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Secondary and Comorbid Conditions

A secondary condition is a preventable physical, mental or social disorder resultingdirectly or indirectly from an initial disabling condition (Lollar, 1999; Simeonsson &McDevitt, 1999). The concept of secondary conditions is one of the hallmarks ofthinking that distinguishes disability in public health from traditional concepts ofprevention (see also Chapters “Introduction” and “Social and Behavioral Dimensions of Health”). Turk (2006) identified the following characteristics of secondary conditions:

“has a causal relationship to the primary condition, may be preventable, may vary in its expression and the timing of its expression, may be modifiable, and may increase the severity of the primary condition” (p. 187). A secondary condition would not occur without a primary condition, but some secondary conditions (e. g., depression)may be a primary condition in its own right. Turk (2006) identified common secondary conditions: pain, osteoporosis, renal insufficiency, chronic lower limbedema, pressure ulcers, obesity, depression, and insulin-resistant diabetes mellitus.Simeonsson and Leskinen (1999) expand the concept to include social (e.g., isolation)and psychological (e.g., self esteem) dimensions, and they note additional definitional criteria: indirect or direct consequences of primary condition, primary condition necessary but not sufficient cause, reflects person-environment interaction,expression varies as a function of developmental stage, expression varies as a function of individual differences, and conditionsare preventable. Kinne, Patrick, and Doyle(2004) identified the 16 most common secondary conditions among adults (age 18+)with disabilities who reported secondary conditions; they included: chronic pain in muscles, joints (55.6% among people with disabilities), sleep problems (41.8%),extreme fatigue (44.8%), weight or eating problems (39.0%), periods of depression(33.5%), skin problems (22.0%), muscle spasms (25.5%), respiratory infections (notcolds) (20.9%), and falls and other injuries (20.6%). No research could be found that stratified secondary conditions by age across a broad population for people with disabilities.

However, investigations regarding aging with specific conditions reveal similar patterns.

A special supplement of Developmental Medicine and Child Neurology (2009)addressed adults and older adults with cerebral palsy. In that issue, Tosi, Maher,Moore, Goldstein, and Aisen (2009) note that increasing survival rates into adulthood have led to increases in secondary musculoskeletal and neurological conditions. Chief among those secondary conditions are pain (ranging from 67 to 82%), fatigue,decreased mobility, decreased fine motor control, and decreased independence. Tosiet al. observe, “CP frequently causes a cycle of deconditioning, in which physical function deteriorates, followed by a further decease in physical activity and a cascade of functional decline” (p. 4).

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