Health disparities among workers and nonworkers with functional limitations: implications for improving employment in the United States.

PURPOSE: The aim of this study was to compare workers and nonworkers who reported mild, moderate, and severe/complete functional limitations to identify disparities in 19 health and social indicators. METHOD: Using the International Classification of Functioning, Disability and Health as our conceptual framework, we analyzed data from the combined 2000-2008 National Health Interview Survey, comparing workers and nonworkers by severity of functional limitations, as measured by the FL12 Scale of Functional Limitation Severity. RESULTS: Only 9.5% of people reporting moderate/severe functional limitations worked. Although not without exception, not working and severity of functional limitation were associated with poorer health outcomes, with nonworkers reporting severe/complete limitations having least optimal health. Prevalence of chronic conditions was associated with level of functional limitation severity, with the strongest associations among nonworkers. CONCLUSIONS: By focusing exclusively on people with functional limitations, we were better able to examine factors contributing to health and participation of workers and nonworkers. People who worked and had moderate or severe/complete limitations often did so while reporting poor health. With improved access to health care, health promotion activities, and other support systems, the quality of life and likelihood of work participation of people with greater functional limitations might also be improved.

Health risk profile for older adults with blindness: an application of the International Classification of Functioning, Disability, and Health framework.

PURPOSE: To develop a health risk profile for adults age 65 years or older with blindness, using the International Classification of Functioning, Disability and Health (ICF) as our conceptual framework. METHODS: We combined and analyzed data from the 2000-2006 National Health Interview Survey after backcoding questions to the ICF. We compared older adults with blindness (n = 477) and older adults with vision loss but not blindness (n = 6,721) with older adults who reported no vision loss (n = 33,497) for the following outcome measures: demographics, functional limitations (self-care, social participation, and mobility limitations), level of psychological distress, physical health status, selected chronic conditions and health risk behaviors (smoking, alcohol use, obesity, and physical inactivity). RESULTS: Older adults with blindness were more likely to be poorer, older, and less educated than older adults without vision loss. They were also more likely to have fair to poor health; to have difficulty walking; to experience diabetes, heart problems, and breathing problems; and to be physically inactive, compared with older adults reporting vision loss but not blindness and older adults without vision loss. CONCLUSION: Older adults with blindness face significant health disparities that can diminish their quality of life without timely, disability-sensitive interventions to address serious psychological distress and physical inactivity.

Aging with cerebral palsy and other disabilities: personal reflections and recommendations.

This article describes the lived experience of one 64-year-old woman who is aging with cerebral palsy (CP) and other multiple disabilities. Reflections are offered on coping with secondary conditions and functional decline; fighting the effects of pain and fatigue; and managing well-meaning, but misdirected, medical advice. Recommendations based on the author's personal and professional experience with disabilities, including CP, are presented on the aging process and on preventive care for adults living with CP.

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

OBJECTIVE: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. METHOD: The authors analyzed data from the 1997-2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. RESULTS: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair-poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). DISCUSSION AND CONCLUSIONS: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity.

Multiple health disparities among minority adults with mobility limitations: san application of the ICF framework and codes.

PURPOSE: To examine the interface between mobility limitations and minority status and its effect on multiple health and health-related domains among adults, using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS: We combined 8 years of data from the 1997-2004 US National Health Interview Survey to investigate health disparities among minorities with mobility limitations as defined by the ICF. A total of 79,739 adults surveyed met these criteria. RESULTS: Adults with both mobility limitations and minority status experienced the greatest disparities (p<0.001) in worsening health (adjusted odds ratio [AOR]=8.5), depressive symptoms (AOR=17.2), diabetes (AOR=5.5), hypertension (AOR=3.4), stroke (AOR=7.2), visual impairment (AOR=4.6), difficulty with activities of daily living (AOR=42.7) and instrumental activities of daily living (AOR=27.7), use of special equipment (AOR = 28.1), obesity (AOR=3.3), physical inactivity (AOR=2.7), and low workforce participation (AOR=0.35). CONCLUSIONS: For most outcome measures, findings supported our hypothesis that persons with both mobility limitations and minority status experience greater health disparities than do adults with minority status or mobility limitations alone.

Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry.

Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural-environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants.

Adverse health behaviors and chronic conditions in working-age women with disabilities.

This retrospective, cross-sectional, multiple cohort study of women with disabilities addresses two health-related areas in a nationally representative sample of women living in the community. Using data from the 1997-1998 National Health Interview Survey (NHIS), health risk behaviors and chronic conditions were examined for women with mild, moderate, and severe functional limitations, and their responses were compared to those of women who reported no limitations. Women with severe limitations evidenced the highest risk for heavy cigarette smoking. They were also more likely to meet the Body Mass Index criterion for obesity. Adverse health behaviors were strongly associated with the five potentially disabling chronic conditions that were studied.

The organization and financing of health services for persons with disabilities.

Americans with disabilities are rarely considered a distinct group of health care users in the same way as are older Americans, children, racial and ethnic minorities, and others who are perceived to have different needs and access issues. Indeed, to some extent individuals with disabilities overlap with all these groups. But they also have distinct needs with material implications for the organization, delivery, and financing of health care services. Despite the disproportionate health care needs and expenditures of many--though not all--individuals with disabilities, the mainstream health services research community has largely neglected them. This article outlines the most pressing health service research issues in addressing the health care needs of individuals with disabilities.