The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.

Every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). Those with an SCI are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries. Dynamic aerobic requires integrated physiologic responses across the musculoskeletal, cardiovascular, autonomic, pulmonary, thermoregulatory, and immunologic systems. Moreover, regular aerobic exercise beneficially impacts these same systems, reducing the risk for a range of diseases and maladies. This book will present comprehensive information on the unique physiologic effects of SCI and the potential role of exercise in treating and mitigating these effects. In addition, it will incorporate work from scientists across a number of disciplines and have contributors at multiple levels of investigation and across physiologic systems. Furthermore, SCI can be considered an accelerated form of aging due to the severely restricted physical inactivity imposed, usually at an early age. Therefore, the information presented may have a broader importance to the physiology of aging as it relates to inactivity. Lastly, the need for certain levels of regular aerobic exercise to engender adaptations beneficial to health is not altered by the burden of an SCI. Indeed, the amounts of exercise necessary may be even greater than the able-bodied due to ‘passive’ ambulation. This book will also address the potential health benefits for those with an SCI that can be realized if a sufficient exercise stimulus is provided.

This book discusses the state of the research and cutting-edge practice with regard to chronic illnesses and rehabilitation in older adults. It emphasizes biopsychosocial and culturally appropriate rehabilitation approaches to reduce the degree of disability and maximize independence in the activities of daily living among the burgeoning aging population. Organized in four sections—Introduction and Overview, Major Illnesses and Problems in Aging Populations, Evaluation of Functional Rehabilitation Approaches for Aging Populations, and Future Clinical Research Needs—the book includes chapters on the “graying” of the West with implications for increased chronic illnesses and disabilities; a review of biopsychosocial rehabilitation approaches; important “aging” issues such as slips-and-falls, musculoskeletal pain, chronic disabling conditions such as cancer and cardiovascular disease, and work-related factors to maintain work engagement in older workers. The US Census Bureau projects that by the year 2030, about 20% of the U.S. population will be 65 or older, contributing to the increased concern about healthcare and rehabilitation issues among older adults. /div This work will be of interest to healthcare, rehabilitation, vocational, human resource and disability management professionals, policy makers as well as researchers in areas of aging, gerontology, chronic illness, disability, rehabilitation, social work, medicine and psychology.

Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.

This book clearly explains when and how different rehabilitation techniques should be applied in the aging patient, thereby enabling readers to identify and apply those rehabilitation strategies that will maximize quality of life and functional independence in individual cases. It is specifically designed for ease of consultation and rapid retrieval of the information most relevant to clinical practice. Prominence is given to the benefits of a multidisciplinary approach to rehabilitation, with discussion of a very wide range of aspects of rehabilitation in different disease settings. The breadth of coverage is illustrated by the attention paid to less commonly addressed topics such as visual and hearing rehabilitation, the role of robotics and 3D imaging techniques, variations in approach among health care systems, and rehabilitation in end-of-life care. The authors are international academic experts in their fields, guaranteeing a high scientific standard throughout. This manual will be an invaluable tool and source of knowledge for geriatricians and physiatrists but will also appeal to a wider range of clinicians, practitioners, and students.

Physical rehabilitation for walking recovery after spinal cord injury is undergoing a paradigm shift. Therapy historically has focused on compensation for sensorimotor deficits after SCI using wheelchairs and bracing to achieve mobility. With locomotor training, the aim is to promote recovery via activation of the neuromuscular system below the level of the lesion. What basic scientists have shown us as the potential of the nervous system for plasticity, to learn, even after injury is being translated into a rehabilitation strategy by taking advantage of the intrinsic biology of the central nervous system. While spinal cord injury from basic and clinical perspectives was the gateway for developing locomotor training, its application has been extended to other populations with neurologic dysfunction resulting in loss of walking or walking disability.