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People discussing health of women with disabilities
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Secondary Conditions--Aging

Secondary Conditions Table of Contents

The health problems associated with aging occur much earlier in women with physical disabilities than non-disabled women.

Women aging with physical disabilities constitute one of the most seriously disadvantaged and rapidly growing segments of the population of the United States. Those aging with severe disabilities differ dramatically on many dimensions from women of the same age.

Dr. Margaret Nosek, Executive Director of the Center for Research on Women with Disabilities, voiced the concern of many others when she said,

...as I look forward in my life as a woman aging with a disability, I am terrified. The odds are seriously stacked against me. I have little hope of enjoying the benefits of my hard work in a retirement of healthy peace and comfort.... As I study the lot of my sisters aging with disability around the country, I see that the rising tide of social and medical progress has not raised our ship along with the others. The vista of our future is not a positive one.

  • People with physical disabilities, even those with severe physical disabilities, are living longer lives and joining the rapidly growing population of persons aging in the U.S.
  • Approximately 40 percent of women 65 years or older have at least one functional limitation. Thus, aging with a physical disability is clearly a woman's health issue.
  • National data revealed that older women with three or more physical limitations differed dramatically from women with no limitations in the following important ways:
    • Social situation (e.g., less likely to be married, more likely to be living alone),
    • Health conditions (e.g., more likely to have hypertension and depression),
    • Socioeconomic position (e.g., less likely to be employed, lower levels of education, more likely to be living in poverty), and
    • Access or utilization of health care services (e.g., less likely to have private health insurance, less likely to receive regular mammograms and pelvic exams).
  • Among the challenges that exist for women aging with long-term physical disabilities is the onset of new health problems and the increase in functional impairments.
    • Persons with disabilities may experience aging-related health conditions earlier than those without disabilities, a phenomenon referred to as "accelerated aging". Aging-related secondary conditions may occur as early as the 30's and 40's, thus potentially adding to the challenge of meeting mid-life role expectations.
    • The secondary conditions experienced by people aging with long-term physical disabilities are thought to be caused by four factors:
      • Overuse of an already weakened neuromuscular system (e.g., Turk, et al,, 1995).
      • Underuse or misuse of the neuromuscular system as a result of problems with gait and mobility or deconditioning (e.g., Krause, 1996)
      • Complications resulting from the original injury, disease, or treatment received (Treischmann, 1987)
      • Poor coping techniques and lifestyle behaviors
      • Environmental and attitudinal barriers that limit access and/or opportunities for social participation or health promoting activities (e.g., DeJong, 1995; Zola, 1993).
    • Women with physical disabilities experience a number of specific secondary conditions that are believed to worsen with age including: a) hypertension, b) nervous system disorders, such as carpal tunnel syndrome, resulting from years of using manual wheelchairs, c) respiratory problems that may become more life threatening with muscular weakness, d) genitourinary problems resulting from years of infrequent urination or bladder management programs, e) increased risk of pressure ulcers due to thinning skin, and f) diminished physical and social functioning due to increased muscle weakness. Other examples of secondary conditions anticipated to increase in frequency or severity with increasing age include: osteoporosis; endocrine disorders, such as diabetes; pervasive fatigue; obesity or weight management difficulties; and problems with immune function.
    • Prevention of secondary conditions has become a major public health goal incorporated into Healthy People 2010. Several researchers have argued that the following are needed to reduce the risk of aging-related secondary conditions:
      • Preventive and assistive technology services provided at an earlier age,
      • Health care providers who are more knowledgeable about aging-related health risks for persons with disabilities,
      • Rehabilitation services on a continual, as-needed, basis (not just post-acute phase), and
      • Accessible health promotion programs.
  • Women aging with long-term physical disabilities may need additional assistance from family and friends as they age and potentially face increasing levels of impairment; yet this increasing need may arise at the same time that sources of support are aging and losing functioning themselves.
    • Tangible support is often provided by individuals of the same age or older who may be facing aging-related health changes themselves. Informal care assistance can be particularly problematic for women with disabilities because they typically spend more years in a disabled state and are likely to spend more of those years without a spouse. Older women with physical disabilities are more likely than men to report having unmet needs for personal assistance with activities of daily living, and they also make up a far greater proportion of nursing home residents
    • Women with physical disabilities are more vulnerable to disruption in their social networks. Nearly a fourth of older women with moderate to severe disabilities do not visit with anyone outside their household in a typical week .
  • Although there is a large literature on the development of physical disabilities late in life, the literature on aging with a long-term physical disability is relatively small.
    • Current theories of aging do not directly address the experience of persons aging with a long-term physical disability.
    • Researchers have often intentionally or unintentionally excluded persons with physical disability from their samples.
  • In addition to the great need for research on women aging with long-term or life-long physical disability, health promotion programs for women aging with a disability are needed to help address the growing health needs of this population. A few such studies have recently been funded, including a NIDRR-funded health promotion program for women with physical disabilities currently in progress at CROWD.
  • The population of people aging with an early-onset physical disability is not large, but the population is anticipated to grow and to have an impact on the field of gerontology and the practice of aging service providers.

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