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OBJECTIVES

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Objectives

  • Define the concept of disability.

  • Review the epidemiology of disabilities among community-dwelling persons.

  • Describe key social, legal, and health policy issues relating to disability.

  • Describe issues raised by disabilities related to vision, hearing, and lower extremity mobility difficulties and strategies to improve these.

  • Describe accessibility considerations for health-care settings.

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INTRODUCTION

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According to the 2011 World Report on Disability, approximately 1 billion people worldwide live with disability.1 The U.S. Census Bureau puts the number of Americans with disabilities at roughly 57 million or about 19% of the population.2 Both in the United States and around the globe, persons with disabilities are much more likely than others to experience significant disadvantages in education, employment, income, housing, and transportation, as well as other eco-social determinants of health.1,3 In addition, people with disabilities often experience disparities in their health care, for example, receiving fewer screening and preventive services than do persons without disabilities. People with disabilities are more likely to experience inactivity, putting them at higher risk of chronic diseases. On average, individuals with disabilities are much more likely to report fair or poor health than are nondisabled persons.

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Disabilities are diverse in their causes, nature, timing, pace, and personal and social implications. Some are congenital, others acquired. Some arrive suddenly with injury or accident; others progress slowly over time. Some gradually limit but do not threaten life; others hasten death. Some are visible to outsiders; others remain hidden. Some engender stigmatization and blame; others prompt pity and paternalism. Some are seen primarily as “diseases” (e.g., end-stage cancer, emphysema, schizophrenia), even when profoundly disabling. Anyone can become disabled, and in the fullness of time, most people do.

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Given this diversity, speaking of “persons with disabilities” as a single subpopulation is almost meaningless. Even within categories of impairments—such as lower extremity mobility difficulties—the causes, manifestations, and clinical implications are wide ranging. This chapter does not discuss specific medical conditions that cause disabilities. Instead, it offers an overview of the key social and health policy issues and selected major practice concerns raised by disability, focusing on persons with disabilities related to seeing, hearing, and walking. For convenience, this chapter uses the term “disability” when referring to sensory or physical impairments. Nonetheless, it makes no presumption that individuals with these conditions are, in fact, disabled, however they choose to define the word. People with other potentially disabling conditions, such as serious and persistent mental illness or developmental disability, might require somewhat different assessments or accommodations than those described later.

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DEFINING DISABILITY

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Judy, in her late 20s, was born to deaf parents who themselves had deaf parents. Judy is third-generation deaf. Judy’s family speaks American Sign Language (ASL), which also was the language used at her Deaf school. She later learned English and now works in the hearing world, relying on lip reading ...

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