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The disablement process

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  • Verbrugge, Lois M.
  • Jette, Alan M.
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    Abstract

    Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicans tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 38 (1994)
    Issue (Month): 1 (January)
    Pages: 1-14

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    Handle: RePEc:eee:socmed:v:38:y:1994:i:1:p:1-14

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    Related research

    Keywords: disablement disability function age;

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    Citations

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    Cited by:
    1. Mary Beth Landrum & Kate A. Stewart & David M. Cutler, 2007. "Clinical Pathways to Disability," NBER Working Papers 13304, National Bureau of Economic Research, Inc.
      • Mary Beth Landrum & Kate A. Stewart & David M. Cutler, 2009. "Clinical Pathways to Disability," NBER Chapters, in: Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly, pages 151-187 National Bureau of Economic Research, Inc.
    2. Mark Hayward & Robert Hummer & Chi-Tsun Chiu & César González-González & Rebeca Wong, 2014. "Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?," Population Research and Policy Review, Springer, vol. 33(1), pages 81-96, February.
    3. Robert W. Fogel, 2003. "Changes in the Process of Aging During the Twentieth Century: Findings and Procedures of the Early Indicators Project," NBER Working Papers 9941, National Bureau of Economic Research, Inc.
    4. Danan Gu & Yi Zeng, 2004. "Sociodemographic Effects on the Onset and Recovery of ADL Disability among Chinese Oldest-old," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 11(1), pages 1-42, August.
    5. Scholte, Robert & van den Berg, Gerard J. & Lindeboom, Maarten & Deeg, Dorly J. H., 2014. "Does the Size of the Effect of Adverse Events at High Ages on Daily-Life Physical Functioning Depend on the Economic Conditions Around Birth?," IZA Discussion Papers 8075, Institute for the Study of Labor (IZA).
    6. Denis Gerstorf & Nilam Ram & Guy Mayraz & Mira Hidajat & Ulman Lindenberger & Gert G. Wagner & Jürgen Schupp, 2010. "Late-Life Decline in Well-Being across Adulthood in Germany, the UK, and the US: Something Is Seriously Wrong at the End of Life," SOEPpapers on Multidisciplinary Panel Data Research 286, DIW Berlin, The German Socio-Economic Panel (SOEP).
    7. Sven Wilson & Joseph Burton & Benjamin Howell, 2005. "Work and the Disability Transition in 20th Century America," NBER Working Papers 11036, National Bureau of Economic Research, Inc.
    8. James N. Laditka & Douglas A. Wolf, 2004. "Duration Data from the National Long-Term Care Survey: Foundation for a Dynamic Multiple-Indicator Model of ADL Dependency," Center for Policy Research Working Papers 65, Center for Policy Research, Maxwell School, Syracuse University.
    9. Emmanuelle Cambois & Caroline Laborde & Isabelle Romieu & Jean-Marie Robine, 2011. "Occupational inequalities in health expectancies in France in the early 2000s: Unequal chances of reaching and living retirement in good health," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 25(12), pages 407-436, August.
    10. Albarrán Lozano, Irene & Alonso González, Pablo & Fajardo Caldera, Miguel Ángel, 2007. "Valoración global de la discapacidad, propuesta de un índice y su aplicación a la población española recogida en la EDDES/Global Measure of the Disability. A Proposal of an Index and its Applicat," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 25, pages 523-549, Abril.
    11. Oliver Schilling & Hans-Werner Wahl & Frank Oswald, 2013. "Change in Life Satisfaction Under Chronic Physical Multi-morbidity in Advanced Old Age: Potential and Limits of Adaptation," Journal of Happiness Studies, Springer, vol. 14(1), pages 19-36, March.
    12. Botticello, Amanda L. & Chen, Yuying & Tulsky, David S., 2012. "Geographic variation in participation for physically disabled adults: The contribution of area economic factors to employment after spinal cord injury," Social Science & Medicine, Elsevier, vol. 75(8), pages 1505-1513.
    13. Denis Gerstorf & Nilam Ram & Jan Goebel & Jürgen Schupp & Ulman Lindenberger & Gert G. Wagner, 2010. "Where People Live and Die Makes a Difference: Individual and Geographic Disparities in Well-Being Progression at the End of Life," SOEPpapers on Multidisciplinary Panel Data Research 287, DIW Berlin, The German Socio-Economic Panel (SOEP).
    14. Linda A. Wray, 2003. "Mental Health and Labor Force Exits in Older Workers: The Mediating or Moderating Roles of Physical Health and Job Factors," Working Papers wp047, University of Michigan, Michigan Retirement Research Center.

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