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The Oration: Ageing And Disability: Toward A Unifying Agenda

From: Australian Disability Review
Creator: Irving Kenneth Zola (author)
Date: 1988
Publication: Australian Disability Review
Source: Available at selected libraries

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"... Those among us who are able-bodied can no longer rationalise treating physically disabled people as 'them', an alien minority. This is not simply a matter of humanitarian bonhomie, for 'they' now include our parents, siblings, and children, our friends, neighbours, and colleagues, and -- one day -- ourselves." (1987, pp. 36-7)

Nature: Is disability the same as it always was?

For years infant mortality has steadily decreased, in large part because of improvements in standards of living and prenatal care. There are thus increasing numbers of low-birth-weight and other infants surviving into childhood and beyond with manifest chronic impairments. With advances in medical therapeutics, many children who would have died are now surviving into adulthood or longer, such that each of us know someone who is the longest lived person with spina bifida or exotic fibrosis.


There is a similar trend evident in the young adult group. While trauma still continues to be a major cause of mortality in this group, there is a major turnaround in the survival rates of people with spinal cord injuries. As recently as the 1950s, death was likely in the very early stages or soon after because of respiratory and other complications. Thus in World War I only 400 men with wounds that paralyzed them from the waist down survived at all, and 90% of them died before they reached home. In World War II, 2000 paraplegics lived and 1700 (over 85% of them) were still alive in the later 1960s (President's Committee on the Employment of the Handicapped 1967). Each decade since has seen a rapid decline in the death rate and thus of long-term survival: of first those with paraplegia; then with quadriplegia; and now, in the 1980s, those with head injuries.


At the moment, the situation with the older population may seem less predictable. At very least, we can speculate that an ageing population will be even more 'at risk' for what were once thought 'natural' occurrences (e.g. decreases in mobility, visual acuity, hearing) and with other musculoskeletal, cardiovascular and cerebrovascular changes whose implications are only beginning to be appreciated.


Still another unappreciated aspect of most chronic conditions is that although permanent they are not necessarily static. While we do, of course, recognise that some diseases are progressive, we are less inclined to see that there is no one-time, overall adaptation or adjustment of the condition; no set treatment, and most important; no design requirement for an individual's working and living situations. Even for a recognised progressive and episodic disorder such as multiple sclerosis, only recently has attention been given to the continuing nature of adaptations (Brooks & Matson 1982). The same is also true for those with end stage renal disease (Gerhardt & Brieskorn-Zinke 1986). With the survival into adulthood of people with diseases that once were usually fatal, come changes and complications. Problems of circulation and vision for people with diabetes, for example, may be due to the disease itself, to the ageing process, or even to the life sustaining treatment (Turk & Speers 1983).


Perhaps the most telling example of a new manifestation of an old disease is the current concern over the so-called 'post-polio syndrome'. To most of the public, to clinicians, and certainly to its bearers, polio has been considered a stable chronic illness. Following its acute onset and a period of rehabilitations, most people had reached a plateau and expected to stay there. For the majority this may still be true, but for at least a quarter of us, it is not. According to the latest reports, some twenty to forty years after the original onset, large numbers of people are experiencing new problems (Halstead & Wiechers 1985; Laurie & Raymond 1984). The most common are fatigue, weakness in muscles previously affected and unaffected, muscle and joint pain, breathing difficulties, and intolerance to cold. Whether these new problems are the mere concomitants of ageing, the re-emergence of a still lingering virus, a long-term effect of the early damage or even of the early rehabilitation programs, or something else, is still at issue. Whatever the 'real' etiology of this phenomenon, there will likely be many more new manifestations of old conditions and disabilities as people survive decades beyond the acute onset of their original diseases or disabilities. Thus, the dichotomy between these people with a progressive condition and those with a 'static' one may well be generally speaking, less distinct than once thought and indeed be more of a continuum.


In other instances, it is not so much the underlying condition that changes but the situation in which it occurs. Thus in studying an older population May Clarke (1969) noted that between 55% and 90% (respondent report versus chiropodist examination) of her sample of 1100 adults had something the matter with their feet. The conditions ranged from corns to skin infections, from ingrown toenails to hammer toes. Only 17% of these problems were often painful and inconvenient, and for the older population, 'functionally crippling', preventing them from travelling or walking any considerable distance and eventually resulting in even greater isolation.

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