Persons With Disabilities: An Unrecognized Health Disparity Population PDF

Persons With Disabilities: An Unrecognized Health Disparity Population Robin Daller, DNP, ACNP-BC Adjunct Faculty Nursing Department Thiel College Defining Disability WHO Definition Social Model Disability is an umbrella Disability...

Persons With Disabilities: An Unrecognized Health Disparity Population Robin Daller, DNP, ACNP-BC Adjunct Faculty Nursing Department Thiel College Defining Disability WHO Definition Social Model Disability is an umbrella Disability results from the term for impairments, activity interaction of having a limitations, or participation condition-based limitation restrictions related to a and experiencing barriers in health condition. the environment. Environmental Factors The environment includes physical, social, attitudinal, and policy barriers that can foster or impede good health and quality of life. Prevalence of Disability 12.5% 46% US Adults Mobility Percentage of US adult population Percentage reporting mobility considered to have a disability under disability HHS standards 39% 43% Cognitive Multiple Percentage reporting problem- Percentage reporting more than one solving or concentration limitations limitation Disability Across the Life Course 1 Childhood Some are born with disabling conditions or develop them early in life (e.g. Down syndrome, autism) 2 Adulthood Others acquire disabilities through injury or chronic conditions (e.g. spinal cord injury, limb loss due to diabetes) 3 Later Life Many develop disabilities in later stages of life (e.g. dementia, age-related mobility disability) Historic Disadvantage 19th-20th Century Common practice to institutionalize children and adults with significant disabilities Mid-20th Century Media exposure of poor conditions in institutions led to calls for closure 1960s-1970s Advocates pressed for deinstitutionalization and community integration 1990-Present Legislation like ADA provides protection from discrimination and promotes equality Key Legislation and Programs 1935: Social Security Act 1973: Rehabilitation Act Title V Section 504 Provided resources to states for First major federal legislation services to children with crippling protecting persons with disabilities or handicapping conditions from discrimination 1990: Americans with 1999: Olmstead Decision Disabilities Act Supreme Court ruling upholding the Comprehensive legislation right for people with disabilities to declaring equality for people with live in the most integrated setting disabilities Health Disparities: Access to Care Delayed or Forgone Care Preventive Care Inadequate Management Adults with disabilities are 2.5 times Women with mobility limitations are People with cognitive limitations may more likely to report skipping or less likely to be current in receive less adequate management delaying health care because of cost mammograms and Pap tests care for conditions like diabetes Health Disparities: Chronic Conditions 3-4x 5x Cardiovascular Disease Diabetes Higher rates of cardiovascular disease People with cognitive limitations are up compared to general population to 5 times more likely to have diabetes 44.6% Obesity Percentage of adults with disabilities who are obese, compared to 34.2% of adults without disabilities Health Disparities: Mental Health and Violence Mental Distress Social Support Violent Crime Intimate Partner Violence Higher rates of depression Less likely to report receiving 1.5 times more likely to be and anxiety adequate social and victims of nonfatal violent Significantly increased risk emotional support crimes for both men and women with disabilities Health Disparities: Injury Risk Heightened Risk Disability status is as great or greater a risk for unintentional injury than age, sex, 1 race, or education Children and Adults 2 Both children and adults with disabilities have increased risk of injury Multiple Factors 3 Risk influenced by type of disability, environmental factors, and social determinants Emergency Preparedness Concerns Evacuation Challenges Inadequate Planning 38% of people who did not Lack of data on emergency evacuate during Hurricane planning for people with Katrina had a mobility disabilities disability or were a care provider for a person with a disability Vulnerability People with disabilities are especially vulnerable during emergencies and disasters Health Insurance Coverage Overall Coverage Private Insurance Uninsured Gap Rates of insurance coverage are Less than 50% of people with complex 28% of people with emotional generally comparable between limitations have private insurance, disabilities are uninsured, representing disability and non-disability compared to 75% of people without the largest gap in coverage populations disabilities Social Determinants of Health Education 1 13% of adults with disabilities lack a high school education vs 9.5% without disabilities Employment 2 17.8% employment rate for adults with disabilities vs 63.6% for those without Income 3 34% of households with disabilities have income