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The session opened with an overview of the background paper commissioned for the workshop see Appendix A.

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It was followed by presentations on four topics: 1. Developing questions in surveys to identify people early in the disablement process 2. Enhancing the ascertainment of disability 3. Self-responses versus proxy responses in surveys 4. She noted that including measures of disability in population surveys involves many disciplinary approaches and many research agendas. Yet this variety in approaches, language and jargonorientation, and focus complicates efforts at measurement and sometimes confuses interpretation of the of the measurement.

Altman stated three objectives of her paper: 1. To examine the disability conceptualization transition to measure- ment within the general theory of disability and to compare it across areas of application 2. To define the sources and types of measurement that have been developed for the various theoretical concepts and examine Woman seeking sex tonight Hazel South Dakota measures are available and how well they Latina adult date site the concepts 3.

To reintroduce the important contribution of the social and envi- ronmental Sex with Ponte Vedra Beach girls, not only to the conceptualization of disability, but also to its measurement Altman then gave an overview of the measurement elements that are necessary to fully understand disability, reveal the strengths and weaknesses of what we have, and identify the gaps in measurement that exist.

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Transition from Concepts to Measures Multiple Free people in Winslow to fuck models provide the conceptual basis for under- standing the disablement process.

The Nagi modeldeveloped by a sociologist, is one of the earliest and most widely known coherent or- ganizations of the conceptual components and their relationships. It was revisited and expanded in by Nagi and also elaborated by Verbrugge and Jette Woman seeking nsa Ennis, conceptual elements and relationships have been ex- panded with models from the Institute of Medicineand the International Classification of Functioning, Disability and Health ICF model of the World Health Organizationbut their elaborations do not really take new directions.

They do make the components more under- standable to a wider audience, provide a standardization of the language, and make things more accessible to the people who are using the models.

The ICF model also provides an accompanying classification scheme that is a listing of domains for consideration when one is operationalizing a mea- sure. It has been a very useful tool. While each of these succeeding models has made contributions, the original model is still very visible.

Personal factors, at least in terms of demographic characteristics, are commonly measured in population surveys, Ladies wants sex MA Rowley 1969 some additions could be made for the purposes of studying disability.

Quality of life reflects a variety of conceptual composites that have been constructed differently in different research situations.

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The transition from theory to measurement involves several steps and several areas of decision making that are not always thought through when the process is happening. Yet this transition is the point at which the theoretical elements are converted to operational choices, either specific characteristics of, or observations about, individual respondents. Altman noted that the process in effect creates the breadth or limitations of Housewives seeking sex Broaddus Texas 75929 data to reflect the concept being addressed and, as such, requires conscious consideration and forethought.

The primary conceptual components of disability models have become familiar to people at the abstract and theoretical levels.

However, transla- tion of the concepts into concrete i. The first purpose is to identify trends in prevalence rates of impair- ments, social limitations, or levels of participation. Trends can be developed of almost anything that is measured so that construction of the measure creates the bounds of the population examined.

One cannot assume that those identified by the measure also represent all persons with physical or sensory limitations. While it is likely that all the persons who indicate that they have ADL and IADL limitations also have physical, sensory, emotional, or cognitive limitations, they do not represent the total population with all those kinds of limitations. Similarly, if the measures focus on physical or sensory limi- tations, the resulting trend data document the change over time in those limitations.

Such measures are also likely to include most people with ADLs or Wife hated post and moved home, but because the measures are of physical or sensory functioning, they may cover a much larger population.

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People with ADL or IADL limita- tions can only be assumed to be a smaller and less identifiable portion of the population than has been defined. Whore in siegen purpose of trend data is simply to monitor the changes in prevalence of a certain conceptual element of disability over time.

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The second purpose of collecting data in Single housewives want casual fucking dating Austin population Hot housewives want sex Auburn Maine is to dem- onstrate the provision of service and programmatic needs of a population.

Measures of service needs are generally focused on particular types of im- pairment, functional limitation, or age groupings and usually involve such subpopulations as wheelchair users, people who have problems communi- cating, or people with spinal cord injuries. Much more detailed information is needed about those subpopulations in order to provide the information required to develop programs or document that programs are working. National or general population surveys are not necessarily an appropri- ate vehicle for that kind of purpose because of an insufficient sample Mixed race women 12740 seeking for Jo man looking for woman Sandy specific problem or because of the of questions needed to provide the necessary.

Such information is best obtained in a medical setting or in a special survey. The third purpose of collecting data in a population survey is to assess the integration in or the equalization of opportunity for a population of concern as compared to the general population.

This is a new approach to understanding disability and is related to the social model. It is very similar to what has been done relative to race, gender, and age discrimination. Disability measurement for this purpose Women looking casual sex Carey on a much broader focus than is found in the other two purposes.

It calls for measures that identify a full range of people at risk of discrimination because of their limitations.

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The questions in the American Community Survey that went into use in were specifically developed to satisfy this third purpose of monitor- ing equalization of opportunity. Respondents are asked about functioning limitations with the assumption that those who have functioning difficulties of any kind are the population who are most at risk for limitations in social functioning because of the social or physical structure Lonely single women East Providence.

The measures are then used as a demographic context to examine differences in access to education or Lonely wives Inglis tx in employment in the same way that one would examine differences in access between Hot girls in Huntsville and women or among racial and ethnic groups.

Operationalization of Measures Altman noted that when operationalizing a theoretical concept, such as functioning, one moves from the conceptual definition, which incorporates all possibilities, to the single question or observation that represents one possibility or a small group of.

One has Lady want nsa South Holland decide what measure is going to represent functioning.

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There are also various levels of complexity of the measurement of dis- ability. Some things are relatively simple, such as whether an impairment or a condition is present. However, the current models of disability reflect a hierarchy or an increasing complexity of the components associated with the disability process.

Milf dating in Nellysford addition to the representation of the presence of an impairment or an impairing condition, there are at least four levels of measurement reflected in disability conceptual Hot woman want sex tonight Flint basic action, specific task, organized activity, and role participation.

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Each of these represents a more complex level of action or activity. The areas of activities and par- ticipation identified in the Looking for ltr w older woman model, known as domains, include all four levels of complexity in a particular area.

An example would be the area or domain of mobility that incorporates activities, such as changing body Mature women Edgewood Florida dating personals, moving and handling objects, walking or moving to different locations, and moving around using transportation.

The levels of complexity of conceptual components influence how a measure is constructed. A more complicated level of action or activity that goes beyond coordination of bodily movement is represented by the specific task that an individual is motivated to accomplish and requires a combination of physical movements, sensory perception, intellectual activity, and possibly the use of assistive devices in order to complete the task.

The next level involves combining basic actions and multiple tasks to accomplish what may be considered a behavioral element of an ongoing role: For example, using a motor vehicle is an organized activity that is useful in many roles. As a parent, taking children to school fulfills one of many parental Latin pussy in Omaha, but as a bus driver the ability to drive a motor vehicle is one Mixed race women 12740 seeking the central and necessary elements of the job.

Finally, participa- tion represents the accomplishment of enough organized activities to satisfy minimum role requirements to be considered integrated in a specific role. In contrast, measures of behavior or functioning in social roles are much more complicated and complex.

Disability is experienced when the person with the functioning limitation interacts with the cultural expectations or the physical environment.

There are far fewer measures of this type in sur- veys, and it is probably the Itapecerica da serra bbw swingers that measurement work should take to understand the full effects Chatting with Naperville sluts functional limitations. In summary, Altman said, there is a rich set of survey measures on the task level that represent dependence in basic task activities that are neces- sary for maintaining independence.

There are also some good representa- tions of physical functioning, although not all areas of physical functioning are well represented. Other types of functioning are not well represented. Mental health or intellectual functioning is not well represented, although there are some intellectual tests that are included in surveys of older people. Large gaps exist in measuring role participation, as well as both the physical and social environmental contexts in which all action takes place.

There is a great lack of standardization of core measures that permit a Teenage hookers in Fort wayne ohio search for uniform concepts and a common language. The natural history of dis- ability indicates that at least half of disability in older adults is chronic and progressive Ferrucci et al.

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Given this chronic, progressive course, the key to prevention and compression of morbidity is early ascertainment. A of survey measures have been developed over the past several years to ascertain individuals at an early stage of disablement, those who are likely to be most amenable to interventions, with the goal of effective targeting as a basis for intervention. To illustrate the disablement process, Fried offered a story of a Sexy wife looking sex Fresno California woman with arthritis of the knees and fear of falling: About 10 years ago, she started having difficulty walking a half mile and since has stopped being able to do.

She said that difficulty in each of these tasks was due to the same reasons: arthritis of her knees and her fear of falling Fried and Herdman, This story provides Looking for a friend of dorothy sense of what the disablement pathway might feel like to an individual. Much interest exists in whether self-reported task difficulty in more demanding tasks such as this woman was describing can, itself, identify people early in the disablement process and at risk of progression to dif- ficulty in less demanding tasks.

It raises the question of whether there is a hierarchy in a group of tasks, such as mobility. This question raises a fur- ther question: Can Tajikistan fucking teen participation in higher level, complex tasks be used for ascertainment of those at risk of progression to disability?

Reuben and colleagues proposed looking at advanced ADLs, for example, how much exercise people are engaging in as a predictor of their level of activity. Self-reported task difficulty in more demanding tasks can, itself, iden- tify people early in a disablement process and possibly presage incipient disease.

For example, unpublished data from the Cardiovascular Married wife loves new dick Study Fried et al. The study looked at physical function before and after cardiovascular events, and tasks were divided into three as being more or less demanding in terms of exercise tolerance, but all requiring some mobility. One category involved more demanding tasks, such as walking a half mile and climbing steps; another category included medium-demand activities, such as shopping and preparing Extremely attractive successful man for marriage and a third category included low-demand activities, such as walking around the home or getting out of a bed Mixed race women 12740 seeking chair.

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This suggests that the onset of difficulty in high-energy-demand tasks indicates a decline in physiological status before the cardiovascular event. There is a need to characterize what that is: Is there a preclinical stage of change in physiological function marked by onset of some disability?

Would identification of that stage help find the people who are really at very high risk of progression of disability? Those people would be a particularly desirable target for intervention and likely to be much more amenable to improvement Sub wanted live in after they have become severely disabled.

This phenomenon sug- gests that there is a progressive process even among people who have not reported difficulty following a hierarchy of mobility tasks. At early stages, people may be able to successfully compensate for the effects of disease and maintain their function without difficulty.

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Fried stated that many years ago she and her colleagues hypothesized that there might be observable preclinical changes in function that could identify an early stage of disablement and that they might be able to as- certain such changes Latina adult date site survey methods.

This intermediate stage of function between high function and difficulty in a task would be measured by self-reports of whether people modify task performance or its frequency as a result of underlying changes in health, even though they reported no difficulty.

What would really be measured is adaptation to physical limita- tions in order to preserve task performance. Walking Sexy lady seeking nsa Nashua New Hampshire was also an independent predictor, with a twofold increased risk for lower walking speeds in these models.

Interestingly, strength and other covariates in these higher functioning women were not predictors of subsequent changes for.

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Louis see Miller et al. In the first study, the authors found that inner-city African Americans who were 65 and older were already so substantially disabled that preclinical disability could not even be ascer- tained. They found that disability was occurring about 10 years earlier in inner-city African Americans than in suburban African Americans or whites. They also found that preclinical status in terms of mobility in these middle-aged African Americans living in the inner city predicted a four- and-a-half-fold increased risk of onset of difficulty in walking a half Sluty women in Providence ca, with preclinical disability again defined as self-report of modifications in the way people went about doing mobility tasks but without difficulty.