Children in wheelchairs.

Three hundred and seventy-five families replied to a questionnaire about the use of their disabled children''s wheelchairs. Many problems were found, such as difficulty in folding the chair and placing it in the car boot and difficulty in using pulbic transport. These families need adequate guidance to anticipate and deal with the problems. Provision of a wheelchair does not solve the mobility problems. The parents are faced with the task of transporting both the disabled child and the wheelchair whenever they want to use their own car or public transport. Ease of folding and lightness are important criteria for wheelchairs carried by cars. Parents need careful guidance about selecting suitable cars and also need to be shown how to lift the chairs without endangering their backs. Such advice should be provided by every wheelchair clinic and assessment and rehabilitation certre.     

The greying of Europe.

About a quarter of the population of Europe is now of pensionable age. Facilities for caring for very old or disabled people differ throughout Europe in scope and means of funding, and the countries of the European Union are far from equity in the status of pensioners. Health expectations have increased in older people--most of the calculated gain in life expectancy is likely to be without disability. Most countries now have specialist geriatric medicine facilities, and international research programmes are under way.     

La nouvelle Loi handicap

Although, over the centuries, disabled persons have been successively considered to be an image of evil, pity, or sin, what image and what rights are provided by the French law of 11/02/2005 on equal rights, participation and citizenship of disabled persons? Isn’t there still an enormous gap between written laws and what really happens in everyday life, as dozens of laws have been added since the first law voted in the 19th century? The vocabulary has also changed over the years from mutilated, to handicapped, to disabled. The marked differences between official figures and figures derived from the HID (Handicap Independence Incapacity) survey conducted between 1998 and 2001, clearly illustrates the difficulty of defining disability. With ageing of the French population aging and improvement of technologies, the number of disable persons will increase considerably over the years to come. Does the new law of 11/02/2005 provide a solution to this urgent situation? Has it identified all of the problems concerning accessibility, human assistance, schooling, rights of the disabled or is it just another law on disability, which is more useful to the legislator than to the people concerned? The new law focuses on four points. First of all, the right to compensation by creating a disability pension, which replaces third party benefits and professional fees benefits and adult disability pension, the right to schooling for all disabled children, the right to employment, and finally the creation of departmental disability centres, staffed by the various actors currently involved in the care of the disabled (Conseil Général, DDASS, CPAM, CAF, etc...). Creation of the disability pension is now based on five main types of assistance: human assistance, technical assistance, adaptation of the home and the vehicle as well as excess transport costs, animal assistance, and finally exceptional and specific aids. Apart from direct assistance to disabled persons, the new law is also designed to improve accessibility (law and decrees already in application since 1991 and 1994) to transport, public places, etc. However, the law also gives another definition of accessibility by extending its scope to all aspects of disability (motor, sensory, cognitive, mental, etc.). This accessibility must be implemented within defined deadlines: 3 years for transport, 5 years for universities and prefectures, and 10 years for other public buildings. Another innovation of this law is that of the initial training and continuing education of healthcare professionals of the medical and social sector (cause of disability, therapeutic innovations, educational innovations, reception and supportive care of disabled persons, announcement of disability, etc.). However, as so little progress has been made the over the centuries, many disabled people will be left by the wayside. Although politicians have now become aware of the problem, the errors, delays, and imperfections of this new law will allow tolerance rather than insertion of the disabled in the years to come. We must develop a different vision of disability, as illustrated by the creation, in 2002, of a European Commission network called “Design for All” to develop systems that can be used by healthy as well as disabled persons. Disabled persons are also trying to find solutions concerning parenthood and childbirth, as although the law has defined “all” aspects for healthy parents with a disabled child, no measures have been taken for disabled parents. The Mother-Child Department of the Institut Mutualiste Montsouris is developing a programme for these future parents with the help of ESCAVIE (Espace Conseil pour l’autonomie en milieu ordinaire de vie) in collaboration with the occupational therapist and social worker. A disabled parents association has also been formed in the Mother-Child Department. A last point does not directly concern the new law, but the bioethics law of August 2004 and preimplantation diagnosis, which was the subject of a recent debate concerning its revision. The old myth of birth control has resurfaced. Unfortunately politicians collude with the media to present this stereotyped image of the perfect, beautiful, normal baby.     

Getting by at home. Community-based long-term care of Latino elders.

Although evidence suggests that the morbidity and mortality of Latino elders (of any Hispanic ancestry) are similar to those of non-Latino whites, Latinos have higher rates of disability. Little is known about influences on the use of in-home health services designed to assist disabled Latino elders. We examine the effects of various cultural and structural factors on the use of visiting nurse, home health aide, and homemaker services. Data are from the Commonwealth Fund Commission''s 1988 national survey of 2,299 Latinos aged 65 and older. Mexican-American elders are less likely than the average Latino to use in-home health services despite similar levels of need. Structural factors including insurance status are important reasons, but acculturation is not pertinent. Physicians should not assume that Latino families are taking care of their disabled elders simply because of a cultural preference. They should provide information and advice on the use of in-home health services when an older Latino patient is physically disabled.     

Spinal cord injury-related bone impairment and fractures: an update on epidemiology and physiopathological mechanisms

A sudden loss of motor function in segments of the spinal cord results in immobilisation and is complicated by bone loss and fractures in areas below the level of injury. Despite the acceptance of osteoporosis and fractures as two major public health problems, in people with spinal cord injuries, the mechanisms are not adequately investigated. Multiple risk factors for bone loss and fractures are present in this disabled population. This review is an update on the epidemiology and physiopathological mechanisms in spinal cord injury-related bone impairment and fractures.     

Helping disabled people--the user's view.

The main needs for most people with physical disabilities are housing and help with daily living. Thus, many of them will find the new emphasis on social aspects of community care particularly relevant. Peter Swain is a disabled man who leads a project in east Devon which ensures that disabled people have a voice in helping to shape the services they need. In this article he explains how the project, Living Options East Devon, works and how the new legislation for community care might affect disabled people.     

Caring for older people. Community services: health.

Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.     

The environment of ageing.

The issue of housing and the wider environment for an ageing population is one where there are many unanswered questions. In this paper a number of key issues are discussed and for each of these the focus is on three aspects. These are the current situation, its reasonableness and what research is needed in order to make decisions about policy and practice. The first three issues relate to the profile of older people themselves and the importance of home to them. The changing profile of older people is not just about an ageing population but also about the growing prominence of those with dementia, women, people from black and ethnic minority groups and one person households, yet little is known about the type of housing which should be provided. Of equal concern is the widening gap between those with a high standard of living (including housing) and those with a low standard of living. The importance of home to older people means that research must focus on how people can be enabled to remain there, and also on the costs, financial and otherwise, to carers and to society. The next three issues relate to the type of housing older people live in and moves in later life. The startling change in the tenure pattern with a growth of owner occupation brings problems as does the decline in social housing. The advantages and disadvantages of the different types of housing--mainstream and specialized--for older people are relatively well known. However the balance between the two needs more research as does that on retirement communities. While it is well known that there are peaks of migration in old age and that moves are often made in haste, little is known about the process of decision making. The final two topics concern links between housing and other aspects of older people''s lives. On health more research is needed on temperature, mortality and morbidity, homelessness and accidents and especially on links between services. These topics have implications for planning and design. The emphasis should be on a multidisciplinary approach using a variety of quantitative and qualitative techniques with an emphasis on dissemination.     

Utilitarianism and the disabled: distribution of resources

Utilitarianism is more convincing than resource egalitarianism or welfare egalitarianism as a theory of how resources should be distributed between disabled people and nondisabled people. Unlike resource egalitarianism, utilitarianism can redistribute resources to the disabled when they would benefit more from those resources than nondisabled people. Unlike welfare egalitarianism, utilitarianism can halt redistribution when the disabled would no longer benefit more than the nondisabled from additional resources.
The author considers one objection to this view: it has been argued, by Sen and others, that there are circumstances under which utilitarianism would unfairly distribute fewer resources to the physically disabled than to nondisabled people, on the ground that the disabled would derive less benefit from those resources. In response, the author claims that critics of utilitarianism have fallaciously exaggerated the circumstances under which the disabled would benefit less than the nondisabled from additional resources. In those limited circumstances in which the disabled really would benefit less from resources, the author argues, it does not seem unfair to distribute fewer resources to them.     

A survey of hospital toilet facilities.

OBJECTIVE--To assess the quality of toilet facilities available for disabled people in a large provincial teaching hospital. DESIGN--Survey of toilet facilities for patients on the wards and in the outpatient department. SETTING--Teaching hospital in Leeds. RESULTS--Although the quality of toilet facilities varied, none met the standards recommended by the British Standards Institution. The worst facilities were found on a ward accommodating elderly patients, where the toilets were unsuitable for use by disabled people and bedside commodes had to be used instead. CONCLUSION--Toilet provision within a major hospital failed to meet standards required for disabled people. Admission to hospital may therefore result in loss of independence and dignity. If hospitals are to be centres of excellence, greater consideration must be given to the requirements of disabled people in the design of new wards, and current inadequate facilities should be upgraded.     

Huisartsgeneeskundige zorg in het verzorgingshuis

Dutch GP's (General Practitioners) take care of people living in homes for the elderly. The population of these homes is selected on the basis of poor functioning on ADL (activities of daily living). We expected to find a group of elderly people within these homes that need more complex primary care. We describe the characteristics of care for an institutionalized elderly population and compare these to the care provided to their independently living peers. The design of this study is a matched case-control study in a Dutch General Practice in the study period 1/1/1998 to 1/7/2004. Our main results show that the rate of cognitive problems is two times, the prevalence of depression even three times higher in older people living in a home for the elderly than in those who live independently. Locomotory problems are a frequent problem in homes for the elderly. Rates of chronic pulmonary problems, atherosclerosis-related diseases and urinary tract infection are higher, whereas no significant differences for CVA, diabetes and cancer were found. Institutionalized older patients use more different types of medication. GP's do not have more contacts with people living in a home for the elderly than with older people living independently. We conclude that people living in homes for the elderly have complex problems, and need special attention for their specific vulnerability. Differences in care are not primarily explained by chronic disease but by problems with mobility, confusion, depression and cognition.     

Helping patients travel by air.

Although safe and rapid, air travel may present problems for people with certain medical conditions. Most medical emergencies that occur during a flight are preventable by judicious screening and preparation. We provide guidelines for physicians who are consulted about the wisdom of undertaking a journey by air. Potential stresses before, during and after the flight are outlined, including decreased atmospheric pressure, low humidity, turbulence, inactivity and time changes. We recommend precautionary measures for passengers with certain medical conditions, such as recent myocardial infarction, pulmonary disorders, pneumothorax, cerebrovascular accidents and diabetes and for those who have recently had surgery. The policy regarding air travel for pregnant women varies with each airline, but for certain conditions associated with pregnancy supplemental oxygen should be ordered before the trip. The special equipment and care that most airlines offer to ill or disabled people are described.     

Rehabilitation of the Aged

The rehabilitation needs and goals of older people differ in many respects from those of the young. In younger individuals a crippling condition may affect an otherwise healthy body, while in an older person it may be superimposed on other pre-existing degenerative diseases. Thus, in older patients the restorative or rehabilitative phase rarely can be separated from the phase of definitive medical treatment.The primary goal of rehabilitation of younger individuals is usually vocational. In the older group this goal or objective is, by and large, secondary. This does not minimize, however, the value of medical and social services in the rehabilitation of older persons. The simple ability to care for his own personal needs can do much to help the elderly disabled patient regain his dignity and self-respect and remove his fears of becoming a burden on his family or society.     

A Qualitative Study of Alcohol,Health and Identities among UK Adults in Later Life

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people''s reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a diverse sample of older adults in North East England (ages 50–95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people''s accounts of either moderate or heavy drinking. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence. Future research should test and assess such approaches.     

Living with disabilities in Austria--with a special focus on the capital

Life expectancy, especially in the older age groups, is growing enormously due to better social and medical care. According to published data on disabled people (1997), about 30 % of the total population (7,119,000) in Austria suffer from at least one physical disability. In this study, data from a micro census as well as a report from the Federal Ministry for Social Security and Generations is analyzed to illuminate the situation of impaired people with a focus on the capital Vienna. Among other results, it is anticipated that a large number of disabled people receive no help at all. About every 7th person regularly receives care, every 10th receives daily support. Care intensity increases with age showing a clear progression from the age of 60 onwards. 88% of the main supporting individuals are related to the handicapped person being supported. Women generally exhibit a much higher participation in nursing. The socio-political developments are discussed.     

Disability as identified from general practice records.

Thirty eight doctors who attended a postgraduate educational course provided information about disabled patients identified in a search of 7000 records. Disablement was defined as a major disruption to the normal lifestyle of patients in appropriate age and sex groups. Altogether 242 people were identified as disabled, equivalent to 32 per 1000 population, which is closely similar to that published by Harris, who identified patients by postal questionnaire. Among adults aged 15 to 64 more men were identified than women, and we suggest that a higher rate of disablement might be expected in men. Disablement among women may be underestimated because of underrecognition by doctors of disability in housewives. Fifty two per cent of all disabled people were able to attend the doctor''s surgery, and 72% were receiving regular medication; 79% were dependent on relatives, but only 30% were dependent on statutory services. In the opinion of the recording doctors medical and nursing needs were well met, though not the social needs, where the importance of living alone is noteworthy.     

Attitudes and access: advancing the rights of people with disabilities

Barriers to movement and communication in the physical environment prevent people with disabilities from enjoying the same rights, privileges and opportunities as other members of society. The guidelines presented by Drs. Karen E. Jones and Itamar E. Tamari in this issue (page 647) remind us that access to physicians'' offices is one area in which improvement is greatly needed. But, as Jones and Tamari acknowledge, accessibility involves more than the removal of physical barriers. The greatest obstacles faced by disabled people are often attitudinal ones. Programs that place responsibility for rehabilitation and integration within the community can foster a better understanding of the issues. Family physicians and other professionals must work with communities to change the attitudes, beliefs and behaviours of policy-makers and the public. Until significant progress is made on this front, problems of access that serve to marginalize people with disabilities will persist.     

Problems of public participation in the Ramsar CEPA programme at the Tana Delta,Kenya

This research examines the problems of public participation in conserving a Ramsar site at the Tana Delta in southeastern Kenya. Given no participation of the public in government initiatives so far, we attempted to find out what had prevented local people from cooperating with responsible government bodies. Using empirical evidence that we obtained from fieldworks, questionnaire surveys, and workshops, we found that the low participation was not mainly due to local people’s unwillingness to conserve natural resources. Instead, we found that they were strongly interested in wetland resources conservation as long as their customary rights to governing resources are sufficiently recognized. We also documented how these local people managed their resources. The Kenya Wildlife Service and the National Museum of Kenya are the main government bodies to promote public participation, but we found that these agencies had not done effective communication works among local people. Our survey then clarified what sources of information can be most effective in communicating with local people in the Tana Delta. Finally, we discuss how the problems of public participation can be solved or reduced.     

Japanese Business Organizations' Level of Familiarity with Assistance Dog Legislation and Their Acceptance of These Dogs in the Workplace

ABSTRACT

In 2003, Japan passed the Act on Assistance Dogs for Persons with Disabilities, requiring public facilities, public transport, and private businesses serving the general public to allow access for people with physical impairments who use assistance dogs. One purpose of this law is to enable people with disabilities to lead independent and fulfilling lives as active members of society. In order to achieve this goal, the law requires public facilities such as national institutions and public transport, as well as private businesses serving the general public, such as hotels and restaurants, to allow access to people with physical impairment accompanied by assistance dogs. In 2007, the law was amended to stipulate acceptance to the workplace of people with a physical impairment accompanied by an assistance dog. We conducted a questionnaire survey of 6,062 business owners covered by the legislation, to ascertain the extent of knowledge of the law and acceptance of assistance dogs. In cases where the respondents had not employed any assistance dog users, they were also asked about the possibility of employing them in the future. The results indicate that assistance dog users are seldom accepted in the workplace, and familiarity with the law has not improved since the last survey in 2004, despite the 2007 amendment which is directly applicable to employers. Regarding the attitudes toward employment, most business owners answered that they would not or might not employ an assistance dog user. The level of knowledge of the law and the related financial support system differs among facility owners carrying out different types of business. Those positive toward employment tended to know much about the Act on Promotion of Smooth Transportation, etc. of Elderly Persons, Disabled Persons, etc. These findings suggest that there is a need for better dissemination of information about the obligation to accept assistance dog users in the workplace, of information about the users' obligations, how to cope with problems, and accessing consultation services.