Blackburn J.A., Dulmus C.N. (Editors). Handbook of gerontology: evidence-based approaches to theory, practice, and policy

Подождите немного. Документ загружается.

196 E

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RACTICE

Almeida, O. P., Norman, P., Hankey, G., Jamrozik, K., & Flicker, L. (2006). Successful men-

tal health aging: Results from a longitudinal study of older Australian men. American

Journal of Geriatric Psychiatry, 14, 27–35.

American Association of Retired Persons. (2004). Synthesis of AARP research in physical ac-

tivity: 1999–2003. Washington, DC: Author.

American Diabetes Association (n.d.). Type 2 diabetes. Retrieved March 8, 2006, from

http://www.diabetes.org/type-2-diabetes.jsp.

American Geriatrics Society. (2001). Guidelines for the prevention of falls in older per-

sons. Journal of the American Geriatrics Society, 49, 664–672.

American Public Health Association. (2005, April 6). Living stronger, longer through protec-

tion. Washington, DC: Author.

Appel, D., & Aldrich, T. (2003). Smoking cessation in the elderly. Clinics of Geriatric Medi-

cine, 19, 77–100.

Atkinson, R. (1993, November). Late onset problem drinking in older adults. Paper presented

at the 46th annual scientific meeting of the Gerontological Society of America, New

Orleans, LA.

Atkinson, R. (1995). Treatment programs for aging alcoholics. In T. Beresford &

E. Gomberg (Eds.), Alcohol and aging (pp. 186–210). New York: Oxford University

Press.

Babor, T., & Grant, M. (1992). Project on identification and management of alcohol-related prob-

lems: Report on phase II—A randomized clinical trial of brief interventions in primary health

care. Geneva, Switzerland: World Health Organization.

Baker, D., King, M., Fortinsky, R., Graff, L., Gottschalk, M., Acampora, D., et al. (2005). Dis-

semination of an evidence-based multicomponent fall risk-assessment and management

strategy throughout a geographic area. Journal of the American Geriatrics Society, 53,

675–680.

Barry, K., Oslin, D., & Blow, F. (2001). Alcohol problems in older adults. New York: Springer.

Blair, S., Kohl, W., Paffenbarger, R., Clark, D. G., Cooper, K. H., & Gibbons, L. W. (1989).

Physical fitness and all-cause mortality: A prospective study of healthy men and

women. Journal of the American Medical Association, 262, 2395–2401.

Bloom, M. (1996). Primary prevention practices. Thousand Oaks, CA: Sage.

Blow, F. (2000). Treatment of older women with alcohol problems: Meeting the chal-

lenge for a special population. Alcoholism: Clinical and Experimental Research, 24(8),

1257–1266.

Blow, F., Walton, M., Chermack, S., Mudd, S., & Brower, K. (2000). Older adult treatment

outcome following elder-specific inpatient alcoholism treatment. Journal of Substance

Abuse Treatment, 19, 67–75.

Booth, F. W., & Winder, W. W. (2005). Role of exercise in reducing the risk of diabetes and

obesity. Journal of Applied Physiology, 99, 3–4.

Butler, R. N., Forette, F., & Greengross, B. S. (2004). Maintaining cognitive health in an

aging society. Journal of the Royal Society for the Promotion of Health, 124(3), 199–121.

Center for the Advancement of Health. (2006, March). A new vision of aging: Helping older

adults make healthier choices (Issue Brief No. 2). Washington, DC: Author.

Centers for Disease Control and Prevention. (1997). Perspectives in disease prevention

and health promotion smoking attributable mortality and years of potential life lost—

United States, 1984. Morbidity and Mortality Weekly Report, 46(20), 444–451.

Centers for Disease Control and Prevention. (2004a). Health, United States, 2004 (DHHS

Publication No. 2005-0152). Washington, DC: National Center for Health Statistics.

Centers for Disease Control and Prevention. (2004b). The state of aging and health in Amer-

ica: 2004. Washington, DC: U.S. Government Printing Office.

Health Promotion 197

Centers for Disease Control and Prevention. (2005). Physical activity and good nutrition: Es-

sential elements to prevent chronic diseases and obesity. Washington, DC: U.S. Government

Printing Office.

Centers for Disease Control and Prevention, National Center for Injury Prevention and

Control. (2006). Web-Based Injury Statistics Query and Reporting System. Retrieved March

30, 2006 from www.cdc.gov/ncipc/wisqars.

Chandra, R. (1997). Graying of the immune system: Can nutrient supplements improve

immunity in the elderly? Journal of the American Medical Association, 277, 1398–1399.

Cicero, M. T. (1946). De senectute [On old age] (W. A. Falconer, Trans.). Cambridge, MA:

Harvard University Press. (Original work c. 44

de Rekeneire, N., Visser, M., Peila, R., Nevitt, M., Cauley, J., Tylavsky, F., et al. (2003). Is a

fall just a fall? Correlates of falling in healthy older persons. Journal of the American

Geriatrics Society, 53, 841–846.

Englander, F., Hodson, T., & Terregrossa, R. (1996). Economic dimensions of slip and fall

injuries. Journal of Forensic Science, 41, 733–746.

Fiore, M., Bailey, W., Cohen, S., Dorfman, S., Goldstein, M., Gritz, E., et al. (2000). Treating

tobacco use and dependence (Clinical Practice Guideline). Washington, DC: U.S. Depart-

ment of Health and Human Services.

Fleming, M., Barry, K., Manwell, L., Johnson, K., & London, R. (1997). Brief physician advice

for problem alcohol drinkers: A randomized controlled trial in community-based pri-

mary care practices. Journal of the American Medical Association, 277, 1039–1045.

Fleming, M., & Manwell, L. (1999). Brief intervention in primary care settings: A primary

treatment method for at-risk, problem, and dependent drinkers. Alcohol Research and

Health, 23(2), 128.

Gill, T. M., DiPietro, L., & Krumholz, H. M. (2000). Role of exercise stress testing and

safety monitoring for older persons starting an exercise program. Journal of the Ameri-

can Medical Association, 284(3), 342–349.

Glei, D. A., Landau, D. A., Goldman, N., Chaung, Y., Rodriguez, G., & Weinstein, M.

(2005). Participating in social activities helps preserve cognitive functioning: An

analysis of a longitudinal, population-based study of the elderly. International Journal of

Epidemiology, 34(4), 864–871.

Googins, B. (1984). Avoidance of the alcoholic client. Social Work, 29, 161–166.

Gosney, M. (2001). Smoking cessation. Gerontology, 47, 236–240.

Goulding, M. (2005). Trends in prescribed medicine use and spending by older Americans,

1992–2001 (Aging Trends, No. 5). Hyattsville, MD: National Center for Health Statistics.

Haber, D. (1999). Health promotion and aging: Implications for the health professions. New

York: Springer.

Hewer, W., Mussell, M., Rist, F., Kulzer, B., & Bergis, K. (2003). Short-term effects of im-

proved glycemic control on cognitive function in patients with Type 2 diabetes. Geron-

tology, 49(2), 86–92.

Hu, F. B., Manson, J. E., Stampfer, M. J., Colditz, G., Liu, S., Solomon, C. G., et al. (2001).

Diet, lifestyle, and the risk of Type 2 diabetes mellitus in women. New England Journal

of Medicine, 345, 790–797.

Hubert, H. B., Bloch, D. A., Oehlert, J. W., & Fries, J. F. (2002). Lifestyle habits and com-

pression of morbidity. Journal of Gerontology, 57(2), 347–351.

Institute of Medicine. (2000). The role of nutrition in maintaining health in the nation’s elderly:

Evaluating coverage of nutrition services for the Medicare population. Washington, DC: Na-

tional Academy Press.

International Diabetes Center. (2003). Type 2 diabetes practice guidelines. Minneapolis, MN:

International Diabetes Center.

198 E

VIDENCE

-B

ASED

EALTH

RACTICE

Jette, A. M., Lachman, M., Giorgetti, M. M., Assmann, S. F., Harris, B. A., Levenson, C.,

et al. (1999). Exercise: It’s never too late—The Strong-for-Life program. American Jour-

nal of Public Health, 89(1), 66–72.

Johnson, D. B., Beaudoin, S., Smith, L. T., Beresford, S. A., & LoGerfo, J. P. (2004). Increas-

ing fruit and vegetable intake in homebound elders: The Seattle Senior Farmers’ Mar-

ket Nutrition Pilot Program. Preventing Chronic Disease [Serial online]. Retrieved April

1, 2006 from http://www.cdc.gov/pcd/issues/2004/jan/03_00010a.htm.

Johnson, I. (2000). Alcohol problems in old age: A review of recent epidemiological re-

search. International Journal of Geriatric Psychiatry, 15, 575–581.

King, M., & Tinetti, M. (1995). Falls in community-dwelling older persons. Journal of the

American Geriatrics Society, 43, 1146–1154.

Klein, W. (2003). Substances, older adulthood: The prevention of problems with the use

and misuse of alcohol among older persons. In T. Gullotta & M. Bloom (Eds.), Ency-

clopedia of primary prevention (pp. 1087–1093). New York: Kluwer Academic/Plenum

Press.

Klein, W., & Bloom, M. (1997). Successful aging: Strategies for healthy living. New York:

Plenum Press.

Klein, W., & Jess, C. (2002). One last pleasure? Alcohol use among seniors in nursing

homes. Health and Social Work, 27, 193–203.

Lachman, M. E., & Jette, A. (1997). A cognitive-behavioral model for promoting regular

physical activity in older adults. Psychology, Health and Medicine, 2(3), 251–262.

Lawton, M., & Nahemow, L. (1973). Ecology and the aging process. In C. Eisdorfer & M. P.

Lawton (Eds.), Psychology of adult development and aging (pp. 619–674). Washington, DC:

American Psychological Association.

Levkoff, S. E., Chee, Y. K., & Noguchi, S. (2001). Aging in good health: Multidisciplinary per-

spective. New York: Springer.

Mirand, A., & Welte, J. (1996). Alcohol consumption among the elderly in a general popu-

lation, Erie County, New York. American Journal of Public Health, 86, 978–984.

National Center on Addiction and Substance Abuse. (1998). Under the rug: Substance abuse

and the mature woman. New York: Columbia University Press.

National Guideline Clearinghouse. (2005a). Guideline synthesis: Screening for breast cancer

(Rev. November 2005). Rockville, MD: Author. Retrieved December 28, 1998, from

http://www.guideline.gov.

National Guideline Clearinghouse. (2005b). Guideline synthesis: Screening for colorectal can-

cer (Updated November 2005). Rockville, MD: Author. Retrieved June 7, 1998, from

http://www.guideline.gov.

National Guideline Clearinghouse. (2005c). Guideline synthesis: Screening for prostate cancer

(Updated September 2005). Rockville, MD: Author. Retrieved December 28, 1998, from

http://www.guideline.gov.

National Institute on Aging. (2000). Age page: Dealing with diabetes. Washington, DC: U.S.

Government Printing Office.

National Institute on Alcohol Abuse and Alcoholism. (2005). Helping patients who drink too

much: A clinician’s guide. Washington, DC: U.S. Department of Health and Human Ser-

vices, National Institutes of Health.

Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J., Carnes, B. A., Brody, J., et al.

(2005). A potential decline in life expectancy in the United States in the 21st century.

New England Journal of Medicine, 352, 1138–1145.

Ondus, K., Hujer, E., Mann, A., & Mion, L. (1999). Substance abuse and the hospitalized

elderly. Orthopaedic Nursing, 18, 27–34.

Health Promotion 199

Ory, M., Hoffman, M., Hawkins, M., Sanner, B., & Mockenhaupt, R. (2003). Challenging

aging stereotypes: Strategies for creating a more active society. American Journal of Pre-

ventive Medicine, 25(3Sii), 164–171.

Patterson, T., & Jeste, D. (1999). The potential impact of the baby-boom generation on sub-

stance abuse among elderly persons. Psychiatric Services, 50, 1184–1188.

Pescatello, L. S. (2001). Exercising for health: The merits of lifestyle physical activity.

Western Journal of Medicine, 174, 114–118.

Pfeiffer, B. A., Clay, S. W., & Conatser, R. R. (2001). A green prescription study: Does

written exercise prescribed by a physician result in increased physical activity among

older adults? Journal of Aging and Health, 13(4), 527–538.

Raiha, I., Kaprio, J., Koskenvuo, M., Rajala, T., & Sourander, L. (1998). Environmental dif-

ferences in twin pairs discordant for Alzheimer’s disease. Journal of Neurology, Neuro-

surgery, and Psychiatry, 65, 785–787.

Rhoades, J. A. (2005). Overweight and obese elderly and near elderly in the United States, 2002:

Estimates for the noninstitutionalized population age 55 and older (Statistical Brief No. 68).

Rockville, MD: Agency for Healthcare Research and Quality.

Rizzo, J., Baker, D., McAvay, G., & Tinetti, M. (1996). Cost-effectiveness of a multifactorial

targeted prevention program for falls among community elderly persons. Medical Care,

34, 954–969.

Rizzo, J., Friedkin, R., Williams, C., Nabors, J., Acampora, D., & Tinetti, M. (1998). Health

care utilization and costs in a Medicare population by fall status. Medical Care, 36,

1174–1188.

Robert Wood Johnson Foundation. (2001). National blueprint: Increasing physical activity

among adults age 50 and older. Princeton, NJ: Author.

Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Dell.

Rundek, T., & Bennett, D. A. (2006). Cognitive leisure activities, but not watching TV, for

future brain benefits. Neurology, 66, 794–795.

Sattin, R. (1992). Falls among older persons: A public health perspective. Annual Review of

Public Health, 13, 489–508.

Schonfeld, L., & Dupree, L. (1990). Older problem drinkers—Long-term and late-life

onset abusers: What triggers their drinking? Aging (No. 361, pp. 5–11). Washington,

DC: Administration on Aging.

Snowdon, D. (2001). Aging with grace. New York: Bantam Books.

Snowdon, D. (2003). Healthy aging and dementia: Findings from the nun study. Annals of

Internal Medicine, 139(5), 450–454.

Spector, A., Thorgrimsen, L., Woods, B., Royan, L., Davies, S., Butterworth, M., et al.

(2003). Efficacy of an evidence-based cognitive stimulation therapy programme for

people with dementia. British Journal of Psychiatry, 183, 248–254.

Sterling, D., O’Connor, J., & Bonadies, J. (2001). Geriatric falls: Injury severity is high and

disproportionate to mechanism. Journal of Trauma, 50, 116–119.

Stewart, D., & Oslin, D. (2001). Recognition and treatment of late-life addictions in med-

ical settings. Journal of Clinical Geropsychology, 7, 145–158.

U.S. Department of Health and Human Services. (1991). Healthy people 2000: National

health promotion and disease prevention objectives. Washington, DC: U.S. Government

Printing Office.

U.S. Department of Health and Human Services. (1996). Physical activity and health: A re-

port of the surgeon general. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2000). Healthy people 2010. Washington,

DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2003). An overview of programs and ini-

tiatives sponsored by DHHS to promote healthy aging: A background paper for the Blueprint on

Aging for the 21st Century Technical Advisory Group meeting. Washington, DC: U.S. Gov-

ernment Printing Office.

U.S. Department of Health and Human Services. (2004). Bone health and osteoporosis: A re-

port of the surgeon general. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2005). Dietary guidelines for Americans

2005. Washington, DC: U.S. Government Printing Office.

U.S. Preventive Services Task Force. (2001). Screening for lipid disorders in adults. Retrieved

January 23, 2007, from http://www.ahrq.gov/clinic/uspstf/uspschol.html.

U.S. Preventive Services Task Force. (2002a). Screening for colorectal cancer. Retrieved Janu-

ary 23, 2007, from http://www.ahrq.gov/clinic/uspstf/uspscolo.html.

U.S. Preventive Services Task Force. (2002b). Screening for prostate cancer. Retrieved Janu-

ary 23, 2007, from http://www.ahrq.gov/clinic/uspstf/uspsprca.html.

Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., et al. (2003).

Leisure activities and the risk of dementia in the elderly. New England Journal of Medi-

cine, 348(25), 2508–2516.

Williams, P., & Lord, S. R. (1995). Predictors of adherence to a structured exercise pro-

gram for older woman. Psychology and Aging, 10(4), 617–624.

Wilson, R. S., Mendes de Leon, C. F., Barnes, L. L., Schneider, J. A., Bienias, J. L., Evans,

D. A., et al. (2002). Participation in cognitively stimulating activities and risk of inci-

dent Alzheimer’s disease. Journal of the American Medical Association, 287(6), 742–748.

World Health Organization. (1948). Preamble to the Constitution of the World Health Or-

ganization as adopted by the International Health Conference, New York, June 19–22,

1946 and entered into force on April 7, 1948. Retrieved January 23, 2007, from

http://www.searo.who.int/EN/Section898/Section1441.htm.

Yeager, S. (2005). Weight gain speeds aging. Prevention, 57(10), 40.

Zimberg, S. (1996). Treating alcoholism: An age-specific intervention that works for older

patients. Geriatrics, 51, 45–49.

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CHAPTER 8

Disability

ELIZABETH LIGHTFOOT

HE FIELDS OF

aging and disability services and policy have traditionally

been distinct. However, there is a growing awareness of the overlap be-

tween aging and disability, as many of the policy and practice issues are in-

tertwined. Both fields have recently experienced a similar paradigm shift

toward community-based services rather than institutional services and increas-

ing consumer control over the types of services people receive. The disability

field has been the leader in advocating for both community-based and consumer-

controlled services, but both are now seen as desirable by many in both fields.

Although the service delivery systems of aging and disability remain essentially

separate, there are more and more instances in which the financing and delivery

of such services are commingled. There has been a growing call for increased

collaboration between the aging and disability sectors.

As people age, most desire to remain in their communities and in control of the

services and supports they need. People with all types of disabilities have the

same desire for remaining in their community, yet they may need unique sup-

ports and interventions, such as in the areas of health, housing, retirement, and

later-life planning.

Many of the issues related to people aging with lifelong disabilities, such as

people with Down syndrome disabilities, and people with disabilities acquired in

later life, such as people with Alzheimer’s disease, are similar. However, this

chapter has a special focus on people aging with lifelong disabilities. In particu-

lar, this chapter presents information on trends, definitions, interventions, and

practice guidelines for working with older people with lifelong disabilities.

The basis of this chapter is an evidence-based approach to working with older

people with disabilities. There has not been a strong focus on evidence-based prac-

tice in the field of disability policy and services, particularly in comparison to

some other fields, such as mental health services and policy. For example, an inter-

vention common in both the fields of mental health and developmental disabilities

is supported employment. Supported employment is considered an evidence-

based practice for people with mental illness (Bond, 2004; Bond et al., 2001;

Crowther, Marshall, Bond, & Husley, 2001; Twamley, Jeste, & Lehman, 2003), yet

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there has been no attempt to establish this as an evidence-based practice for peo-

ple with developmental disabilities (National Council on Disability, 2005). And al-

though there is a growing trend for federally funded medical interventions

related to rehabilitation of people with disabilities to use evidence-based practice

guidelines (National Council on Disability, 2005), this is confined mainly to the

fields of medicine and supporting health professions, such as occupational ther-

apy. Other types of disability interventions, such as supported living, education,

and employment, are far less focused on evidence-based guidelines. However,

there is a strong focus in these areas on outcomes and evaluation research of par-

ticular interventions and policies.

In fact, there is much skepticism in the field of disability as to the rise of evidence-

based practice (National Council on Disability, 2005). There are concerns that evi-

dence-based practice is not focusing on indicators that might be important to an

individual with a disability, but rather focusing on a professional’s view of appro-

priate outcomes. For example, Scherer, Coombs, and Hansen (2003) describe how a

person with a disability may view getting out of a house quickly using a wheelchair

and a ramp as more satisfying and having higher functional utility, yet a profes-

sional may find that getting out of a house by walking down the stairs with a cane,

albeit more time-consuming and tiring, is higher functioning. A related concern is

that because this model originated in the medical field, it portrays the medical

model approach to intervention (Muentz & Frese, 2001), which is viewed with great

trepidation by people within the disability movement. This attention on evidence-

based interventions rarely focuses on removing societal barriers, but rather on indi-

vidual’s rehabilitation to fit in with society. Further, there are concerns that the

focus on evidence-based practice is inherently intertwined with a cost-containment

mentality, and people with disabilities with great needs may end up getting ser-

vices cut if they are not shown to have evidence of improvement (National Council

on Disability, 2005). Thus, this chapter, which describes current research in regard

to disabilities, consciously presents a social model approach to evidence and cau-

tions practitioners to use a broad approach to evaluating and using evidence-based

interventions.

TRENDS AND INCIDENCE

The prevalence of disability among people over age 65 rapidly increased during

the twentieth century in the United States and other industrialized nations. Ac-

cording to the U.S. census, 54.7% of people over age 65 had a disability in 2000, ap-

proximately 18 million people (McNeil, 2001). The U.S. Census Bureau (1996)

projects that 20% of the total population will be over age 65 by the year 2030, and,

if disability rates remain constant, approximately 38 million people over age 65

will have a disability.

The growing number of people with disabilities over age 65 includes both a

growing number of people with lifelong disabilities who are living into later

years, and a growing number of people living longer and acquiring disabilities in

their later years. People with lifelong disabilities, such as intellectual or other de-

velopmental disabilities, rarely lived into adulthood at the beginning of the twen-

tieth century (see Box 8.1). Currently there are about 641,000 people over age 65

with developmental disabilities in the United States, and this population is ex-

pected to rise to approximately 1,242,800 by the year 2030 (Heller, Janicki, Ham-

mel, & Factor, 2002). Some of this growth is due to overall population growth of

Disability 203

Box 8.1

Intellectual Disability: A More Respectful Name

Intellectual disability is the preferred term worldwide for what some people in the

United States still refer to as “mental retardation” (Sushila, Mammen, Russell, &

Sudhakar, 2005). In the United States, many influential groups such as the Presi-

dent’s Committee on Intellectual Disabilities (2003; formerly known as the Presi-

dent’s Committee on Mental Retardation) and the Special Olympics have now

officially substituted the term “intellectual disability” as a synonym for “mental

retardation,” and other professional groups are having ongoing debates about the

terminology. The term mental retardation is becoming unpopular for two reasons.

First, the term is sometimes confused with mental illness. Second, the word “re-

tarded” or “retardation” has become a common slur (President’s Committee on In-

tellectual Disabilities, 2003). Although many government and professional groups

are still using the older term, it is falling into disfavor.

older adults, but the primary reason for these dramatic leaps is the growing life

expectancy of people with intellectual or developmental disabilities. In 1930, the

average life expectancy for a person with an intellectual disability was only about

20 years (Carter & Jancar, 1983). Currently, people with Down syndrome have a

life expectancy of almost 60 years, and people with other developmental disabili-

ties have a life expectancy approaching that of people without disabilities (Jan-

icki, Dalton, Henderson, & Davidson, 1999; Warren, 1998). This older population

of people with intellectual and developmental disabilities has essentially become

a brand-new population, with needs for new types of supports and services to

help them lead meaningful lives. As this population ages, they may experience

new types of disabilities related to aging that require an increase in support, yet

at the same time may now be outliving their parents who had previously been

their sole source of support (Doka & Lavin, 2003). New services, supports, and in-

terventions are needed to serve this emerging population.

Another sizable population of older people with disabilities is the growing

number of people who have acquired a new disability as they age. The disability

rate increases dramatically with age. According to U.S. census figures (McNeil,

1993), about 23.3% of people age 45 to 54 have a disability. This percentage in-

creases to 41.4% for people 60 to 64 years old, and again to 58.7% for people age 75

to 80. For the oldest old, or people over age 85, approximately 84.2% report having

a disability. The proportion of people with severe disability increases with age as

well. Among people age 45 to 54, 10.6% have a severe disability and 12.7% have a

nonsevere disability; among people ages 75 to 84, 41.5% report a severe disability

and 22.2% a nonsevere disability (McNeil, 1993). As the disability rate rises as

people age, and the overall longevity rate increases, we are seeing a quick rise in

the older population with age-related disabilities. Researchers are noting that dis-

ability rates have actually been falling in recent decades among older people

(Wolf, Hunt, & Knickman, 2005) as overall longevity is increasing, yet the total

numbers of individuals with disabilities is still greatly expanding. These people

with newly acquired disabilities may have little experience in receiving services

and little familiarity with the disability system, and may not consider themselves

to have a disability, despite having a functional limitation.

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Older people with disabilities generally have the same wants and needs as peo-

ple without disabilities. They desire to live at home in a community, to participate

in activities of interest to them, and to have some level of control over the types of

services they receive (American Association of Retired Persons [AARP], 2003).

Older people with lifelong disabilities and those with newly acquired disabilities

have some similar and differing barriers to living and participating in the com-

munity and needs for services. The following outlines the key trend in services

over the past several decades that impacts older people with disabilities: the trend

toward community-based and consumer-driven care for people with disabilities.

REND TOWARD

OMMUNITY

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ASED

ARE

The most significant paradigm shift in the area of disability services has been the

trend toward providing community based care for people with disabilities. In the

mid-twentieth century, most people with intellectual disabilities resided in institu-

tions, and services to people with all types of disabilities were provided in institu-

tions. The prevailing model viewed people with disabilities through the lens of the

medical model. In the medical model, a person’s impairment is viewed as a problem

that must be treated. Persons with a disability were either rehabilitated to the extent

that they could function in society, or else they were sent to segregated institutions

to live. People with disabilities had little input into where and how they would live,

with professionals alone determining their appropriate services and supports.

In the second half of the twentieth century there was a shift to community-

based services for people with disabilities. It is now considered best practice for

people with disabilities to live in a community-based setting rather than an insti-

tutionalized or formal setting and to have input into the types of services and

supports they need. People with disabilities now live, work, and socialize in the

community. They are not simply integrated into community settings, but rather

are included in the community as full, valued members. “Disability” is now

viewed less as a medical concept and more as a sociopolitical concept. This new

view of disability fits with the social model of disability, a common philosophy in

Europe and growing in the United States. In the social model, many of the prob-

lems associated with disability are viewed as caused by an inaccessible and op-

pressive society, rather than an individual and his or her impairment. Viewing

disability through a social model lens brings attention to barriers in society, such

as inaccessible buildings, lack of accessible transportation, segregated schools,

and lack of residential options, which are significant problems for people with

disabilities that must be alleviated.

REND TOWARD

ONSUMER

-C

ONTROLLED

ERVICES

Along with services being community based, there is a co-occurring trend toward

consumer-driven services. The consumer-controlled movement that is gaining

steam in the aging network had its origins in the U.S. disability movement and goes

hand in hand with the trend toward community inclusion. Beginning in the 1960s,

the growing disability movement in the United States coalesced around the concept

of independent living (Shapiro, 1993). People with disabilities, reacting against the

paternalism of the disability service sector, the segregation that they experienced

living and receiving services in isolated and subpar institutions, and general socie-

tal discrimination, formed a new movement in which they asserted control over

Disability 205

their own destinies. There was a strong emphasis on controlling their own services,

advocating for their rights, and eliminating societal, political, and structural barri-

ers to their community participation and independence. A key aspect of the disabil-

ity movement was a focus on determining the types of services they were going to

receive, including hiring and firing their own staff and determining their own needs

(Brisenden, 1986). This desire by people with disabilities has grown into formal pro-

grams today, funded through the federal government and private foundations,

called consumer-controlled or consumer-directed services.

REND TOWARD

OLLABORATION BETWEEN

GING AND

ISABILITIES

IELDS

There is a new recognition by those in the fields of aging and disability services

and advocacy that there is considerable overlap between these two areas. Many of

the key issues of older people and people with disabilities of all ages are similar,

for example, family caregiving, residential options, consumer-directed services,

and accessible transportation. This is especially evident for older people with dis-

abilities, who often have to navigate a disjointed service system and would be

better served through an integrated system. There is some beginning collabora-

tion between the fields. For example, consumer-controlled service models cur-

rently target people with disabilities of all ages (Benjamin, Matthias, & Franke,

2000; Doty, 2000; Nadash, 1998); there have been joint policy efforts by disability

and aging advocates for personal assistance services (Doty, Kasper, & Litvik,

1996; Eustis & Fischer, 1992); and the federal government, under the New Free-

dom Initiative (E.O. 13127, 1991), has just authorized states to develop Aging and

Disability Resource Centers, which are jointly funded, to become a single point of

entry for older people and people with disabilities into the state service system.

However, much of the research, policy, practice, and advocacy efforts between

these two fields are distinct.

DEFINITIONS AND ETIOLOGIES OF DISABILITY

Exploring the concept of definitions and etiologies of disability has become a

frightfully political endeavor in the past several decades. This stems from the

broad array of disciplines that study disability, including medicine, nursing, edu-

cation, social work, economics, sociology, and recreation; the varying types of in-

terventions related to disability, including health care, rehabilitation, behavioral,

social service, housing, technological, and policy: the varying international con-

ceptions of disability; the increased growth in a humanities approach to viewing

disability as a social construction or a cultural group; the negative reaction by

many people with disabilities toward labeling people based on disability; and the

growing adoption of the social model of disability, which rejects the notion of fo-

cusing on personal impairment in general.

The World Health Organization (WHO, 2002) and representatives from across

the world spent many years developing WHO’s recently adopted International Clas-

sification of Functioning, Disability and Health (ICF). The ICF model reflects an in-

tentional blending of the medical and social models, and it rests on what WHO calls

a biopsychosocial model of disability (see Figure 8.1). Under the ICF, disability and

functioning are seen as the result of the interactions between an individual’s health

conditions and contextual factors. Health conditions include diseases, disorders,