Chapter 10
Chronic illness, disability and rehabilitation
213
walking, climbing stairs, lifting or carrying objects, performing
activities of daily living, doing schoolwork or working at a
job. The disability is severe if the person cannot perform one
or more activities, uses an assistive device for mobility, or
needs help from another person to accomplish basic activities.
Assistive technology
is the overarching terms used for devices
that aid the functional ability of people with disabilities. The
purpose of
adaptive devices
, a type of assistive technology used
to change the environment or help the person to modify the
environment (e.g. a ramp that can be used in place of steps
for someone in a wheelchair)
and
assistive devices
, a type of
assistive technology that helps people with disabilities perform
a given task (e.g. a lap board with pictures that is used to assist
a person who cannot talk to communicate), is to maximise
independence and thereby promote access. A person is also
considered severely disabled if he or she receives a disability
benefit because of an inability to work.
Prevalence of disability
Disability includes an identified self-care deficit requiring
personal assistance with one or more activities of daily living
(ADLs), defined as activities related to personal care; or instru
mental activities of daily living (IADLs), defined as activities
related to independent living (National Center for Health
Statistics, 2007). In Australia, 18.5% of the total population
report a disability (ABS, 2012a). The largest proportion (85%)
of reported disability related to a physical condition and less
(15%) to a mental or behavioural disorder. A profound or
severe level of disability was reported in 5.8% of cases. The
prevalence of disability in New Zealand was lower (17%)
than Australia. However, in New Zealand illness constituted
the largest reported source (68% of adults), followed by aged-
related conditions (37%) (Statistics New Zealand, 2006).
In Australia, the number of people with disabilities has
declined slightly (1.5%) due to improvements in physical
conditions such as asthma, and back pain has declined slightly
(ABS, 2010b). As the population ages, the prevalence of
disability is expected to increase. Although disability is often
perceived as being associated only with old age, national
data demonstrate that disability occurs across the lifespan;
however, its incidence increases with age. For example, in
Australia almost nine out of ten (88%) of those aged 90 years
and over had a disability, compared with only 3.4% of those
aged four years and under (ABS, 2010b). Many people with
disabilities who are unemployed want to work; however, they
are often unable to do so because of the limited access to work
settings, lack of accommodations in the workplace, reluctance
of employers to hire them, and financial risk if their income
exceeds eligibility limits to qualify for disability benefits.
Characteristics of disability
Categories and types of disability
Disabilities can be categorised as developmental disabil
ities, acquired disabilities and age-associated disabilities.
Developmental disabilities are those that occur any time
from birth to 22 years of age and result in impairment of
physical or mental health, cognition, speech, language or self-
care. Examples of developmental disabilities are spina bifida,
cerebral palsy, Down syndrome and muscular dystrophy. Some
developmental disabilities occur as a result of birth trauma
or severe illness or injury at a very young age, whereas many
developmental disabilities are genetic in origin. Acquired
disabilities may occur as a result of an acute and sudden injury
(e.g. traumatic brain injury, spinal cord injury, traumatic
amputation), acute non-traumatic disorders (e.g. stroke, myo
cardial infarction), or progression of a chronic disorder (e.g.
arthritis, multiple sclerosis, chronic obstructive pulmonary
illness, blindness due to diabetic retinopathy). Age-related
disabilities are those that occur in the elderly population
and are thought to be due to the ageing process. Examples of
age-related disabilities include osteoarthritis, osteoporosis and
hearing loss. There is a growing number of young, middle-aged
and elderly adults with disabilities, including developmental
disabilities because people with disabilities, including those
with severe developmental disabilities, are surviving longer
than ever before.
Types of disability include sensory disabilities that affect
hearing or vision; learning disabilities that affect the ability
to learn, remember or concentrate; disabilities that affect the
ability to speak or communicate; and disabilities that affect
the ability to work, shop, care for oneself or obtain healthcare
(ABS, 2012a). Many disabilities are visible, but invisible dis
abilities are often as disabling as those that can be seen. Some
disabilities affect only IADLs, whereas others affect ADLs. In
2012, 87% of Australians who reported a disability identified
that they needed assistance to manage their everyday activities
(ABS, 2012a). Lack of mobility was also the most reported lim
itation to everyday activity for disabled people in New Zealand
(NZMOH, 2006).
People can be temporarily disabled because of an injury
or acute exacerbation of a chronic disorder but later return
to full functioning; this definition of disability may not apply
for legal purposes. Although different impairments may result
from different types of disabilities, there are some similarities
across disabilities. People with disabilities are often considered
by society to be dependent and in need of care from others.
Of those identified as carers, only 29% reported providing
care for greater than 40 hours a week (ABS, 2012a). However,
many people with disabilities are highly functioning, indepen
dent, productive people who are capable of caring for them
selves and others, having children and raising families, holding
a full-time job, and making significant and major contributions
to society. The case study in Chart 10-4 illustrates how a
person with significant disability can still be an extremely pro
ductive person with substantial quality of life.
Like most other people, those with disabilities often prefer
to live in their own homes with family members. Indeed, most
people with disabilities are able to live at home independently.
Some patients live alone in their own homes and use home
care services. However, alternative living arrangements may be
necessary; these include assisted living facilities, long-term care
facilities and group homes.
Models of disability
Several models of disability have been used to address or
explain the issues encountered by people with disabilities
(Smeltzer, 2007a). These include the medical and rehabilita
tion models, the social model, the biopsychosocial model and
the interface model. Chart 10-5 briefly describes these models
of disability. Of these, the interface model (Goodall, 1995)
may be the most appropriate for use by nurses to provide care
that is empowering rather than care that promotes depen
dence. The interface model can serve as a basis for the role of
nurses as advocates for the removal of barriers to healthcare
