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Pathways to Disability

The characteristics of disability are shaped in large part by three pathways to disability.

The most common pathway to disability occurs among older people who experience functional decline in later years – generally as a result of chronic conditions,or combinations of chronic conditions that create activity limitations overtime. For example, mild arthritis may be annoying and painful, but severe arthritis may lead to functional limitations – walking, stooping, reaching, and climbingstairs. Indeed, arthritis is the leading cause of disability in theUnited States(Centers for Disease Control and Prevention, 2001). Other age-related changes orcircumstances may lead to catastrophic loss, for example, falls (injury, alsodescribed as a pathway below) and stroke.

A second pathway to disability occurs as a result of a developmental disabilityin the early stages of life, resulting in lifelong limitations in function. People withsevere disabilities increasingly live into middle and old age, and thus they mustaddress the combined effects of the primary disabling condition along with thechanges defined by aging. For example, a person who has cerebral palsy may havefunctional limitations and spasticity attributed to CP. With age, the damaged jointsmay further limit mobility and result in substantial pain. Overlaying those changesare the age-related chronic conditions that may compromise health and function.Many investigators agree that aging with a disability accelerates the aging process(Cooper & Stein, 2005).

A third pathway to disability is injury. Severe injuries, acquired at any age, havelifelong implications. A spinal cord injury in one’s 20s may place someone at riskfor pressure ulcers, weight gain, inability to exercise and sustain conditioning, andoveruse of shoulders and neck. The leading cause of death among people withspinal cord injury is now cardiovascular disease (Hagen, Lie, Rekand, Gilhus, &Gronning, 2010). Falls and consequent injury (broken hips or traumatic brain injury[TBI]) may have devastating consequences for older people. Injury is not a discretepathway to disability as we shall see below.

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