei, Choy-Lye; Menon, Edward Balan; Chow, Wai-Leng; Quah, Stella; Chan, Angelique; Ajay, Shweta; Matchar, David BruceObjective To delineate positive aspects of caregiving trajectories among family caregivers of stroke-survivors and determine the impact of stroke-survivor disability, a time-varying factor, on the delineated trajectories. Methods In a longitudinal study, family caregivers of 173 stroke-survivors in Singapore were administered the Positive Aspects of Caregiving scale (PAC scale) thrice (baseline/3 months/6 months). Group-based trajectory modeling delineated positive aspects of caregiving trajectories and identified the impact of stroke-survivor disability on the trajectories. Results Two distinct positive aspects of caregiving trajectories, Persistently Low and Persistently High were delineated. Increase in stroke-survivor disability was associated with a significant downward shift (reduction in positive aspects of caregiving) of the Persistently Low trajectory and a significant upward shift (increase in positive aspects of caregiving) of the Persistently High trajectory. Older caregivers were more likely to follow the Persistently High trajectory. Conclusions Care professionals should be mindful of the heterogeneity in the longitudinal pattern of positive feelings resulting from care provision among family caregivers of stroke-survivors, and the differential impact of stroke-survivor disability on the pattern of positive feelings. Younger caregivers as well as family caregivers who have low positive feelings at the start of their caregiver journey and experience worsening functional disability of their care recipient (stroke-survivor) require greater attention and support.