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Rehabilitation Research and Training Center on Aging with a Disability

Quality Of Life Issues While Aging With A Disability Bryan Kemp, PhD Director Rehabilitation Research and Training Center on Aging with a Disability Clinical Professor University of California at Irvine. Rehabilitation Research and Training Center on Aging with a Disability.

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Rehabilitation Research and Training Center on Aging with a Disability

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  1. Quality Of Life Issues While Aging With A DisabilityBryan Kemp, PhDDirectorRehabilitation Research and Training Center on Aging with a DisabilityClinical ProfessorUniversity of California at Irvine

  2. Rehabilitation Research and Training Center on Aging with a Disability Rancho Los Amigos National Rehabilitation Center Funded by the National Institute on Disability and Rehabilitation Research

  3. Three Major Outcomes In Rehabilitation • Health • Maximum functioning • Quality of Life

  4. Conceptual Issues In Quality of Life Research • Objective versus subjective Quality of Life (QOL) • The measurement of QOL • Including both positive and negative QOL

  5. Despair Distress Depression O.K. So-So Boring Life Satisfaction Happiness Well-Being Negative Positive Quality of Life Continuum

  6. Very Distressing So-So Great ! 1 2 3 4 5 6 7 QOL

  7. 1 5.5 7 4.5 Low Med High

  8. Cumulative Percentages (n=675) Lo Med Hi %

  9. CORRELATIONS(n=675) • Age: .05 • Education: .09 • Depression: -.66 • Life satisfaction: .63 • OARS (ADL): -.21 • Community Activities .28

  10. Correlations of QOL With Other Variables In a Mega Analysis Impairment: .05 Disability: .17 Handicap: .38 Duration: .21 Age: .00 Source: Dijkers, 1999, APMR

  11. Negative Quality of Life And The Problem of Depression

  12. Why Depression Is A Major Problem • It is poorly recognized • Prevalence is between 25% and 50% • It greatly affects health and function • It is not self-limiting; can last for years

  13. Why Depression Is Poorly Recognized • The symptoms of depression overlap with the symptoms of chronic disease. • Clinicians and others “normalize” depression. • Clinicians believe depression is untreatable because of the disability.

  14. 16 11 6 Negative Neutral Positive QOL Depression Scores and QOL

  15. Depression Scores Across Groups Percent

  16. Depression is not related to: the severity of the impairment age (current or onset) the duration of impairment how impairment affects ADLs and IADLs

  17. Depression is related to:The ability to cope with changes and losses, which is separate from the disability.

  18. Life Satisfaction by Change in IADLSPolio Sample No Change Little-Great Deal Change in IADLS

  19. Effects of Treatment on Depression DL-SCA 4 3 2 1 25 20 15 10 22 16 11 6 *p < .05 **p < .001 D n.s. ** ** ** n.s. L-S ** * C Baseline Start 8 24 WEEKS

  20. Summary of Factors Related to Negative QOL • Difficulty coping with changes and losses. • Not related to severity of impairment or degree of disability. • Depression is the most common manifestation of negative QOL.

  21. What About Positive QOL?

  22. Percent with High QOL (p<.001)

  23. Correlations with QOLSCI Sample Level of Injury .11 (ns) Activities of Daily Living .10 (ns) Community Activities .40 (<.001)

  24. R2 The Relation of ADLs, IADLs and Community Activities to Life Satisfaction Across Groups

  25. Community Activities and QOL QOL

  26. Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Dissatisfied Negative Positive QOL How Does Life Satisfaction Relate to QOL?

  27. Factors Related to Positive QOL in Persons Aging with a Disability • Not related to age, severity of impairment or to degree of disability. • The ability to engage in meaningful, enjoyable or productive activities. • The number and kind of community activities the person does. • Somewhat related to social support, attitude, and personality.

  28. QUALITY OF LIFE:The presence of a reasonable amount of pleasurable, successful and meaningful experiences.

  29. FACTOR 1 The Ability to Cope FACTOR 2 Doing Valued Activities Negative Positive QOL Continuum Two Factors in QOL

  30. Resources Positive e.g. – growth Life Events + - Appraisal Negative e.g. - depression Support Personality Coping Methods A General Model of Psychological Stress Triggers Processes Outcomes

  31. FACTOR 1 Inability to Cope FACTOR 2 Valued Activities Negative Positive QOL Continuum

  32. Negative Positive Quality Of Life

  33. % Quality of Life as Related to Change in Functioning 20 yrs ago Now 20 yrs ago Now No Change Change Percentage Rating Life as Good or Excellent

  34. What Is Quality of Life? • Objective QOL • Subjective QOL

  35. Life Satisfaction Distress QOL

  36. Despair Distress Depression O.K. So-So Boring Life Satisfaction Happiness Well-Being Negative Positive Quality of Life Continuum

  37. Causes of Depression • Not caused by the disability or the impairment. • Most likely caused by difficulties coping with the disability and the societal problems.

  38. Distress Despair Depression Boring So-So O.K. Pleasure Success Meaning QOL

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