Unable to work? Characteristics of people with blindness and low vision who are out of the labor force

BACKGROUND

Approximately half of the people who are blind or have low vision in the U.S. are not in the labor force, yet we know little about their characteristics or reasons for being out of the labor force.

OBJECTIVE/HYPOTHESIS

The objective of this study was to compare people with blindness or low vision who reported being unable to work to those out of the labor force for other reasons, unemployed, and employed, and investigate characteristics that differentiate these groups.

METHODS

Our sample of people with blindness or low vision was selected from the Behavioral Risk Factor Surveillance System to compare people who reported being unable to work to those in other employment groups utilizing multinomial logistic regression.

RESULTS

The majority of people out of the labor force reported they were unable to work. People unable to work were likely to have low income, more chronic health conditions, days with poor physical health, and functional disabilities than all other groups. They were also more likely to have access to health care than other groups and were more likely to be male and uncoupled compared to those out of the labor force for other reasons.

CONCLUSIONS

People who reported being unable to work had more chronic health and functional disability issues. Because being out of the labor force puts one at economic risk, further research is indicated to assess policy issues and strategies that might identify employment options that accommodate people with blindness or low vision and additional health issues and disabilities.

Labor Participation of Retirement-Aged Workers: Understanding the Influencing Mechanism of Health Status and Social Pension Insurance Participation

BACKGROUND

Delayed retirement initiative is taken as one of the proposed solutions to population aging. Rare research attention has been paid to determinants in decisions-making of late retirement.

METHOD

This study applies data from CHARLS survey (2018) that traces the health status among older adults in China, and implements the stepwise multiple regression analysis adjusted with robust standard errors on individual level.

RESULTS

The difficulty in instrumental activities of daily living (IADLs) and chronic conditions could increase the intention of retirement-aged workers to withdraw from late career participation; and the overlay of both would interact to reinforce such intention. Besides, the employment-related social pension participation could further strengthen the jointly contributing effect of both on withdrawal from late career participation.

CONCLUSION

The triple interaction mechanism in retirement-aged workers' decisions of late retirement needs considering in the policy formulation of delayed retirement initiative.

Course of employment in adults with cerebral palsy over a 14-year period

AIM

To explore the course of employment in adults with cerebral palsy (CP) over 14 years, and to identify subgroups at risk for unemployment.

METHOD

Sixty-five adults with CP (33 males, 32 females; baseline age 25y 8mo, standard deviation [SD] 3y 2mo; intellectual impairment 25%; bilateral CP 65%) participated in a prospective cohort study. Self-reports of employment and work hours per week in 1996, 2000, and 2010 were documented. The course of employment (including sheltered work) and work hours per week were analysed, using generalized estimating equations (GEE).

RESULTS

Overall, employment rate was stable over time (38-45%, p=0.413), but lower than in the general population (75-86%, p<0.001). Employment rates were specifically low in adults with intellectual impairment, bilateral CP, and in adults with Gross Motor Function Classification System (GMFCS) levels IV and V. Work hours per week declined (35.0 [SD 7.9] to 31.2 [SD 10.3], p=0.033), especially among females (32.3 [SD 6.4] to 23.4 [SD 7.4], p<0.001). Similar to the general population, females often worked part-time.

INTERPRETATION

Employment was low compared with the general population, but remained stable in the long term; however, work hours per week decreased. Adults with intellectual impairment, bilateral CP, and GMFCS levels IV and V are subgroups at risk for unemployment.

Predictors of permanent disability among adults with spinal dysraphism

OBJECTIVE Predictors of permanent disability among individuals with spinal dysraphism are not well established. In this study, the authors examined potential risk factors for self-reported permanent disability among adults with spinal dysraphism. METHODS A total of 188 consecutive individuals undergoing follow-up in an adult spinal dysraphism clinic completed a standardized National Spina Bifida Patient Registry survey. Chi-square tests and logistic regression were used to assess bivariate relationships, while multivariate logistic regression was used to identify factors independently associated with self-identification as "permanently disabled." RESULTS A total of 106 (56.4%) adults with spina bifida identified themselves as permanently disabled. On multivariate analysis, relative to completion of primary and/or secondary school, completion of technical school (OR 0.01, 95% CI 0-0.40; p = 0.021), some college (OR 0.22, 95% CI 0.08-0.53; p < 0.001), college degree (OR 0.06, 95% CI 0.003-0.66; p = 0.019), and holding an advanced degree (OR 0.12, 95% CI 0.03-0.45; p = 0.002) were negatively associated with permanent disability. Relative to open myelomeningocele, diagnosis of closed spinal dysraphism was also negatively associated with permanent disability (OR 0.20, 95% CI 0.04-0.90; p = 0.036). Additionally, relative to no stool incontinence, stool incontinence occurring at least daily (OR 6.41, 95% CI 1.56-32.90; p = 0.009) or more than weekly (OR 3.43, 95% CI 1.10-11.89; p = 0.033) were both positively associated with permanent disability. There was a suggestion of a dose-response relationship with respect to the influence of educational achievement and frequency of stool incontinence on the likelihood of permanent disability. CONCLUSIONS The authors' findings suggest that level of education and degree of stool incontinence are the strongest predictors of permanent disability among adults with spinal dysraphism. These findings will be the basis of efforts to improve community engagement and to improve readiness for transition to adult care in a multidisciplinary pediatric spina bifida clinic.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

INTRODUCTION

The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia.

MATERIALS AND METHODS

Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives.

RESULTS

Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention.

DISCUSSION

Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

The Impact of Health Behaviors and Health Management on Employment After SCI: Physical Health and Functioning

Background: Research has shown that employment following spinal cord injury (SCI) is related to health and functioning, with physical health and functioning after SCI frequently identified as a primary barrier to employment. Objective: To examine the relationship between employment and behaviors associated with the management of physical health and functioning as described by individuals with SCI who have been employed post injury. Methods: A qualitative approach using 6 focus groups at 2 sites included 44 participants with SCI who had worked at some time post injury. Heterogeneous and homogeneous groups were created based on specific characteristics, such as education, gender, or race. A semi-structured interview format asked questions about personal, environmental, and policy-related factors influencing employment after SCI. Groups were recorded, transcribed, and entered into NVivo before coding by 2 reviewers. Results: Within the area of behaviors and management of physical health and functioning, 4 overlapping themes were identified: (1) relearning your own body and what it can do; (2) general health and wellness behaviors; (3) communication, education, and advocacy; and (4) secondary conditions and aging. Specific themes articulate the many types of behaviors individuals must master and their impact on return to work as well as on finding, maintaining, and deciding to leave employment. Conclusions: Individuals with SCI who are successfully employed after injury must learn how to perform necessary behaviors to manage health and function in a work environment. The decision to leave employment often appears to be associated with secondary complications and other conditions that occur as persons with SCI age.

An exploratory study of inclusive worksite wellness: Considering employees with disabilities

BACKGROUND

An increasing number of employers are offering worksite wellness programs, yet, little is known about the participation of workers with disabilities.

OBJECTIVE

The primary purpose of this study was to explore the factors, which facilitate and impede participation in worksite wellness offerings by individuals with disabilities.

METHODS

Participants completed the Access to Worksite Wellness Services to Employees with Disabilities (AWWSED).

RESULTS

The decision to participate in worksite wellness programs is influenced by several individual, social, and organizational factors including perceptions of the impact of one's disability on health, the health habits of coworkers, and an organizational commitment to employee well-being. Study participants also indicated the importance of affordability, convenient times, and interest in the wellness activities being offered, as influencing participation decisions.

CONCLUSIONS

These findings suggest that individual, social, and organizational factors all contribute to the decision to participate and suggest that social support from colleagues as well as easily obtained and understandable program information from the employer, may be especially useful in engaging employees with disabilities in wellness programs.

The effect of adaptive sports on employment among people with disabilities

PURPOSE

The purpose of this study is to analyse the role of adaptive sport in predicting employment for individuals with physical disabilities.

METHOD

This study is cross-sectional. We collected survey data on employment and other covariates including education, age, age at disability onset, veteran status and athletic classification from 140 mobility impaired athletes who play either wheelchair rugby or wheelchair basketball.

RESULTS

One hundred and thirty-one participants were studied. Our analysis shows that playing an additional year of adaptive sport is associated with an approximately 4% increase in likelihood of employment. Education and duration of disability are found to be positive predictors of employment, while veteran status and severity of injury are negative predictors of employment. Age of disability onset is not found to be a predictor of employment when other controls are included.

CONCLUSIONS

This result indicates that a substantial economic benefit would result from increased participation in adaptive sport, and therefore may justify additional funding to expand adaptive sport programs. Implications for Rehabilitation Employment rates are very low among individuals with physical disabilities, despite research indicating extensive benefits from employment. Participation in adaptive sport is associated with a higher likelihood of employment. Efforts to increase participation in adaptive sport could have a large economic benefit.

Impact of Employment and Age on Quality of Life of Individuals With Disabilities

The purposes of this study are (a) to explore how people with disabilities (PWD) experience differences in their quality of life (QOL) over the course of their lives, (b) to examine the effect of employment on QOL, and (c) to investigate the impact of age on overall QOL for PWD both inter- and intra-individually. To address these aims, this study used the data set for the Panel Survey of Employment for the Disabled (PSED) collected by the Korean Employment Agency for the Disabled (KEAD). The target populations of the study were 5,092 registered persons with disability. No longitudinal approach to examine the impact of employment and age on QOL for individuals with disabilities has been considered in the previous literature. Thus, multilevel modeling was used to examine the relationship between employment, age, and QOL for PWD. Results of this study indicated that employment status and age were significant predictors of QOL among PWD. These findings call attention for the need to consider the impact of employment and age on QOL of PWD both inter- and intra-individually.

Rural and Urban Differences in Vocational Rehabilitation Case Mix, Delivery Practices, and Employment Outcomes

Purpose: To examine rural and urban differences in Vocational Rehabilitation (VR) case mix, delivery practices, and employment outcomes.

Methods: Rehabilitation Services Administration 911 (RSA-911) case data do not include location indicators that allow for rural analyses. We compiled RSA-911 data with county and ZIP code information from 47 VR agencies matched with additional sources to control for geographic and economic variations. Rural analyses included cross tabulations and logistic regression.

Results: Findings indicate that urban, large rural, small rural, and isolated rural outcomes and case mixes are significantly different based on education, age, minority status, receipt of Social Security Disability Insurance and Supplemental Security Income, and disability type (p ≤ .001).

Conclusion: Geographic indicators allow for differences to be explored and considered when making programmatic changes within the VR system.

Resilience, age, and perceived symptoms in persons with long-term physical disabilities

Resilience may mitigate impact of secondary symptoms such as pain and fatigue on quality of life in persons aging with disability. This study examined resilience in a large sample of individuals with disabling medical conditions by validating the Connor-Davidson Resilience Scale, obtaining descriptive information about resilience and evaluating resilience as a mediator among key secondary symptoms and quality of life using structural equation modeling. Results indicated that the measure's psychometric properties were adequate in this sample. Resilience was lowest among participants who were middle-aged or younger, and participants with depression. Resilience mediated associations between secondary symptoms and quality of life.

Ageing with cerebral palsy: psychosocial issues

BACKGROUND

although much has been written about biomedical concerns in adults ageing with cerebral palsy (CP), few studies or reviews have addressed psychosocial aspects.

OBJECTIVE

the purpose of this narrative review is to critically examine studies that have addressed needs for social support, as well as issues affecting morale, self-efficacy, health attitudes, employment and sense of coherence (SOC) in adults ageing with CP.

DESIGN

a systematic and detailed search of the literature was conducted.

METHODS

searches of CINAHL (1982-present), ERIC, PubMed (1950-present), MEDLINE (Ovid) and Web of Science databases, as well as the American Academy of Cerebral Palsy and Developmental Medicine website, were conducted. Key search terms included 'cerebral palsy and ageing', 'adults with cerebral palsy', 'secondary conditions', 'functional loss', 'health' and 'psychosocial'. Nine studies were recovered that described psychosocial consequences of living with a lifespan disability. We used McMaster University's Guidelines for Critical Review Form--Quantitative and Qualitative Studies to evaluate the studies.

RESULTS

psychosocial issues of concern to adults ageing with CP include the need for social support, self-acceptance and acceptance by others; the need for accommodations in the workplace and the environment; and SOC of adults ageing with CP.

CONCLUSIONS

several studies concluded that adults with CP need greater knowledge and understanding to enhance decision-making processes about their health. The studies reviewed also provide knowledge for healthcare and social service providers who care for adults with CP to better understand how psychosocial health can be preserved during the ageing process.

Employment of persons with spinal cord lesions injured more than 20 years ago

PURPOSE

The primary objective was to study factors influencing post-injury employment and withdrawal from work in persons who sustained traumatic spinal cord injury (SCI) more than 20 years ago. A secondary objective was to study life satisfaction in the same patients.

METHOD

A cross-sectional study with retrospective data of 165 SCI-patients admitted to Sunnaas Rehabilitation Hospital 1961-1982. Multiple logistic regression was used to identify predictors for obtaining work post-injury. A Cox proportional hazards regression model was used to study factors influencing early withdrawal from work, i.e. time from injury until discontinuing employment.

RESULTS

Sixty-five percent of the participants were employed at some point after the injury. Thirty-five percent still had work at the time of the survey. The odds of obtaining work after injury were higher in persons of younger age at injury, higher in males versus females, higher for persons with paraplegia versus tetraplegia, and for persons classified as Frankel D-E compared to a more severe SCI. Factors associated with shorter time from injury until discontinuing employment were higher age at injury, incidence of injury after 1975 versus before, and a history of pre-injury medical condition(s). Life satisfaction was better for currently employed participants.

CONCLUSION

The study indicates a low employment-rate in persons with SCI, even several years after injury. From the results, we suggest more support, especially to persons of older age at injury and/or with a history of pre-injury medical condition(s), to help them to obtain work and sustain employed for more years after injury.

Return to work following spinal cord injury: a review

PURPOSE

To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work.

METHODS

A systematic review for 2000 - 2006 was carried out in PubMed/Medline, AMED, (ISI) Web of Science, EMBASE, CINAHL, PsycInfo and Sociological abstracts database. The keywords 'spinal cord injuries', 'spinal cord disorder', 'spinal cord lesion' or 'spinal cord disease' were cross-indexed with 'employment', 'return to work', 'occupation' or 'vocational'.

RESULTS

Out of approximately 270 hits, 110 references were used, plus 13 more found elsewhere. Among individuals with SCI working at the time of injury 21 - 67% returned to work after injury. RTW was higher in persons injured at a younger age, had less severe injuries and higher functional independence. Employment rate improved with time after SCI. Persons with SCI employed ranged from 11.5% to 74%. Individuals who sustained SCI during childhood or adolescence had higher adult employment rates. Most common reported barriers to employment were problems with transportation, health and physical limitations, lack of work experience, education or training, physical or architectural barriers, discrimination by employers, and loss of benefits. Individuals with SCI discontinue working at younger age.

CONCLUSIONS

This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.