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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

WORKSHOP ON DISABILITY IN AMERICA A NEW LOOK

Summary and Background Papers

Based on a Workshop of the Committee on Disability in America: A New Look

Board on Health Sciences Policy

Marilyn J. Field, Alan M. Jette, and Linda Martin, editors

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

THE NATIONAL ACADEMIES PRESS
500 FIFTH STREET, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. 200-2000-00629, TO #32 between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for the project.

Library of Congress Cataloging-in-Publication Data

Workshop on Disability in America, a New Look (2005 : Washington, D.C.)

Workshop on Disability in America, a New Look : summary and papers : based on a workshop of the Committee on Disability in America: a New Look, Board on Health Sciences Policy / Marilyn J. Field, Alan M. Jette, and Linda Martin, editors.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-309-10090-9 (pbk.)

1. People with disabilities—United States—Congresses. 2. People with disabilities—Health and hygiene—United States—Congresses. 3. Disabilities—Age factors—United States—Congresses. 4. Health promotion—United States—Congresses.

[DNLM: 1. Disabled Persons—United States—Congresses. 2. Age Factors—United States—Congresses. 3. Chronic Disease—epidemiology—United States—Congresses. 4. Comorbidity—United States—Congresses. 5. Disabled Persons—classification—United States—Congresses. ] I. Field, Marilyn J. (Marilyn Jane) II. Jette, Alan M. III. Martin, Linda G., 1947- IV. Institute of Medicine (U.S.). Committee on Disability in America: a New Look. V. Title.

HV1553.W67 2005

362.40973—dc22

2005036811

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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

WORKSHOP COMMITTEE ON DISABILITY IN AMERICA: A NEW LOOK

ALAN M. JETTE (Chair), Director,

Health & Disability Research Institute, Boston University

ELENA ANDRESEN, Professor and Chief,

Epidemiology Division, Department of Health Services Research, Management, and Policy, University of Florida Health Sciences Center

DUDLEY S. CHILDRESS, Professor of Biomedical Engineering and Physical Medicine and Rehabilitation,

McCormick School of Engineering and Feinberg School of Medicine, Northwestern University

VICKI A. FREEDMAN, Professor,

Department of Health Systems and Policy, School of Public Health, University of Medicine and Dentistry of New Jersey

PATRICIA HICKS, Associate Professor of Pediatrics and Director, Continuity of Care Clinic,

University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center at Dallas

LISA I. IEZZONI, Professor of Medicine,

Harvard University and Beth Israel Deaconess Medical Center

JUNE ISAACSON KAILES, Associate Director,

Center for Disability Issues and the Health Professions, Western University of Health Sciences

LAURA MOSQUEDA, Director of Geriatrics,

College of Medicine, University of California, Irvine

P. HUNTER PECKHAM, Donnell Professor of Biomedical Engineering and Orthopaedics,

Case Western Reserve University

JAMES MARC PERRIN, Professor of Pediatrics,

Harvard Medical School and Massachusetts General Hospital

Following the workshop and with the initiation of the second phase of the disability study, additional members were appointed to the committee: Michael Chernew, Ph.D., professor of health management and policy, School of Public Health, University of Michigan; Margaret A. Turk, M.D., professor of physical medicine & rehabilitation, State University of New York Upstate Medical University at Syracuse; Gregg Vanderheiden, Ph.D., professor of industrial and biomedical engineering and director, Trace Research and Development Center, University of Wisconsin at Madison; and John Whyte, M.D., Ph.D., director, Moss Rehabilitation Research Institute, Philadelphia.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

Study Staff

MARILYN J. FIELD, Study Director

AFRAH ALI, Senior Project Assistant

FRANKLIN BRANCH, Research Assistant

LINDA MARTIN, Institute of Medicine Scholar in Residence

Board on Health Sciences Policy Staff

ANDREW POPE, Director, Board on Health Sciences Policy

AMY HAAS, Administrative Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

Boxes, Figures, and Tables

BOXES

I-1

 

Health Care Transitions for Young Adults with Special Health Care Needs,

 

176

K-1

 

Directions for Research on Health Living with a Disability,

 

203

FIGURES

B-1

 

ICF model of disability,

 

55

E-1

 

Percentage of the community-based population ages 70 years and older reporting need for help with personal care or only routine care activities, 1982 to 2004,

 

103

H-1

 

Models of the pathway from disease to disability,

 

161

H-2

 

Percentage of American men and women age 50 years or older projected to survive to age 90 years and older,

 

163

H-3

 

Percentage of individuals age 70 years or older defined as disabled by year before death,

 

164

J-1

 

Conceptual model of aging with different characteristics,

 

191

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

M-1

 

Fitted values for percentage of forced vital capacity (FVC) predicted by level of complete motor lesions. C = cervical; T = thoracic; L = lumbar,

 

223

M-2

 

Level of HDL cholesterol by extent of neurological deficit,

 

225

M-3

 

Association between the percentage of total percent lean tissue in the body and age for able-bodied controls (solid arrow; slope = −0.102; r2 = 0.02) compared with that for individuals with spinal cord injuries (SCI) (dashed arrow; slope = −0.275; r2 = 0.10) (*, p < 0.0001),

 

227

M-4

 

Relationship of percent body fat to BMI for individuals with spinal cord injuries (SCI) compared with that for controls,

 

228

M-5

 

Oral glucose tolerance by level of neurological deficit. NT= normal glucose tolerance; IGT = impaired glucose tolerance; DM = diabetes mellitus,

 

229

M-6

 

Bowel evacuation after the administration of neostigmine or neostigmine and glycopyrrolate compared with that after administration of a placebo (*, p < 0.01 for both drugs compared with placebo),

 

230

M-7

 

Distribution of serum 25-hydroxyvitamin D [25(OH)D] in 40 individuals with spinal cord injuries who received supplementary vitamin D (800 units per day for 12 months),

 

231

N-1

 

Depression prevalence among people with different types of disabling conditions,

 

241

N-2

 

A general model of psychological stress and coping,

 

244

N-3

 

Effects of treatment on depression,

 

247

O-1

 

Relationship between environmental, physiological, and behavioral risk and protective factors and limitations due to secondary conditions,

 

253

O-2

 

Surveillance systems for secondary conditions in the population of adults with intellectual and developmental disabilities living in supported arrangements,

 

254

O-3

 

Oral health ratings obtained by using two measures, the Gingivitis Index (GI) and the Lobene Stain Index (LSS), across regular (Reg) and novel (experimental [Exp]) toothbrushes during the baseline and at 6 weeks after the intervention,

 

260

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

TABLES

B-1

 

Concepts and Terminology Used by Models of Disability,

 

54

C-1

 

Complementary Contributions of Three Continuum Concepts to Defining Disability in Childhood,

 

72

C-2

 

Examples of ICF Activities and Participation Codes for Key Indicators,

 

83

D-1

 

Comparison of Approaches for Measurement of the Environment,

 

93

F-1

 

Age-Specific Trends in the Proportion of People with Personal Care or Routine Care Needs Limitations per 10,000 Population, 1984 to 2000,

 

120

F-2

 

A Decomposition of Changes in the Prevalence of Disability Due to Chronic Disease, 1984 to 1996,

 

128

F-3

 

A Decomposition of Changes in the Prevalence of Disability for 30-Year-Olds Due to Chronic Disease, 1984 to 1996,

 

129

F-4

 

A Decomposition of Changes in Disability Prevalence for 45-Year-Olds Due to Chronic Disease, 1984 to 1996,

 

130

F-5

 

A Decomposition of Changes in Disability Prevalence for 60-Year-Olds Due to Chronic Disease, 1984 to 1996,

 

131

H-1

 

Most Common Diseases Reported to Cause Difficulty with Specific Tasks,

 

159

O-1

 

Top Ranked Secondary Conditions,

 

256

O-2

 

Secondary Condition Factors and Items Represented,

 

257

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
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Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published reports as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Diane L Damiano, Ph.D., P.T., Research Associate Professor, Department of Neurology, Washington University, Saint Louis

John Ditunno, M.D., Professor of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University

Corinne Kirchner, Ph.D., Director, Policy Research and Program Evaluation, American Foundation for the Blind

John Melvin, M.D., Chair, Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University

Kenneth J. Ottenbacher, Ph.D., Associate Director, Sealy Center on Aging, University of Texas Medical Branch, Galveston

Susan Palsbo, Ph.D., Principal Research Associate, Center for Health Research, Policy, and Ethics, George Mason University

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the report nor did they see the final draft before its release. The review of this report was overseen by Mel Worth, M.D., Scholar in Residence at the Institute of Medicine. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with the institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
×


WORKSHOP ON DISABILITY IN AMERICA A NEW LOOK

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Workshop on Disability in America: A New Look: Summary and Background Papers. Washington, DC: The National Academies Press. doi: 10.17226/11579.
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Beginning in late 2004, the IOM began a project to take a new look at disability in America. It will review developments and progress since the publication of the 1991 and 1997 Institute reports. For technical contracting reasons, the new project was split into two phases. During the limited first phase, a committee appointed by IOM planned and convened a 1-day workshop to examine a subset of topics as background for the second phase of project. As was agreed upon with the sponsor of the workshop, the Centers for Disease Control and Prevention (CDC), the topics were:

  • methodological and policy issues related to the conceptualization, definition, measurement, and monitoring of disability and health over time;
  • trends in the amount, types, and causes of disability;
  • disability across the age spectrum and in the context of normal aging; and
  • secondary health conditions.

The phase-one workshop was held in Washington, D.C. on August 1, 2005. Its participants included researchers, clinicians, social service professionals, policy experts, and consumer representatives and advocates. The meeting agenda and list of participants are included in Appendix A. Workshop on Disability in America: A New Look- Summary and Background Papers summarizes the workshop presentations and discussions. The background papers prepared for the workshop are included in Appendixes B through O. Some papers were submitted and circulated in advance of the meeting, whereas others were first presented at the meeting. The analyses, definitions, and views presented in the papers are those of the paper authors and are not necessarily those of the IOM committee. Likewise, the discussion summary is limited to the views of the workshop participants.

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