1. EXAMINING THE BURDEN OF DISABILITY IN THE CONTEXT OF CHRONIC DISEASE: IMPLICATION FOR TRINIDAD & TOBAGO Caroline Alexis-Thomas, RN, BSc, MPH People’s Space November 24, 2009

2. BURDEN OF DISABILITY Disability in terms of Altered Functionality: Instrumental Activities of Daily Living (IADL) (shopping, cooking) Activities of Daily Living (ADL) (dressing, eating)

3. Chronic Disease and Disability chronic disease and disability as a ‘double burden of disease’ (Yack 2001). disability increases linearly with the number of chronic morbidities where in the presence of any chronic disease, the risk of having a disability was 1.9-4.5 times more and in the presence of 5-6 chronic disease co-morbidities, the risk increases to 2.7-42.9 times (Zhao et al. 2009). Chronic disease is the leading cause of disability in most countries of the Americas (Escobar 2008)

4. Chronic Disease and Disability ischaemic heart disease, cerebrovascular disease and chronic obstructive pulmonary disease are among the leading causes of disability-adjusted life-years (Murray and Lopez 1997) Chronic diseases account for almost 50%-75% of disability adjusted life years lost in the Americas (Rose, Hennis, Hambleton, 2008; Pan American Health Organization 2009)

5. Chronic Disease and Disability Diabetes-blindness, amputations Cerebrovascular accidents (stroke)-cognitive impairment, visual field defect, urinary incontinence, loss/limited use of extremities (Mahabir, Bickram, Gulliford 1998, World Health Organization 2001)

6. Chronic Disease and Disability Study in Spain (2002): osteoarthritis (41.8%), heart and lung disease (7%), cerebrovascular disease (5.9%) Caribbean-diabetes, arthritis, hypertension contributed to a majority of disabilities in 60+ especially women (Schmid, Vezina, Ebbeson 2008)

7. Risk Factors Overweight and obesity – 40% of disability in chronic disease (Bhattacharya,Choudhry, Lakdawalla 2008) High-calorie diet, lack of exercise/low physical activity (Hawthorne 2000; Albach 2001)

8. Social Profile-Age at least one chronic illness is found in almost 75% of persons 65 years and older with at least 50% of them having at least two chronic diseases Chronic disease was also a main factor contributing to disability in the 45+ age group (Zhao et al. 2009).

9. Psychological Profile-Age & Gender “elderly people may not seek medical care for undiagnosed diseases, contributing to the progression of disability” (Valderrama-Gamma et al. 2002) belief among women that being affected with a chronic disease after 40 years is normal and that having its related complications which include disabilities, is a natural progression of life (Wiltshire & Brown 1989)

10. Impact Limited focus of the additional burden of disability as a result of chronic disease Growing economic cost for individual and country Limited support from the health care system Limited social support

11. Recommendations Access to social and economic security Access to affordable health care services Upgrading of medical technology, equipment and supplies Environmental Changes Access to health insurance Increased access to health improving opportunities Upgrading of skills and training of health care providers

12. Recommendations Disease Prevention Promotion of healthy lifestyle at an early age (to reduce chronic disease and associated disabilities) Population Assessment and Research Continuous population surveys on chronic diseases and associated disabilities Ongoing research to include required social and economic support

13. Recommendations Collaboration and Coordination Integrated, multi-sectoral approach Development of clear objectives with targets Increased collaboration between the proponents of chronic disease (Health sector) and disability (Social sector) More concerted efforts to reduce the risk factors for chronic diseases Comprehensive policies, plans and budgets aimed at prevention, surveillance, control and rehabilitation Collaboration on best practice

14. Conclusion chronic disease is contributing to the increasing prevalence of disability especially in the 45 years and over age group and women. Therefore, it is important to address disability from the model of promoting prevention and early screening of chronic diseases in Trinidad and Tobago

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