Better Dead than Disabled?

I have just read a shocking survey, commissioned by Disaboom, which suggests that more than half of Americans would rather die than live with a serious disability.

The research also showed that more affluent and more educated people were more likely to choose death over disability than those with lower incomes and poorer standards of education.

What on earth does this say about the United States? What would the results of a similar survey in Britain show? There may be very few but a militant minority who would actually choose disability rather than life without an impairment, but death rather than life? When we are surrounded by so many examples of people living fantastic, fulfilling lives despite serious disabilities?

I may not agree with their current political leadership, or their attitude to other countries' ability to manage their own internal affairs, but I have always thought of Americans as the ultimate "can-do" citizens. These are the people who believe in selling or spending their way out of economic downturns; who pity us poor Brits for failing to capitalise on our wonderful inventions; the home of the superhero, where any achievements are hailed with admiration, rather than envy or embarrassment.

So why are so many of them apparently ready to wimp out when it comes to dealing with disability? Is this a reflection of their inadequate public healthcare system, a general ignorance of the possibilities of independent living, or something else altogether?

What do you think? If you are affected by disability, please add your comments here - anonymously if you prefer - and we can compare our entirely unscientific survey of Independent Living visitors with our cousins across the water!

 

 

In Sickness and in Health

I spend rather more time reading and listening to the radio these days, as my arms remain determined to pursue their status as redundant appendages, rather than reliable tools. I continue as editor of this website, using iListen, voice recognition software, which despite hiccups along the way, as we learned to accommodate each other's foibles, has now become an indispensable part of my working life. Although still not 100 percent reliable, the fact that it can make possible a job that formerly required hours of keyboard and mouse use, is a testament to the progress that has been made in this area.

And when I heard Alan Johnson, the health secretary, announcing that in future doctors should be issuing well notes, rather than sick notes, to encourage employers and employees alike to think about what people could do, rather than what they couldn't, my own situation seemed to provide an interesting illustration.

Almost certainly, if I had an employer, they would have stopped me working many months ago, when overuse of the computer first made my hands and arms too painful to continue. Rest is always the first prescribed treatment for repetitive strain injuries, and - perhaps also with an eye on some very large tribunal awards for work-related disabilities - responsible employers take no chances with the long-term well-being of their people.

But not having an employer, I don't have anyone telling me I mustn't work. Independent Living is my passion, and I'm not about to relinquish it.

So, rather as the government minister is recommending that occupational therapists should be assessing how much and what type of work someone can do when they have been ill, I have run a uniquely qualified eye over my own situation, and acquired the necessary tools to help me keep working. I am not as productive as I used to be - but given that high productivity almost certainly contributed to the problem, maybe that isn't so bad. And most importantly, instead of adding mental health problems of stress and depression to my woes, I do wake up most mornings, focused on what I can do, rather than what I can't.

 

 

Fall Prevention - priorities

"Fall prevention" is a subject that has exercised both the NHS and the government considerably in recent years. The National Service Framework for Older People includes prevention of falls as one of its "Standards", and health authorities around the country have been scrambling to develop Fall Prevention Strategies that demonstrate their focus on the problem.

Depending on whose figures you read, somewhere between a third and half of people over 65 suffer a fall in any given year, and the cost to the NHS of treating these fractures is very nearly £1 billion.

Preventing falls is clearly something that is well worth spending resources on, in financial terms alone, never mind the human costs of pain, lowered self-confidence, loss of mobility and independence.

And yet, all this high-powered attention has largely failed. The major effort has gone into osteoporosis screening and subsequent drug therapy for those identified as "at risk". Osteoporosis is a horrible condition, and there is no doubt that people whose vulnerability to it has been recognised will be grateful for the intervention. But the strategy has at least two weaknesses. Firstly, the test itself, which assesses bone mineral density (BMD), is not reliable, frequently either under- or over-estimating the condition, and therefore encouraging doctors to prescribe drug therapy for the wrong people. And secondly, the drugs - bisphosphonates- are quite expensive if over-prescribed. It has been calculated, for example, that the cost of preventing one hip fracture - the result of medicating 577 post-menopausal women for 12 months - is £120,000.

How does taking bisphosphonates stop you falling? The answer, of course, is that it doesn't. What it should do, is help to build up bone strength, so that the individual is less likely to suffer a fracture if they do fall. But as a means of preventing falls, it can have no value - and given that 80% of falls occur amongst people who don't have osteoporosis anyway, perhaps we should not be surprised that the overall strategy is not delivering the hoped-for results.

The real causes of falls are many, and can be complex. Certain illnesses, such as Parkinson's and Alzheimer's, bring an increased risk, as do some medications, notably antidepressants and diuretics, both of which are widely used in the most vulnerable age-group. Equally, there are many falls which could be avoided with a combination of exercise and commonsense. Exercise - and specifically gait-training - to improve strength, confidence and balance. Commonsense, to ensure that we remove hazards around the home (where most falls occur), such as rumpled rugs, trailing electrical flexes and general household clutter left in hallways.

Perhaps PCTs would do better to devote more of their resources to training their patients in how to keep themselves safe from falls, starting with those people most at risk due to medical conditions and medication regimes. Then we might see a real decline in the number of older people who lose their ability to live independently as the result of an accident.

You can read our guide to preventing and coping with falls here: Independent Living - fall prevention