When Walking Fails: Mobility Problems of Adults with Chronic Conditions
http://www.100md.com
《新英格兰医药杂志》
In this wonderful book, Lisa Iezzoni opens a window to the overlooked world of people with mobility problems. She draws from extensive interviews of 119 mobility-challenged people (whose insights she quotes liberally), undertaken during her many months of policy research as a Robert Wood Johnson Health Policy Fellow. Her material is also a product of her experiences with her own mobility problems, which developed during medical school, where she experienced distressing prejudice and intolerance.
Few physicians have received training in this area or know how to discuss mobility problems with patients and where to refer them. Many people live with impaired mobility, and there are many effective interventions and approaches for improving their lives, yet only a small fraction of these people receive the assessment and care that they need. It is important for all health care professionals to be aware of and deal with issues related to problems of mobility in adults.
The book begins with a systematic survey of the epidemiology of mobility problems (which affect about 10 percent of the adult population), the conditions that cause them, and the effects of these problems on health care and costs to society. Iezzoni liberally intersperses facts with often heart-wrenching quotations from patients and anecdotes of her personal experiences. She describes the normal gait cycle and how it is affected by a number of disabling conditions. She explores the ways that people conceptualize their disabilities and the ways that families and society react to the disabilities.
Furthermore, Iezzoni relates the history of social programs, geared toward improving the lives of disabled people, that emerged from neglect in the early 20th century. These include the Social Security Act of 1935, Medicare and Medicaid in the mid-1960s, and programs associated with the Americans with Disabilities Act of 1990 (spurred on by the disability-rights movement), along with more recent reactions and retrenchments. Iezzoni gives a tour through the sometimes Kafkaesque labyrinth of entitlement programs and government regulations, which reflect the good intentions of their designers but are often difficult to maneuver and make sense of.
People with disabilities cope in a variety of ways, and their methods of coping can affect functional outcomes. Some people are able to accept major limitations with positive inner strength, but regardless, most face a variety of setbacks and disappointments. Life for them has changed, and they face the reality of major loss of independence in an often cruel and intolerant society. Simply performing activities of daily life involves large expenditures of energy and requires creative adaptations.
This book does much more than make health care professionals aware of the mobility problems of adults. It contains useful and practical information that can help all of us to provide care more effectively. Iezzoni suggests ways that patients can help physicians be more responsive to the patients' needs. She describes the programs that are available to people with disabilities and also analyzes the treacherous disincentives for their use that discourage people from getting the help they need. Many public disability welfare programs pay people not to work but give almost nothing for adaptive equipment that would enable them to work. And the benefits often stop completely if the person can somehow become employed.
Iezzoni explores the difficulties of driving and the factors involved in deciding whether to drive with adaptive equipment or to stop altogether. She suggests ways to benefit from physical therapy, occupational therapy, and prosthetics, and she discusses the major types of assistive devices, including canes, crutches, walkers, wheelchairs, and motorized scooters.
In addition, she describes the insidious tendency for physicians and patients alike to delay using assistive and adaptive equipment, particularly wheelchairs, because of the fear of hastening the progression of the disability. But these devices can vastly improve the quality of life in many ways not imagined by people who have been barely getting by without them. Iezzoni's chapter on wheeled mobility is an eye-opening essay on the amazing benefits enjoyed by people who use wheelchairs and scooters, as well as the major impediments that people face when deciding to start using them. She discusses who will pay for mobility assessments and aids, which is often a major stumbling block but one that can usually be surmounted with knowledge of the available programs and with persistence.
In the last chapter, Iezzoni describes her fantasy of a one-stop Mobility Mart that would solve most of the problems identified in her book. It would provide an interdisciplinary team of professionals to assess needs and prescribe the full spectrum of mobility aids and assistive devices, networks of peer counselors or support groups, information about community resources, and insurance advisers.
An appendix of resources enhances this useful, interesting, and well-written book, which contains more than enough information to qualify as a textbook but is fast and enjoyable to read. It will appeal to professionals and laypeople alike.
Laurence Z. Rubenstein, M.D.
UCLA–Veterans Affairs Medical Center
Sepulveda, CA 91343
lzrubens@ucla.edu
When Walking Fails: Mobility Problems of Adults with Chronic Conditions
(California/Milbank Books on Health and the Public. Vol. 8.) By Lisa I. Iezzoni. 355 pp. Berkeley and New York, University of California Press and the Milbank Memorial Fund, 2003. $60 (cloth); $19.95 (paper). ISBN 0-520-23742-0 (cloth); 0-520-23819-2 (paper).
In this wonderful book, Lisa Iezzoni opens a window to the overlooked world of people with mobility problems. She draws from extensive interviews of 119 mobility-challenged people (whose insights she quotes liberally), undertaken during her many months of policy research as a Robert Wood Johnson Health Policy Fellow. Her material is also a product of her experiences with her own mobility problems, which developed during medical school, where she experienced distressing prejudice and intolerance.
Few physicians have received training in this area or know how to discuss mobility problems with patients and where to refer them. Many people live with impaired mobility, and there are many effective interventions and approaches for improving their lives, yet only a small fraction of these people receive the assessment and care that they need. It is important for all health care professionals to be aware of and deal with issues related to problems of mobility in adults.
The book begins with a systematic survey of the epidemiology of mobility problems (which affect about 10 percent of the adult population), the conditions that cause them, and the effects of these problems on health care and costs to society. Iezzoni liberally intersperses facts with often heart-wrenching quotations from patients and anecdotes of her personal experiences. She describes the normal gait cycle and how it is affected by a number of disabling conditions. She explores the ways that people conceptualize their disabilities and the ways that families and society react to the disabilities.
Furthermore, Iezzoni relates the history of social programs, geared toward improving the lives of disabled people, that emerged from neglect in the early 20th century. These include the Social Security Act of 1935, Medicare and Medicaid in the mid-1960s, and programs associated with the Americans with Disabilities Act of 1990 (spurred on by the disability-rights movement), along with more recent reactions and retrenchments. Iezzoni gives a tour through the sometimes Kafkaesque labyrinth of entitlement programs and government regulations, which reflect the good intentions of their designers but are often difficult to maneuver and make sense of.
People with disabilities cope in a variety of ways, and their methods of coping can affect functional outcomes. Some people are able to accept major limitations with positive inner strength, but regardless, most face a variety of setbacks and disappointments. Life for them has changed, and they face the reality of major loss of independence in an often cruel and intolerant society. Simply performing activities of daily life involves large expenditures of energy and requires creative adaptations.
This book does much more than make health care professionals aware of the mobility problems of adults. It contains useful and practical information that can help all of us to provide care more effectively. Iezzoni suggests ways that patients can help physicians be more responsive to the patients' needs. She describes the programs that are available to people with disabilities and also analyzes the treacherous disincentives for their use that discourage people from getting the help they need. Many public disability welfare programs pay people not to work but give almost nothing for adaptive equipment that would enable them to work. And the benefits often stop completely if the person can somehow become employed.
Iezzoni explores the difficulties of driving and the factors involved in deciding whether to drive with adaptive equipment or to stop altogether. She suggests ways to benefit from physical therapy, occupational therapy, and prosthetics, and she discusses the major types of assistive devices, including canes, crutches, walkers, wheelchairs, and motorized scooters.
In addition, she describes the insidious tendency for physicians and patients alike to delay using assistive and adaptive equipment, particularly wheelchairs, because of the fear of hastening the progression of the disability. But these devices can vastly improve the quality of life in many ways not imagined by people who have been barely getting by without them. Iezzoni's chapter on wheeled mobility is an eye-opening essay on the amazing benefits enjoyed by people who use wheelchairs and scooters, as well as the major impediments that people face when deciding to start using them. She discusses who will pay for mobility assessments and aids, which is often a major stumbling block but one that can usually be surmounted with knowledge of the available programs and with persistence.
In the last chapter, Iezzoni describes her fantasy of a one-stop Mobility Mart that would solve most of the problems identified in her book. It would provide an interdisciplinary team of professionals to assess needs and prescribe the full spectrum of mobility aids and assistive devices, networks of peer counselors or support groups, information about community resources, and insurance advisers.
An appendix of resources enhances this useful, interesting, and well-written book, which contains more than enough information to qualify as a textbook but is fast and enjoyable to read. It will appeal to professionals and laypeople alike.
Laurence Z. Rubenstein, M.D.
UCLA–Veterans Affairs Medical Center
Sepulveda, CA 91343
lzrubens@ucla.edu((California/Milbank Books)
Few physicians have received training in this area or know how to discuss mobility problems with patients and where to refer them. Many people live with impaired mobility, and there are many effective interventions and approaches for improving their lives, yet only a small fraction of these people receive the assessment and care that they need. It is important for all health care professionals to be aware of and deal with issues related to problems of mobility in adults.
The book begins with a systematic survey of the epidemiology of mobility problems (which affect about 10 percent of the adult population), the conditions that cause them, and the effects of these problems on health care and costs to society. Iezzoni liberally intersperses facts with often heart-wrenching quotations from patients and anecdotes of her personal experiences. She describes the normal gait cycle and how it is affected by a number of disabling conditions. She explores the ways that people conceptualize their disabilities and the ways that families and society react to the disabilities.
Furthermore, Iezzoni relates the history of social programs, geared toward improving the lives of disabled people, that emerged from neglect in the early 20th century. These include the Social Security Act of 1935, Medicare and Medicaid in the mid-1960s, and programs associated with the Americans with Disabilities Act of 1990 (spurred on by the disability-rights movement), along with more recent reactions and retrenchments. Iezzoni gives a tour through the sometimes Kafkaesque labyrinth of entitlement programs and government regulations, which reflect the good intentions of their designers but are often difficult to maneuver and make sense of.
People with disabilities cope in a variety of ways, and their methods of coping can affect functional outcomes. Some people are able to accept major limitations with positive inner strength, but regardless, most face a variety of setbacks and disappointments. Life for them has changed, and they face the reality of major loss of independence in an often cruel and intolerant society. Simply performing activities of daily life involves large expenditures of energy and requires creative adaptations.
This book does much more than make health care professionals aware of the mobility problems of adults. It contains useful and practical information that can help all of us to provide care more effectively. Iezzoni suggests ways that patients can help physicians be more responsive to the patients' needs. She describes the programs that are available to people with disabilities and also analyzes the treacherous disincentives for their use that discourage people from getting the help they need. Many public disability welfare programs pay people not to work but give almost nothing for adaptive equipment that would enable them to work. And the benefits often stop completely if the person can somehow become employed.
Iezzoni explores the difficulties of driving and the factors involved in deciding whether to drive with adaptive equipment or to stop altogether. She suggests ways to benefit from physical therapy, occupational therapy, and prosthetics, and she discusses the major types of assistive devices, including canes, crutches, walkers, wheelchairs, and motorized scooters.
In addition, she describes the insidious tendency for physicians and patients alike to delay using assistive and adaptive equipment, particularly wheelchairs, because of the fear of hastening the progression of the disability. But these devices can vastly improve the quality of life in many ways not imagined by people who have been barely getting by without them. Iezzoni's chapter on wheeled mobility is an eye-opening essay on the amazing benefits enjoyed by people who use wheelchairs and scooters, as well as the major impediments that people face when deciding to start using them. She discusses who will pay for mobility assessments and aids, which is often a major stumbling block but one that can usually be surmounted with knowledge of the available programs and with persistence.
In the last chapter, Iezzoni describes her fantasy of a one-stop Mobility Mart that would solve most of the problems identified in her book. It would provide an interdisciplinary team of professionals to assess needs and prescribe the full spectrum of mobility aids and assistive devices, networks of peer counselors or support groups, information about community resources, and insurance advisers.
An appendix of resources enhances this useful, interesting, and well-written book, which contains more than enough information to qualify as a textbook but is fast and enjoyable to read. It will appeal to professionals and laypeople alike.
Laurence Z. Rubenstein, M.D.
UCLA–Veterans Affairs Medical Center
Sepulveda, CA 91343
lzrubens@ucla.edu
When Walking Fails: Mobility Problems of Adults with Chronic Conditions
(California/Milbank Books on Health and the Public. Vol. 8.) By Lisa I. Iezzoni. 355 pp. Berkeley and New York, University of California Press and the Milbank Memorial Fund, 2003. $60 (cloth); $19.95 (paper). ISBN 0-520-23742-0 (cloth); 0-520-23819-2 (paper).
In this wonderful book, Lisa Iezzoni opens a window to the overlooked world of people with mobility problems. She draws from extensive interviews of 119 mobility-challenged people (whose insights she quotes liberally), undertaken during her many months of policy research as a Robert Wood Johnson Health Policy Fellow. Her material is also a product of her experiences with her own mobility problems, which developed during medical school, where she experienced distressing prejudice and intolerance.
Few physicians have received training in this area or know how to discuss mobility problems with patients and where to refer them. Many people live with impaired mobility, and there are many effective interventions and approaches for improving their lives, yet only a small fraction of these people receive the assessment and care that they need. It is important for all health care professionals to be aware of and deal with issues related to problems of mobility in adults.
The book begins with a systematic survey of the epidemiology of mobility problems (which affect about 10 percent of the adult population), the conditions that cause them, and the effects of these problems on health care and costs to society. Iezzoni liberally intersperses facts with often heart-wrenching quotations from patients and anecdotes of her personal experiences. She describes the normal gait cycle and how it is affected by a number of disabling conditions. She explores the ways that people conceptualize their disabilities and the ways that families and society react to the disabilities.
Furthermore, Iezzoni relates the history of social programs, geared toward improving the lives of disabled people, that emerged from neglect in the early 20th century. These include the Social Security Act of 1935, Medicare and Medicaid in the mid-1960s, and programs associated with the Americans with Disabilities Act of 1990 (spurred on by the disability-rights movement), along with more recent reactions and retrenchments. Iezzoni gives a tour through the sometimes Kafkaesque labyrinth of entitlement programs and government regulations, which reflect the good intentions of their designers but are often difficult to maneuver and make sense of.
People with disabilities cope in a variety of ways, and their methods of coping can affect functional outcomes. Some people are able to accept major limitations with positive inner strength, but regardless, most face a variety of setbacks and disappointments. Life for them has changed, and they face the reality of major loss of independence in an often cruel and intolerant society. Simply performing activities of daily life involves large expenditures of energy and requires creative adaptations.
This book does much more than make health care professionals aware of the mobility problems of adults. It contains useful and practical information that can help all of us to provide care more effectively. Iezzoni suggests ways that patients can help physicians be more responsive to the patients' needs. She describes the programs that are available to people with disabilities and also analyzes the treacherous disincentives for their use that discourage people from getting the help they need. Many public disability welfare programs pay people not to work but give almost nothing for adaptive equipment that would enable them to work. And the benefits often stop completely if the person can somehow become employed.
Iezzoni explores the difficulties of driving and the factors involved in deciding whether to drive with adaptive equipment or to stop altogether. She suggests ways to benefit from physical therapy, occupational therapy, and prosthetics, and she discusses the major types of assistive devices, including canes, crutches, walkers, wheelchairs, and motorized scooters.
In addition, she describes the insidious tendency for physicians and patients alike to delay using assistive and adaptive equipment, particularly wheelchairs, because of the fear of hastening the progression of the disability. But these devices can vastly improve the quality of life in many ways not imagined by people who have been barely getting by without them. Iezzoni's chapter on wheeled mobility is an eye-opening essay on the amazing benefits enjoyed by people who use wheelchairs and scooters, as well as the major impediments that people face when deciding to start using them. She discusses who will pay for mobility assessments and aids, which is often a major stumbling block but one that can usually be surmounted with knowledge of the available programs and with persistence.
In the last chapter, Iezzoni describes her fantasy of a one-stop Mobility Mart that would solve most of the problems identified in her book. It would provide an interdisciplinary team of professionals to assess needs and prescribe the full spectrum of mobility aids and assistive devices, networks of peer counselors or support groups, information about community resources, and insurance advisers.
An appendix of resources enhances this useful, interesting, and well-written book, which contains more than enough information to qualify as a textbook but is fast and enjoyable to read. It will appeal to professionals and laypeople alike.
Laurence Z. Rubenstein, M.D.
UCLA–Veterans Affairs Medical Center
Sepulveda, CA 91343
lzrubens@ucla.edu((California/Milbank Books)