Textbook of Medical-Surgical Nursing 3e

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Chapter 10

Chronic illness, disability and rehabilitation

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 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. 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 benefit because of an inability to work. Prevalence of disability Characteristics of disability Categories and types of disability

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 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 facilities and group homes. Models of disability