Aging with a Disability: What the Practitioner Needs to Know AACPDM Presentation Summary Sept 29, 2004 Bryan Kemp, PhD University of California at Irvine

%Capacity AGE What is Aging? A Look at the Organ Systems Rate of Aging = Rate of Aging = 1% per year Required Capacity 40 Reserve Capacity

%Capacity AGE Aging with a Disability vs. Typical Aging Non-Disabled = Non-Disabled = 1% per year Disabled = 1.5% per year 40

>60 Walking Cessation by Age in CP Group % AGE n = 27 Murphy K, et al. Dev Med Child Neuro. 1995, 37, Stopped by 30 due to: fatigue fatigue inefficiency inefficiency Stopped by 50 Stopped by 50 due to: pain pain fatigue fatigue

Incidence of Pain by Impairment Group n = 337 % (120)(23)(60)(9)(125) Severitymildmod/severe RRTC on Aging with a Disability Natural Course of Aging with a Disability Study, 2002

Incidence of Fatigue by Impairment Groups % n = 351 RRTC on Aging with a Disability, Natural course of aging with a disability study, 2001 Polio CPSCIControl

Loss of Function with Age AGE Disabled Non-disabled Recreation IADLs Employment ADLs

Example of Typical Daily Functional Demands for W/C users Rise and Shine -Up and out of bed! Bathing/Toileting/Dressing/Pressure relief raises Transfers (cars, chairs, toilets, bathbench, couches, floor, bed) Propulsion (hills, rough terrain, ramps, curb cuts, distance) ramps, curb cuts, distance) Outings (work, school, social, community chores, recreation) Exercise? Household chores To bed - Sleep?

Two Important Psychological Issues Coping and the problem of depression Quality of Life and community involvement

Depression Scores Across Groups Percent

Why Depression Is Poorly Recognized  The symptoms of depression overlap with the symptoms of chronic disease.  Clinicians and others “normalize” depression.  Clinicians believe depression is untreatable because of the disability.

Causes of Depression  Not caused by the disability or the impairment.  Most likely caused by difficulties coping with the disability and the societal problems.

Factors Related to Positive QOL in Persons Aging with a Disability v Not related to age, severity of impairment or to degree of disability. v The ability to engage in meaningful, enjoyable or productive activities. v The number and kind of community activities the person does. v Somewhat related to social support, attitude, and personality.

QUALITY OF LIFE: The presence of a reasonable amount of pleasurable, successful and meaningful experiences.

Recognize the value of education about long-term life issues. Initial rehab may be the only teachable moment. Recognize the value of education about long-term life issues. Initial rehab may be the only teachable moment. Assist with finding the balance between the need for exercise and the need for efficient movement. Assist with finding the balance between the need for exercise and the need for efficient movement. The primary means of mobility should not be the means for exercise. Emphasize performance skills that protect the musculoskeletal system and provide the rational for specific performance techniques. Emphasize performance skills that protect the musculoskeletal system and provide the rational for specific performance techniques. Educate clients about potential changes and how to recognize and respond to symptoms associated with functional change. Educate clients about potential changes and how to recognize and respond to symptoms associated with functional change. Initial Rehabilitation focus

Instead of… “Use it or lose it” “No pain, no gain” Consider… “Conserve it to preserve it”

Website Resources “Aging with a Disability: Putting Research into Practice and Education” March 2003 –Video of presentations –Powerpoint slides

Additional Readings Lankasky, K. (2004). A consumer’s perspective on living with a disability: How change in function affects daily life. In B.J. Kemp & L. Mosqueda (Eds.), Aging with a Disability: What the Clinician Needs to Know (pp. 9-18). Baltimore: The Johns Hopkins University Press. Murphy, K.P., Molnar, G.E., & Lankasky, KI. (1995). Medical and functional status of adults with cerebral palsy. Developmental Medicine and Child Neurology, 37,