Why Depression Is Poorly Recognized. The symptoms o

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Quality Of Life Issues While Aging With A
DisabilityBryan Kemp, PhDDirector
Rehabilitation Research and Training Center on
Aging with a DisabilityClinical Professor
University of California at Irvine
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Rehabilitation Research and Training Center on
Aging with a Disability
Rancho Los Amigos National Rehabilitation Center
Funded by the National Institute on Disability
and Rehabilitation Research
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Three Major Outcomes In Rehabilitation

• Health
• Maximum functioning
• Quality of Life

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Conceptual Issues In Quality of Life Research

• Objective versus subjective Quality of Life
  (QOL)
• The measurement of QOL
• Including both positive and negative QOL

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Despair Distress Depression
O.K. So-So Boring
Life Satisfaction Happiness Well-Being
Negative
Positive
Quality of Life Continuum
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Cumulative Percentages (n675)
Lo
Hi
Med

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CORRELATIONS(n675)

• Age .05
• Education .09
• Depression -.66
• Life satisfaction .63
• OARS (ADL) -.21
• Community Activities .28

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Correlations of QOL With Other Variables In a
Mega Analysis

• Impairment .05
• Disability .17
• Handicap .38
• Duration .21
• Age .00

Source Dijkers, 1999, APMR
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Negative Quality of Life And The Problem of
Depression
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Why Depression Is A Major Problem

• It is poorly recognized
• Prevalence is between 25 and 50
• It greatly affects health and function
• It is not self-limiting can last for years

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Why Depression Is Poorly Recognized

• The symptoms of depression overlap with the
  symptoms of chronic disease.
• Clinicians and others normalize depression.
• Clinicians believe depression is untreatable
  because of the disability.

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Depression Scores and QOL
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Depression Scores Across Groups
Percent
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Depression is not related to

• the severity of the impairment
• age (current or onset)
• the duration of impairment
• how impairment affects ADLs and IADLs

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Depression is related toThe ability to cope
with changes and losses, which is separate from
the disability.
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Life Satisfaction by Change in IADLSPolio Sample
No Change Little-Great Deal
Change in IADLS
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Effects of Treatment on Depression
D L-S CA
4 3 2 1
25 20 15 10
22 16 11 6
p lt .05 p lt .001
D
n.s.



n.s.
L-S


C
Baseline Start 8
24 WEEKS
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Summary of Factors Related to Negative QOL

• Difficulty coping with changes and losses.
• Not related to severity of impairment or degree
  of disability.
• Depression is the most common manifestation of
  negative QOL.

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What About Positive QOL?
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Percent with High QOL
(plt.001)
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Correlations with QOLSCI Sample
Level of Injury .11 (ns) Activities of Daily
Living .10 (ns) Community Activities .40 (lt.001)
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The Relation of ADLs, IADLs and Community
Activities to Life Satisfaction Across Groups
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Community Activities and QOL
QOL
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How Does Life Satisfaction Relate to QOL?
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Factors Related to Positive QOL in Persons Aging
with a Disability

• Not related to age, severity of impairment or to
  degree of disability.
• The ability to engage in meaningful, enjoyable
  or productive activities.
• The number and kind of community activities the
  person does.
• Somewhat related to social support, attitude,
  and personality.

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QUALITY OF LIFE The presence of a reasonable
amount of pleasurable, successful and meaningful
experiences.
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Two Factors in QOL
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A General Model of Psychological Stress
Triggers Processes Outcomes
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Quality of Life as Related to Change in
Functioning
20 yrs ago Now 20 yrs ago Now
No Change Change Percentage Rating Life
as Good or Excellent
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What Is Quality of Life?

• Objective QOL
• Subjective QOL

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Causes of Depression

• Not caused by the disability or the impairment.
• Most likely caused by difficulties coping with
  the disability and the societal problems.

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