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The Journals of Gerontology. Series A,... Oct 2020Although disability is often precipitated by an illness/injury, it may arise insidiously. Our objectives were to identify the factors associated with the development of...
BACKGROUND
Although disability is often precipitated by an illness/injury, it may arise insidiously. Our objectives were to identify the factors associated with the development of insidious and noninsidious disability and to determine whether these risk factors differ between the two types of disability.
METHODS
We prospectively evaluated 754 community-living persons, 70+ years, from 1998 to 2016. The unit of analysis was an 18-month person-interval, with risk factors assessed at the start of each interval. Disability in four activities of daily living and exposure to intervening events, defined as illnesses/injuries leading to hospitalization, emergency department visits, or restricted activity, were assessed each month. Insidious and noninsidious disability were defined based on the absence and presence of an intervening event.
RESULTS
The rate of noninsidious disability (21.7%) was twice that of insidious disability (10.8%). In multivariable recurrent-event Cox analyses, six factors were associated with both disability outcomes: non-Hispanic white race, lower extremity muscle weakness, poor manual dexterity, and (most strongly) frailty, cognitive impairment, and low functional self-efficacy. Three factors were associated with only noninsidious disability (older age, number of chronic conditions, and depressive symptoms), whereas four were associated with only insidious disability (female sex, lives with others, low SPPB score, and upper extremity weakness). The modest differences in risk factors identified for the two outcomes in multivariable analyses were less apparent in the bivariate analyses.
CONCLUSIONS
Although arising from different mechanisms, insidious and noninsidious disability share a similar set of risk factors. Interventions to prevent disability should prioritize this shared set of risk factors.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Disabled Persons; Female; Geriatric Assessment; Humans; Independent Living; Male; Precipitating Factors; Prospective Studies; Risk Assessment; Risk Factors
PubMed: 31907523
DOI: 10.1093/gerona/glaa002 -
Public Health Reports (Washington, D.C.... 2021Given the growth in national disability-associated health care expenditures (DAHE) and the changes in health insurance-specific DAHE distribution, updated estimates of...
OBJECTIVE
Given the growth in national disability-associated health care expenditures (DAHE) and the changes in health insurance-specific DAHE distribution, updated estimates of state-level DAHE are needed. The objective of this study was to update state-level estimates of DAHE.
METHODS
We combined data from the 2013-2015 Medical Expenditure Panel Survey, 2013-2015 Behavioral Risk Factor Surveillance System, and 2014 National Health Expenditure Accounts to calculate state-level DAHE for US adults in total, per adult, and per (adult) person with disability (PWD). We adjusted expenditures to 2017 prices and assessed changes in DAHE from 2003 to 2015.
RESULTS
In 2015, DAHE were $868 billion nationally (range, $1.4 billion in Wyoming to $102.8 billion in California) accounting for 36% of total health care expenditures (range, 29%-41%). From 2003 to 2015, total DAHE increased by 65% (range, 35%-125%). In 2015, DAHE per PWD were highest in the District of Columbia ($27 839) and lowest in Alabama ($12 603). From 2003 to 2015, per-PWD DAHE increased by 13% (range, -20% to 61%) and per-capita DAHE increased by 28% (range, 7%-84%). In 2015, Medicare DAHE per PWD ranged from $10 067 in Alaska to $18 768 in New Jersey. Medicaid DAHE per PWD ranged from $9825 in Nevada to $43 365 in the District of Columbia. Nonpublic-health insurer per-PWD DAHE ranged from $7641 in Arkansas to $18 796 in Alaska.
CONCLUSION
DAHE are substantial and vary by state. The public sector largely supports the health care costs of people with disabilities. State policy makers and other stakeholders can use these results to inform the development of public health programs that support and provide ongoing health care to people with disabilities.
Topics: Disabled Persons; Health Expenditures; Humans; Medicaid; Medicare; State Government; United States
PubMed: 33673781
DOI: 10.1177/0033354920979807 -
JAMA Network Open May 2024
Topics: Humans; Burnout, Professional; Male; Female; Disabled Persons; Physicians; Middle Aged; Adult; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 38722631
DOI: 10.1001/jamanetworkopen.2024.10701 -
Nursing Research 2020Black men experience the highest rate of disability compared to White, Asian, and Hispanic men. Yet, we know little about how Black men with disabilities experience the... (Comparative Study)
Comparative Study
BACKGROUND
Black men experience the highest rate of disability compared to White, Asian, and Hispanic men. Yet, we know little about how Black men with disabilities experience the embodiment of their gender, race, social class, and disability positionalities and how they draw from their cultural backgrounds as they engage in health-seeking behaviors.
OBJECTIVES
The purpose of this study was to explore how young Black men experienced the onset of chronic disabling conditions while negotiating health-promoting activities in the context of gender, race, social class, disability positionalities, and culture.
METHODS
This descriptive study used hermeneutic phenomenology to achieve study objectives. This study's research questions were answered using audiotaped, one-on-one qualitative interviews, along with detailed field notes. Each participant was interviewed twice at a mutually decided upon location to ensure their privacy and comfort.
RESULTS
In relation to their embodied interactions of self in the context of disability, these men described their health-related decisions using four themes: maintaining manhood, economic constraints, the "risk" of healthcare, and health promotion.
CONCLUSIONS
By examining the experiences of young adult Black men living with disabilities, knowledge of their perspectives and experiences at earlier stages in their life course contributes to the understanding of their personal challenges, health needs, and their perspectives of health-promoting strategies.
Topics: Adult; Black or African American; Aged; Aged, 80 and over; Asian People; Attitude to Health; Disabled Persons; Health Behavior; Hispanic or Latino; Humans; Male; Middle Aged; Qualitative Research; United States; White People
PubMed: 31834116
DOI: 10.1097/NNR.0000000000000396 -
CMAJ : Canadian Medical Association... Apr 2020
Review
Topics: Disabled Persons; Humans; Medicine; Prejudice
PubMed: 32392505
DOI: 10.1503/cmaj.191597 -
The Journals of Gerontology. Series B,... Oct 2019Late-life disability is highly dynamic but within-person short-term fluctuations have not been assessed previously. We analyze how substantial such late-life disability...
OBJECTIVES
Late-life disability is highly dynamic but within-person short-term fluctuations have not been assessed previously. We analyze how substantial such late-life disability fluctuations are and whether they are associated with time-to-death, long-term disability trajectories, frailty, and sociodemographics.
METHODS
Monthly survey data (Precipitating Events Project Study) on activities of daily living/instrumental activities of daily living (ADL/IADL) disability (0-9) in the last years of life from 642 deceased respondents providing 56,308 observations were analyzed with a two-step approach. Observation-level residuals extracted from a Poisson mixed regression model (first step), which depict vertical short-term fluctuations from individual long-term trajectories, were analyzed with a linear mixed regression model (second step).
RESULTS
Short-term disability fluctuations amounted to about one ADL/IADL limitation, increased in the last 4 years of life, and were closely associated with disability increases. Associations with frailty or sociodemographics characteristics were absent except for living alone.
DISCUSSION
Short-term disability fluctuations in late life were substantial, were linked to mortality-related processes, and represent a concomitant feature of disability increases in late life.
Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Connecticut; Disabled Persons; Female; Frail Elderly; Humans; Male; Mortality; Poisson Distribution; Socioeconomic Factors; Surveys and Questionnaires; Time Factors
PubMed: 31298701
DOI: 10.1093/geronb/gbz089 -
European Journal of Physical and... Aug 2014In the current population we observe a rise of chronic health problems often with multiple characteristics. This results in a growing number of people who are... (Review)
Review
In the current population we observe a rise of chronic health problems often with multiple characteristics. This results in a growing number of people who are experiencing long-term disabilities or difficulties in functioning because of disability. These conditions require a complex response over an extended period of time, that involves coordinated inputs from a wide range of health professionals. This paper argues the central role and benefit of rehabilitation and describes the rehabilitation as an integral component in the management of people with chronic disabilities. It also presents the most important related definitions: long-term care, rehabilitation for chronic disease and disability, the aim of physical and rehabilitation medicine (PRM). An interdisciplinary team is ideal for an effective implementation of rehabilitation for chronic disease and disability. However, the article mainly focuses on defining the role and contribution of the PRM physician in the rehabilitation of persons with long-term disabilities. The article includes: descriptions of his/her key role and competencies, particularly with regard to medical and functional status and prognosis, of the ability to comprehensively define the rehabilitation needs of the patient/person with respect to ICD-WHO classification domains, of the cooperation with other medical specialists and health professionals, of determining the rehabilitation potential, of developing the rehabilitation plan tailored to specific needs, as well as of the contribution of PRM physician in the follow-up care pathways.
Topics: Clinical Competence; Disabled Persons; Disease Management; Humans; Long-Term Care; Physical and Rehabilitation Medicine
PubMed: 25061984
DOI: No ID Found -
International Journal For Equity in... Jan 2021Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were...
BACKGROUND
Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi's National Disability Mainstreaming Strategy and Implementation Plan.
METHODS
We applied an analytical methodology to review the Malawi's National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion.
RESULTS
The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process.
CONCLUSIONS
The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production - co-implementation - co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.
Topics: Community Participation; Disabled Persons; Health Policy; Humans; Malawi; Policy Making; Vulnerable Populations
PubMed: 33413443
DOI: 10.1186/s12939-020-01378-y -
Medical Care Sep 2020In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE.
BACKGROUND
In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE.
OBJECTIVE
The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade.
RESEARCH DESIGN
Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data.
MEASURES
National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability.
RESULTS
DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability.
CONCLUSIONS
The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.
Topics: Activities of Daily Living; Adult; Age Factors; Aged; Chronic Disease; Disabled Persons; Female; Health Expenditures; Humans; Male; Medicaid; Medicare; Middle Aged; Physical Functional Performance; Racial Groups; Residence Characteristics; Sex Factors; Social Work; Socioeconomic Factors; United States; Work Capacity Evaluation
PubMed: 32826747
DOI: 10.1097/MLR.0000000000001371 -
The American Journal of Geriatric... Mar 2021Assess a conceptual model linking caregiving factors to care recipient mortality in a large representative sample of older adults with disability.
OBJECTIVE
Assess a conceptual model linking caregiving factors to care recipient mortality in a large representative sample of older adults with disability.
DESIGN
Descriptive longitudinal study with 5-year mortality follow-up among older adults with disability. Baseline in person and telephone interviews/assessments of older adults with disability and their family caregivers carried out in 2011.
SETTING
Representative samples of older US population and their family caregivers.
PARTICIPANTS
US representative samples of older adults with disability aged 65 and over (National Health and Aging Study) and their family caregivers (National Study of Caregiving; www.nhats.org; N = 1,262).
MEASUREMENT
Controlling for known risk factors for mortality in older adults, including age, gender, race, education, socioeconomic status, disability, and cognitive status, we assess the role of three caregiving factors (depression, anxiety, and burden) and three mediating factors (care recipient depression, anxiety, and unmet needs for care) as predictors of care recipient mortality.
RESULTS
Caregiver burden, care recipient depression, and care recipient unmet needs are independent predictors of care recipient mortality.
CONCLUSION
Caregiving factors may play an important role in the survival of their care recipients. This is a relatively unexplored research area that calls for fine-grained studies capturing caregiver-care recipient health-related interactions over time.
Topics: Aged; Aged, 80 and over; Anxiety; Caregiver Burden; Caregivers; Depression; Disabled Persons; Female; Humans; Longitudinal Studies; Male; Prognosis; Stress, Psychological; Survival Rate
PubMed: 32718853
DOI: 10.1016/j.jagp.2020.06.025