Identifying the Specialized Needs of Women with Disabilities Jennifer Featherston MS, CRC, ABD

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Identifying the Specialized Needs of Women with
DisabilitiesJennifer Featherston MS, CRC, ABD
Community Opportunities for Individuals with
Disabilities 2nd Brown Bag Roundtable
Discussion August 8, 2006
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Agenda

• Prevalence of Disability
• Differences between men and women with
  disabilities
• Health disparities among women with disabilities
• Possible solutions?

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(No Transcript)
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National Womens Health Information Center, 2002
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Prevalence of disability type among women

• back disorder 15.3
• arthritis 13.3
• cardiovascular disease 9.7
• asthma 5.3
• orthopedic impairment of lower extremity 4.2
• mental disabilities 3.3
• diabetes 3.3
• learning disabilities and mental retardation 2.5

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Health disparities

• Lack of physicians in rural areas
• Unequal treatment for minorities
• Lack of diversity among health care providers
• Low health literacy
• Lack of insurance
• Exposures to environmental risks
• Poverty and cancer

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Disability and health disparities

• Denied reproductive and other types of health
  care
• Given substandard care
• Limited opportunities in the healthcare
  professions
• Difficulty obtaining health information
• Lack of insurance
• Environmental pollution
• Poverty

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Significant disparities among women with
disabilities
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Osteoporosis

• Hip fractures
• Age
• Younger women with disabilities had seven times
  the rate of osteoporosis as women without
  disabilities

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Diabetes

• Physical limitations
• Prevalence of diabetes as a secondary condition
  in women with physical disabilities
• Highly correlated with lack of mobility
• Rates of physical limitations
• Consequences of the coexistence of diabetes and
  disability

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Hypertension

• 21.4 - 22.9 women 18
• Women 45
• Black women
• 56.2 women with disabilities

Center for Research on Women with Disabilities,
May 2005
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Arthritis

• Age-adjusted rate of activity limitations
• Women 3.4
• Men 2
• Older women
• Medical costs
• Increase in incidence

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Obesity

• 24.9 of persons with disabilities are obese
  compared to 15.1 of those without disabilities
• overweight persons with severe mobility
  limitations were significantly less likely to
  attempt to lose weight than those who were
  overweight but did not have mobility
  difficulties
• women with three or more limitations were
  significantly more likely to be overweight
  (43.2) compared to women without limitations
  (21.6)
• the highest percentage of obesity (52) can be
  found among women age 45-64 with 3 or more
  limitations, double the statistic (26.1) of
  women with no limitations.

1994-1995 National Health Interview Survey
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Obesity

• 21.4 - 22.9 women 18
• More women than men
• Aged 45-74
• Black, Hispanic
• 47.6 women with disabilities BMI 30
• 43.2 women with three or more limitations

NHIS
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Weight management

• barriers to increasing physical activity
• barriers to healthy diet
• inability to obtain dietary information

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Physical activity

• People with disabilities reporting regular
  moderate physical activity 27.2
• People without disabilities reporting regular
  moderate physical activity 34.4
• People with disabilities reporting regular
  vigorous activity 9.6
• People without disabilities reporting regular
  vigorous activity 14.2

U.S. Department of Health and Human Services
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Clinical guidelines for obesity

• Few offer suggestions for counseling overweight
  persons with mobility impairments
• Current established recommendations dont take
  into account
• reduced metabolism
• difficulty in obtaining informed recommendations
  for diet and exercise appropriate for disabling
  conditions
• physical inability to engage in aerobic activity
• limited access to fitness facilities that can
  accommodate people with severe mobility
  impairments
• psychosocial issues that may accompany mobility
  limitation

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Measurement Issues

• BMI
• Height and weight
• Scales

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Womens Issues

• Sexuality
• Reproductive health
• Gender-specific illnesses

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Romantic relationships

• Dating
• Friendships
• Serious romantic relationships or marriage
• Reasons not married or in a serious relationship
• Ending of a marriage or other serious
  relationship
• Fewer women with disabilities had borne children
• Staying in a bad marriage

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Sexual desire and sexual activity

• Occurrence of sexual activity
• Information about sexual functioning
• Levels of sexual activity, response and
  satisfaction
• Level of sexual activity

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Menstrual Management
Manual dexterity Transfer techniques
Pharmaceutical intervention
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Disability and Menopause
Premature osteoporosis
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Abuse

• Incidence of abuse
• Duration of abuse
• Types of abuse
• Access to programs

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Emotional health

• Depression
• Self-esteem
• Abuse
• Body Image
• Social connectedness/isolation

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Depression

• A common secondary health
• condition among women with disabilities.
• More common for women with disabilities than for
  other people.
• At least twice as common among women as among
  men.
• Appears to be possibly three times more common
  for people with disabilities than for people in
  general.

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Self-esteem

• Severity of disability
• When disability acquired
• Special education
• Working
• Relationships
• Abuse

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Body Image

• Development of body image
• in childhood a woman learns what her body can and
  cannot do, what her body looks like, and whether
  she is a boy or a girl
• develops a value for herself

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Quote from an Asian woman with tetraplegia
"You lost most of the confidence when you become
disabled. Before that I like to wear fashion
clothes, spend more time with myself like what
kind of make-up and what kind of hairstyle I'd
like to have today. After the accident, since I
cannot do it myself, then you cannot be so picky
when other people do it for you. It makes it very
difficult at first because I was just not happy
with the way that I looked, at first once I
became disabled. Now I can accept it more, but I
just don't think of myself as attractive as
before.
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Social Connectedness

• Associated with positive health outcomes for
  women with disabilities
• Has been found to help reduce psychological and
  physical problems

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Social Isolation

• Leaves both women and men with disabilities
  vulnerable for psychological and other health
  problems
• National study comparing women with and without
  physical disabilities
• Women with disabilities have significantly
  greater levels of social isolation
• Women with disabilities with positive school
  environments, less over-protection, and more
  affection in the home tend to experience less
  social isolation
• Age, education, and disability severity do not
  tend to be related to social isolation

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Substance use

• Alcohol and other drug abuse disorders tend
  to increase as functional limitation becomes more
  severe among women with disabilities.

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Anecdotes reported by women who use wheelchairs
You dont have to worry about osteoporosis
because you cannot walk. There is no reason for
some one like you to be tested for AIDS the test
should be administered to those who really need
it (people who are sexually active).
Im sorry, but unless you can stand, we cant do
a mammogram. Didnt you bring someone to
transfer you? If you cant get yourself on
the examination table, we cannot do the
colonoscopy. Our staff are not trained to do
that.
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Barriers to receiving general and reproductive
health care

• Care provided?
• Identifying physicians
• Differences in secondary illnesses
• Use of public health clinics

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Barriers to participation in physical activity

• Intrapersonal constraints
• Interpersonal constraints
• Structural constraints

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Determinants of physical activity among people
with disabilities

• Reporting lower motivational barriers
• Higher exercise self-efficacy

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Americans with Disabilities Act

• Accessible parking, ramps, and rails for getting
  in and out of buildings
• Restrooms large enough for wheelchairs
• Other universal design features not required by
  law but more welcoming to women with disabilities
  include
• Lower reception counters to greet women in
  wheelchairs
• Scales that accommodate people who use
  wheelchairs or have difficulty standing without
  support
• Motorized, adjustable-height examination tables

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Center for Research on Women with Disabilities

• a substantial proportion of primary care
  physicians offices are not in compliance with
  ADA requirements
• nearly a third of women with physical
  disabilities are denied services at a doctors
  office solely because of their disability
• indicated that 56 percent of disabled women who
  had given birth in hospitals reported that the
  hospital was ill prepared to accommodate their
  disability-specific needs

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Instances of Discrimination
Source US Department of Justice Status
Reports April 1994 March 2003
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National Organization on Disability

• Needed particular therapies, equipment, or
  medications not covered by health plans
• 28 people with disabilities
• 7 of people without disabilities
• Needed medical care within the previous year but
  did not get it
• 19 people with disabilities
• 6 people without disabilities

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ADA Requirements

• Guaranteed services Equal services
  Integrated setting Facility evaluation
  Accessibility modifications Administrative or
  eligibility criteria Practices, policies, and
  procedures Providers costs

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Ideal physicians office

• Hallways and exam room able to accommodate
  wheelchair
• Adjustable-height, extra-wide padded exam table
• Platform scale
• Staff trained to assist with dressing and to be
  sensitive to disability issues

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Examples
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Exam table
ADJUSTABLE
HEIGHT
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Platform scale
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The Institute of Medicine

• Safe, avoids injuring patients
• Effective, based on scientific evidence of
  benefit
• Patient-centered, respectful of patients
  preferences, needs, and values
• Timely, reduces waits and harmful delays
• Efficient, avoids waste of equipment, supplies,
  ideas, and energy
• Equitable, equal quality regardless of patients
  personal characteristics

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SUMMARY

• 19.3 percent of the U.S. population,
• or 49.7 million Americans, report having
• disabilities
• By 2049, if the age-specific prevalence of major
• chronic conditions remains unchanged, the
• absolute number of Americans with functional
  
• limitations will rise by more than 300
• People with disabilities share these
  characteristics
• Significant high use of healthcare services
• Frequent expressions of dissatisfaction with
  their care
• Particular susceptibility to disparities in care
  that can result from a failure to provide safe
  and accessible services
• Experiences of widespread lack of appropriate
  accommodations