Socio-economic inequalities in physical functioning: a comparative study of English and Greek elderly men

The associations between socio-economic position (SEP) and physical functioning have frequently been investigated but little is known about which measures of SEP are the best to use for older people. This study examined how different SEP indicators related to the physical functioning of men aged 50 or more years in England and Greece. The data derived from Wave 1 of the English Longitudinal Study of Ageing (ELSA) and from the Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported physical functioning limitations and mobility difficulties were combined and categorised into ‘no disability’, ‘mild disability’ and ‘severe disability’. The SEP indicators studied were: wealth, educational level and occupational class. The findings indicate that respondents with less wealth, fewer educational qualifications and lower occupational class were more likely to experience mild or severe physical disability than those of high SEP. When all three measures of SEP were adjusted for each other, in both samples wealth maintained a strong association with mild and severe disability, while education was associated with severe disability but only among English men. Occupational class was not strongly associated with physical disability in either case. Hence, among English and Greek older men, wealth was a more important predictor of physical functioning difficulties than either occupational class or education

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective

Forming norms: informing diagnosis and management in sports medicine

Clinicians aim to identify abnormalities, and distinguish harmful from harmless abnormalities. In sports medicine, measures of physical function such as strength, balance and joint flexibility are used as diagnostic tools to identify causes of pain and disability and monitor progression in response to an intervention. Comparing results from clinical measures against ‘normal’ values guides decision-making regarding health outcomes. Understanding ‘normal’ is therefore central to appropriate management of disease and disability. However, ‘normal’ is difficult to clarify and definitions are dependent on context. ‘Normal’ in the clinical setting is best understood as an appropriate state of physical function. Particularly as disease, pain and sickness are expected occurrences of being human, understanding ‘normal’ at each stage of the lifespan is essential to avoid the medicalisation of usual life processes. Clinicians use physical measures to assess physical function and identify disability. Accurate diagnosis hinges on access to ‘normal’ reference values for such measures. However our knowledge of ‘normal’ for many clinical measures in sports medicine is limited. Improved knowledge of normal physical function across the lifespan will assist greatly in the diagnosis and management of pain, disease and disability

College Student Perceptions of Varying Disability Types: Does Contact Experience Matter?

Studies exploring prejudices between groups have suggested that contact is related to attitudes. This relationship has been studied in the context of attitudes toward people with disabilities and has yielded inconsistent results. Other variables, such as gender, type of relationship, and the type of disability, have been studied in conjunction with and distinct from the contact variable. The present study, conducted among college students, investigated if the contact experience or the exposure to a specific type of disability in a vignette individually were associated with the attitude variable of social distance, as well as if there was an interaction between the two independent variables. Contact experience did not significantly predict scores on the social distance measure; however, type of disability was a significant predictor of undergraduate students’ social distance attitudes. Specifically, physical disability predicted significantly lower scores of social distance than intellectual disability, Attention-Deficit Hyperactivity disorder, and Autism Spectrum Disorder. The results of this research were consistent with prior studies measuring similar variables, prompting a need for further research on the role of contact experience and disability type in forming prejudices toward people with disabilities. As type of disability seems to play a significant role in attitudes toward people with disabilities, greater efforts should be directed towards educating students and faculty on non-physical disability types

Risk factors for incidence and persistence of disability in chronic major depression and alcohol use disorders: longitudinal analyses of a population-based study

BackgroundMajor depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD. MethodData from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively. ResultsAnalyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group. ConclusionsChronic MD and chronic AUD are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.<br/

Disabilty in Older Adults with Depression

Depression is a leading cause of disability among older adults which can change the scope of daily life for older adults and threaten their ability to live independently in the community. This dissertation explored task disability in older adults with depression in three studies. A unique aspect of the studies was the assessment of disability through performance-testing. The first study examined task disability patterns in a sample of older adults with depression being treated as inpatients (n = 60) or outpatients (n = 59). Rasch analysis revealed that the degree of disability for task domains (functional mobility [FM], basic activities of daily living [BADL], instrumental activities of daily living [IADL] with a greater physical component [IADL-physical], and IADL with a greater cognitive component [IADL-cognitive]), and task items, was different for older women whose depression resulted in inpatient versus outpatient treatment. With the same sample, the second study examined the impact of information processing speed on task disability. The patients were separated into groups by speed of processing (slower patients, n = 76; faster patients, n = 23) based on their performance on the Trail Making Test - B. Speed of processing was associated with severity of depression and both depression and slower speed of processing interfered more with effortful processing tasks (i.e., IADL-cognitive and IADL-physical) and less with tasks requiring automatic processing (i.e. FM). The third study compared physician rated disability on the Global Assessment of Function (GAF) Scale with performance-disability observed on the Performance Assessment of Self-Care Skills (PASS) in a hospitalized community-based sample separated into subgroups by readmission status (readmit patients, n = 15; non-readmit patients, n = 43). There was a lack of concordance between the measures with only the GAF Scale showing significant reduction in disability at discharge. Findings from these studies suggest that for older adults with depression, there may be sentinel tasks which are disability indicators and those tasks may differ based on speed of processing. The lack of concordance between the disability measures suggests the need for consideration of performance-based testing of daily life tasks as a component of usual care

On making disability in rural places more visible: challenges and opportunities [Introduction to a special issue]

This essay prefaces a special issue of the Journal of Rural Studies (JRS) concerned with a sub-field of inquiry that might be termed the rural geography of disability, addressing multiple dimensions of disability, physical and mental, associated with life in rural localities (as conventionally identified). Drawing on three vignettes where rurality and disability co-mingle, the authors explore both bad and good rurals with respect to disability: meaning properties of rural areas that can generate, exacerbate or stigmatise disability, on the one hand, and qualities of rural environments that may prevent, alleviate or mollify disability, on the other. Through a brief review of papers in JRS where disability has made an appearance, together with references across to relevant studies elsewhere, this essay lays the groundwork for a rural geography of disability as well as serving to introduce the papers that follow in the special issue

Poverty and Disability: The Endless Loop

[Excerpt] Disability is a critical dimension of poverty in developing countries because poverty contributes to disability and disability leads to poverty. Poverty alleviation measures are unlikely to help poor disabled people who are insulated from information and isolated from opportunities and services by a de facto apartheid enforced by informational, physical and social obstacles. To be fully effective, poverty programs must take disability explicitly into account. The World Bank has noted that without paying attention to the rights and needs of people with disabilities (PWDs), Millennium Development Goals are unlikely to be achieved

Disability, Physical Inactivity, and Impaired Health-Related Quality of Life Are Not Different in Metabolically Healthy vs. Unhealthy Obese Subjects

BACKGROUND: Obesity represents a major health hazard, affecting morbidity, psychological status, physical functionality, quality of life, and mortality. The aim of the present study was to explore the differences between metabolically healthy (MHO) and metabolically unhealthy (MUO) obese subjects with regard to physical activity, disability, and health-related quality of life (HR-QoL). METHODS: All subjects underwent a multidimensional evaluation, encompassing the assessment of body composition, metabolic biomarkers and inflammation, physical activity level (IPAQ questionnaire), disability (TSD-OC test), and HR-QoL (SF-36 questionnaire). MHO and MUO were defined based on the absence or the presence of the metabolic syndrome, respectively. RESULTS: 253 subjects were included (54 men and 199 women; age: 51.7 ± 12.8 vs. 50.3 ± 11.7 years, p = 0.46; BMI: 38.1 ± 5.7 vs. 38.9 ± 6.7 kg/m², p = 0.37). No significant difference was observed in body composition. There was no difference between MHO and MUO considering inflammation (hs-CRP: 6517.1 ± 11,409.9 vs. 5294.1 ± 5612.2 g/L; p = 0.37), physical inactivity (IPAQ score below 3000 METs-min/week in 77.6% of MHO vs. 80% of MUO subjects; p = 0.36), obesity-related disability (TSD-OC score > 33%, indicating a high level of obesity-related disability, in 20.2% of MHO vs. 26.5% of MUO subjects; p = 0.28), and the HR-QoL (SF-36 total score: 60 ± 20.8 vs. 62.8 ± 18.2, p = 0.27). DISCUSSION AND CONCLUSION:The metabolic comorbidity and the impairment of functional ability and psycho-social functioning may have a different timing in the natural history of obesity. Alterations in the physical activity level and mobility disabilities may precede the onset of metabolic abnormalities. (Trial registration 2369 prot 166/12-registered 23 February 2012; Amendment 223/14-registered 13 February 2014)