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Preventing Excessive Disability
Disabilities – Irrespective of Age
Disability relates to an interaction between features of a person's body and features of the society in which he or she lives. The term “disability” is an umbrella phrase covering impairments, activity limitations, and participation restrictions.
  • Impairment is a problem in body function or structure;
  • Activity limitation is a difficulty encountered by an individual while executing a task or action;
  • Participation restriction is a problem experienced by an individual’s involvement in life situations.
Excess disability refers to the loss of an ability that comes from something other than the disease or impairment itself. In dementia care, for example, this generally refers to the loss of abilities that go beyond the physiological changes that are caused by the inherent conditions associated with dementia.
Excess disability during morning care in nursing home residents with dementia
Excess disability was examined in 17 nursing home residents with dementia by comparing their performance of morning care tasks under two activities of daily living (ADL).

The results suggest that excess disability in severely cognitively impaired and functionally disabled residents can be reduced by “increasing” opportunities for independent activity.

https://pubmed.ncbi.nlm.nih.gov/10937545/
Unintentionally Feeding the Flame
All too often the excess disability is “unintentionally” created by actions of well-meaning professionals and/or family care giver(s).

One of the best examples of this is when individuals take over a specific task in order to reduce the time it would take the disabled individual to complete the task at hand. Effectively preventing the individual from, “practicing to maintain their skills”.

This would also apply to any skill that the individual may still be able to accomplish but perhaps does so slower than before due to cognitive, physical or mental disabilities. Even though some tasks may take longer to accomplish the inclination to take over easily and in some instances, permanently, creates “excess disability”.

This becomes evident when attending to everyday ADL’s and IDL’s:
  • Activities of daily living (ADL’s) include personal-care activities such as eating, bathing, dressing, and using the toilet.
  • Instrumental activities of daily living (IADL’s) include household chores, shopping, managing medication, climbing stairs, public transport, finances and walking. They can be affected by cognitive impairment.
“USE IT OR LOOSE IT”
This statement speaks volumes when discussing the learning points about this topic. The truth of the matter is that “excess disability” is not created by the illness in of itself, nor by the deficits affecting the individual, it is grown from the seed that comes from overdoing for others.

It needs to be stated at this point that the impulse to take over may be instigated by good intentions. It may propagate from sincere compassion, concern, and deeply instilled desires to reduce the burden inflicted by the individuals’ personal deficit.
[Case Study]  
A loving mother’s infant is 9-month-old (Marcus) and has begun showing subtle signs of interest in moving from the crawling stages to upright movements to begin walking. Little Marcus’ initial attempts in those beginnings stages resulted in several injuries. Such was this ever-attentive new mother, that she turned herself into an ever present “shield” so that every move that was made by little Marcus was intervened to prevent another injury.

By the age of 18 months, little Marcus was still not walking and in fact no longer presented with any interest at all. He had grown completely reliant on his mother at every turn to the point that he developed an ingrained pattern of behavior that was unintentionally perpetuated by his mother’s compassion. He was not allowed to experience the valued lesson of getting back up after a fall (or setback) in order to prevail.
Clearly, even the young are vulnerable when it comes to “excess disability.” Happy to report that this caring mother did catch on; her second born was up and enthusiastically walking at approximately the age of 11 months despite a few minor injuries along the way. Live and learn!
Adaptive Strategies
With focus on our aging population, the concept “USE IT OR LOOSE IT” may require adaptations, interventions, and therapeutic plans of care. These strategies have the common goal of creating a means to enable this population of individuals to succeed independently despite his/her impairment.

It may be a simple as:
  • Installing devices such as grip rails, stair lifts, and removal of dangers such as cluttered pathways, loose carpets, or inappropriate footwear can be helpful.
  • Glasses, low-vision aids (such as magnifying glasses), large-print materials, talking clocks and watches, telephones with large numbers, audio books, and safety measures such as raised-dot dials on kitchen equipment, may all be helpful.
  • Hearing aids to give the gift of sound awareness can greatly improve quality of life.
  • Adapted safety devices may be needed (e.g., flashing light on cell phones or exit signs).

Looking for ways to help your residents to enjoy their independence may be an unexpected gift returned - there is nothing more rewarding and gratifying than seeing your resident rejoice in their ability to regain or sustain independence and continue achieving personal self-directed milestones as long as possible.
Self-determining - Self-governing - Self-regulating - Self-realization
Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org
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Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network.
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