Judith M. Mitchell

The Effects of Aging on Employment of People With and Without Disabilities

A cross-sectional study investigated the role of both aging and disability on employment status over the life span. Current employment rates of 262 people with a disability and 115 people without a disability were compared. Impairments were polio, cerebral palsy, spinal cord injury, rheumatoid arthritis, stroke, and miscellaneous. Ages ranged from 23 to 64 years. Data from the disability group represented a faster and earlier decline in employment over the life span than the comparison group. By the 60s age decade, the disability group reported a 50% reduction in employment compared to 35% for the comparison group. A significant “age by disability” interaction suggested that employment decline is a result of both aging and having a disability. A college education improved employment rates for people with disabilities in their 20s and 30s but did not prevent significant employment loss by their 40s.

Impact of a Multifactorial Fall Prevention Program Upon Falls of Older Frail Adults Attending an Adult Health Day Care Center

A 3-month multifactorial fall prevention program was provided to 72 frail older adults attending an adult health day care center. A treatment control group design was used, with data collected at baseline and 6-month follow-up. Treatment consisted of a physical therapy assessment, 3-month exercise program, home hazards assessment, and fall prevention education. At 6 months, the treatment group significantly reduced their falls to 21.7% falling, compared to 46.2% for the control group. Home hazards were also significantly reduced by 50%. At 3 months, the treatment participants improved on 2 of the 4 strength and performance measures, but these gains were lost by the 6-month time period. Authors conclude that a fall prevention program with multiple components is beneficial for very frail older adults.

Functional Assessment in Geriatric Mental Health

Publisher Summary In geriatric mental health, an assessment is done for the following reasons: (1) to establish a diagnosis; (2) to determine the personal, social, and environmental dynamics that maintain, control and influence the behavior; (3) to establish a baseline measure from which to assess the effects of treatment or natural changes in one disorder; and (4) to assess the persons ability to look after himself or herself and to function in various environments. Functional assessment is a vital part of psychiatric intervention with older persons. This chapter reviews and discusses the rationale and methods of functional assessment of older persons with psychiatric problems. Functional assessment focuses primarily on the areas that have come to be known as activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The chapter further describes the physiological substrates of functional performance, skilled performance, and social-role performance. All functioning, from being able to dress oneself to performing a job, has multiple determinants. These determinants are generally divided into biological, psychosocial, and environmental components. The chapter describes the relationship among these components and presents a case for a hierarchical arrangement of functional abilities. By targeting functional assessments to these areas, the effect of psychiatric disorders can be determined, interventions can be designed to compensate for the older persons functional deficits, proper living arrangements can be defined, and improvements resulting from psychiatric care can be measured. Without a functional assessment, only the persons degree of distress and suffering can really be known. The chapter also reviews many of the measures of functional performance that are available today.

Prevalence and Predictors of Unmet Functional Care Needs in Assisted Living Facilities

Prevalence and predictors of activities of daily living (ADL) and instrumental activities of daily living (IADL) unmet care needs of seniors in assisted living facilities were investigated with interview data collected from 201 residents in 55 randomly selected facilities. Variables were ADL and IADL unmet needs and potential predictors of dependency in ADL and IADL, age, family visits, facility size, and social environment. Approximately 45% of residents reported at least 1 ADL or IADL unmet need. Predictors of unmet needs were higher impairment in ADL and IADL and a lower cohesive social environment. Extra care to residents with more severe impairments and positive staff-resident relations may reduce unmet needs.