Janiece L. Walker

Relationship Between Chronic Conditions and Disability in African American Men and Women

BACKGROUND Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans. METHODS We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension. RESULTS After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD. CONCLUSIONS These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans. PUBLICATION INDICES Pubmed, Pubmed Central, Web of Science database.

The Meaning of Gender While Aging With Paralytic Polio

The purpose of this article is to report the influence of gender on aging with childhood onset paralytic polio. The hermeneutic phenomenological exploration of gender was done using multiple qualitative interviews with 25 women, age 55 to 75 years of age, who had polio since before 14 years of age. We noted three themes: (a) the movement of her body, (b) integrating body and gender, and (c) gender discrepancies. Findings are discussed in the context of gendered expectations and the womens bodies.

Factors associated with disability among middle-aged and older African American women with osteoarthritis

BACKGROUND Middle-aged and older African American women experience disproportionate rates of functional limitations and disability from osteoarthritis (OA) compared to other racial ethnic groups; however, little is known about what factors contribute to this disparity within African American women. OBJECTIVE To examine factors associated with physical function and disability among African American women ages 50-80 with OA using the disablement process model. METHODS This descriptive study included 120 African American women with OA from the Southwestern region of the United States. Regression techniques were used to model the correlates of physical function and disability and to test a mediation model. RESULTS BMI and pain severity were significantly related to functional limitations. Depressive symptoms mediated the relationship between racial discrimination and disability. CONCLUSION Biological, intra-individual, and extra-individual factors are related to disablement outcomes in this sample of African American women, which is consistent with theory suggesting the need for treatment coupled with environmental modifications. This study can inform the development of future bio-behavioral interventions.

A Qualitative Analysis of Life Course Adjustment to Multiple Morbidity and Disability

The accumulation of limitations over the life course requires that women readapt to environmental barriers they encounter over time. The purpose of this qualitative case study was to detail the life experiences associated with living with mobility, cognitive, and sensory loss experienced by a woman and her sister who participated in an ongoing ethnographic study of mobility impairment in women. In-depth interviews were subjected to thematic, life course analysis. A family case study was interpreted as an exemplar for aging with early-onset disability into multiple morbidity, which was described as a series of loss, recovery, and reengagement. Within the case study, the participant suggested that because her functional limitations were not accommodated earlier in life due to societal and family-level disadvantage, these limitations were more difficult to adjust to in later years.

A Study of the Health Literacy Needs of People With Visual Impairments

The purpose of this mixed methods study was to understand preferences surrounding health literacy for 18 men and women with permanent and severe visual impairment (VI). Participants completed demographic questions—the National Eye Institute Visual Function Questionnaire (NEI-VFQ)—and 1 semi-structured interview to ascertain views on obtaining, processing, and understanding health information. Overall, the sample had low total eye health scores on the NEI-VFQ—indicating that the sample represented a group with severe visual impairments. The sample mentioned multiple health promotion topics of interest and types of devices used to gain information. They also described multiple barriers to health information, which could be eliminated. Implications for intervention development and technology use are provided.

Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: An analysis of baseline data from CAPABLE

A complex relationship exists between pain, depression, and functional limitation. These conditions, which substantially impact health care spending and quality of life, remain under-addressed in the current system of health care delivery, particularly among low-income and minority populations. This analysis uses baseline assessment data from CAPABLE, an ongoing randomized controlled trial (RCT), to examine associations between pain, depression, and functional limitation among a sample of low-income, community-dwelling elders with functional limitations. Linear regression revealed close associations between depression, pain, and activity of daily living (ADL) limitation. Mediation analyses indicated that depression fully mediated the relationship between pain intensity and functional limitation and partially mediated the relationship between pain interference and depression. Past research has shown that these conditions may be easily identified using validated assessment tools and effectively addressed through the introduction of interdisciplinary interventions. Several recommendations are presented for clinicians and health care organizations.

How to accommodate women with mobility limitations in biological studies.

People with disabilities should be routinely included in research studies if there is no specific reason for their exclusion. Regardless, they may be inadvertently excluded because of the procedures of the study. By conducting a community-based biological study with women aging with mobility limitations, these authors gained further understanding of their accommodation needs during research participation. The women aging with mobility limitations offered specific physical, cultural, or environmental needs that could have influenced the methods, procedures, and possible outcomes involved when conducting a biological study with this community living population. The authors and participants identified methodological challenges for women with mobility impairments within three key areas: recruitment procedures, laboratory procedures, and community-based data collection. The authors propose possible solutions to these identified challenges. It is our hope that this will begin a larger dialogue on how to routinely accommodate people with disabilities in biological research studies.

Factors Associated With Physical Activity in Latina Women A Systematic Review

The purpose of this systemic literature review is to unveil a greater understanding of Physical Activity in Latinas. We used PubMed and PsycInfo databases to search for articles published between 1991 and August 2016, examining physical activity and its correlates exclusively in adult Latinas. Only 21 primary studies met the inclusion criteria. Although physical activity derives from body movements in various domains, the leisure domain led the focus of research interest. The use of self-reports, cross-sectional design, and the ecological framework predominated. Only one study included examining the occupational domain, albeit as disaggregate in studies with a general physical activity approach. Occupational physical activity showed negative associations with education and acculturation. Positive associations were found between leisure-time physical activity, education, acculturation, and perceived health status. Despite the limited evidence to reach overall conclusions, this review uncovered methodological challenges and opportunities to advance knowledge about physical activity in Latinas.

Measuring Gender Satisfaction Among Women Aging With Paralytic Polio

In this study we tested the Gendered Outcome Scale as a measure of gender satisfaction among 295 women aging with the disabling effects of paralytic polio. Principal components analysis, reliability analyses, and content validity were analyzed on the scale. The scale had a Cronbachs alpha of.90. Younger women had more gender satisfaction (r =.181, p <.01), and women who had greater disability had greater gender satisfaction. (r = –.127, p <.05). The results support that the scale is a valid and reliable measure for determing gender satisfaction. Further work is needed to test the scale in diversified samples.

Work Related Injury Among Aging Women

This article reports the experiences of women aged 55 to 75 with mobility impairments who attributed aspects of their limitations to workplace injuries and provides insight into worker’s compensation policies. The study sample includes Mexican American (MA) and non-Hispanic White (NHW) women aged 55 to 75 who participated in a 4-year ethnographic study of disablement. Ninety-two of the 122 participants in the study attributed aspects of their functional limitations to employment, and their experiences were analyzed using data from 354 meetings. Using Lipscomb and colleagues’ conceptual model of work and health disparities, the women’s experiences were grouped into three categories according to type of injury, assistance gained, and the consequences of a workplace injury; the results have broad implications for policies that influence aging outcomes. Workplace injuries causing permanent functional limitations compound the effects of age and gender on employment outcomes. Policies addressing health disparities should consider work related influences.