Disability in America Toward a National Agenda for Prevention (1991) / Chapter Skim
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7 Prevention of Secondary Conditions
7 Prevention of Secondary Conditions
Pages 214-241
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From page 214... ...
In the interest of conceptual clarity, however, the committee has adopted the term secondary conditions because many of the conditions that occur are not disabilities per se but pathologies, impairments, and functional limitations. Thus a secondary condition is a condition that is causally related to a disabling condition (i.e., occurs as a result of the primary disabling condition)
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From page 215... ...
Critical elements of interventions include regular monitoring of health status, continuity of care, availability of appropriate assistive technology, training in coping with limitations, and community support including measures that ensure access to transportation, housing, and opportunities for employment. MODEL OF SECONDARY CONDITIONS All primary disabling conditions entail increased vulnerability to secondary conditions that can arise in many ways.
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From page 216... ...
Speculated lack of physical fitness, nutritional disorders, stress and possibly genetic disorder. Lack of physical fitness, acute and chronic illness, environmental quality problems, alcohol and drug problems, tobacco use, unsanitary living conditions, genetic disorders.
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From page 217... ...
Secondary Functional ~ imitating Secondary Disability ~1 . ~ ~ Quality ~ ~1~ 217 FIGURE 7-1 Model of secondary conditions.
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From page 218... ...
J.R.'s experience clearly demonstrates the importance of the life course perspective on longitudinal health care, as well as the significant role played by nonmedical factors. Surveillance and Epidemiological Understanding Although clinical experience has generated a long list of secondary conditions that frequently occur in people with disabling conditions, epidemiological information on the incidence and prevalence of secondary conditions and on the underlying causative factors is sparse.
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From page 219... ...
As a result of these pressure sores, he was admitted to an acute hospital for two weeks and subsequently referred back to the nursing home. For a period of eight weeks, he was not able to sit up in a chair but rather had to move from place to place on a cart in order to avoid pressure over the healing sores.
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From page 220... ...
The paucity of data also limits the ability to accurately estimate the economic costs associated with secondary conditions and, therefore, the potential savings that can be achieved with effective interventions. Advocates of people with disabling conditions and clinicians who treat them generally agree that the associated costs are substantial, and that significant savings can be achieved with consistent, appropriate programs of medical care, rehabilitation, and social support.
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From page 221... ...
also have found that the severity of the psychological response is inversely related to the age at which the disabling condition is acquired. In terms of psychological vulnerability, according to Castelnuovo-Tedesco, the least unfavorable time for a disabling condition to develop tends to be after stable adult integration has occurred.
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From page 222... ...
222 DISABILITY IN AMERICA Patient 1 is a 44-year-old white, Protestant, married physician who is the father of three teenage children and suffers an occlusion of the anterior descending coronary artery. After three weeks in the hospital, he returns home on a regimen of aspirin, a low-cholesterol diet, and a systematic exercise program.
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From page 223... ...
COMPONENTS OF A COMPREHENSIVE PREVENTION PROGRAM People with disabling conditions and those who treat these conditions generally believe that the techniques used to minimize the physical, psychological, and social effects of primary disabling conditions also are beneficial in the prevention of secondary conditions. This consensus is largely the product of intuition rather than rigorous scientific evaluation of interventions.
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From page 224... ...
Because of the service system's fragmented organization and its emphasis on acute conditions, many people with disabling conditions are underserved and little attention is focused on prevention. One consequence is the occurrence of avoidable secondary conditions that worsen a disabling condition and increase the need for services.
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From page 225... ...
Collectively, these services and activities constitute a comprehensive, rational approach to the prevention of secondary conditions, addressing not only health concerns but also issues related to the quality of life. Indeed, the aim of the independent-living movement to foster "control over one's life based on the choice of acceptable options that minimize reliance on others in making decisions and in performing everyday activities" (Texas Institute for Rehabilitation and Research, 1978)
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From page 226... ...
By helping people to interact more fully with their environment, assistive technologies can improve or at least maintain functional capacity, and by fostering greater control over one's activities, assistive technologies foster autonomy, which often translates into a higher quality of life. In turn, these benefits spawn the additional advantage of reducing the risk of secondary conditions.
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From page 227... ...
Similarly, the beneficial effects of personal assistance services and durable medical equipment need to be recognized for their effectiveness in preventing disability and secondary conditions. Health Promotion The concept and benefits of health promotion are the same for people with disabling conditions as for people without them, and both groups must
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From page 228... ...
assume general responsibility for their physical, psychological, and social well-being. However, disabling conditions often necessitate the development of special skills and the availability of additional information and assistive technology in order to assume this responsibility.
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From page 229... ...
In addition, people with disabling conditions tend to gain weight as they age. This excess weight further restricts mobility, often results in fewer weight shifts to relieve pressure on the skin, and increases the risk of abrasions and bruises during transfers.
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From page 230... ...
Public Education Many secondary conditions can be prevented with the aid of an appropriately informed public. Many advocates of people with disabling conditions and many care providers believe that if physical and attitudinal barriers to participation in society, including employment, are eliminated, then the estrangement, isolation, depression, and poverty that often accompany disabling conditions will decrease.
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From page 231... ...
The shortage of PMR specialists underscores the importance of acquainting all future health care professionals with the needs of people with disabling conditions. Specific accreditation criteria are needed for assessing whether medical schools provide adequate education on the prevention of disability and secondary conditions and on the rehabilitation of people with physical or mental disability.
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From page 232... ...
These could be developed under the auspices of public health departments; departments of preventive medicine, geriatrics, or physical medicine and rehabilitation at local medical schools; independent living centers; local rehabilitation centers; foundations; and voluntary organizations. Educational programs on topics related to the prevention of secondary conditions need to be expanded with emphasis placed on reaching people with disabling conditions, their families, advocates, and personal attendants.
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From page 233... ...
Financial resources and the reimbursement policies of public and private insurers are the primary determinants of whether the immediate living environment is adapted to the needs and capabilities of the person with a disabling condition. Many "off-the-shelf" assistive technologies can be instrumental in promoting greater autonomy.
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From page 234... ...
Similarly, the amount of additional disability that can result encompasses a broad range, influencing, for example, the decision of whether to prescribe major medical treatment or to rely on compensatory assistive technology. Moreover, the interactive relationship between the risk of secondary conditions and social, economic, and environmental characteristics introduces more variability that must be anticipated in the development of protocols.
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From page 235... ...
The protocol should also list secondary conditions associated with the category. Supporting informational elements include descriptions of the signs and symptoms of the pathologies, impairments, and functional limitations that can lead to a secondary condition and additional disability.
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From page 236... ...
If the primary disabling condition or other existing factors pose a high risk of secondary conditions, the physician should consider medical interventions for reducing the risk. Changes in bladder functioning and emptying dynamics following spinal cord injury, for example, require intermittent catheterization or other bladder management techniques.
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From page 237... ...
The impact of assistive technology on the individual's quality of life may be far greater than the minor improvement in functioning achieved with extensive occupational and physical therapy. Specification of Assistive Technologies Appropriate assistive technology can significantly reduce the impact of disabling conditions on personal autonomy and participation in the everyday affairs of society.
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From page 238... ...
Such guidance is useful to all health care and social service professionals who work with people with disabling conditions. It is especially valuable for the many care and service providers who have little knowledge of the often debilitating effects of secondary conditions.
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From page 239... ...
Protocols aid in disability prevention and rehabilita tion planning and in the identification of potential physical and psychiatric secondary conditions. Education Medical school and speciality training impart insufficient knowledge and skills in principles of physical medi cine and rehabilitation and psychosocial rehabilitation.
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From page 240... ...
Research is needed to determine how intervention affects the prevention of secondary conditions, including psychiatric complications.
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From page 241... ...
. Assessment is needed of the efficacy of protocols for treatment of primary disabling conditions and prevention of physical and psychiatric secondary disabilities.
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