Block 5 Flashcards
Name 3 activities of daily living (ADL)
Tying shoelaces
Getting out of bed
Walking to the shop
Walking upstairs
Making a cup of tea
Turning a key in the door
what is an ADL
Anything that is an essential part of life that we tend
to do nearly every day.
Name 3 common neurological
conditions which are likely to affect ADLs
Neurological = stroke, Parkinson’s disease,
cerebral palsy, MS, paraplegia/tetraplegia,
traumatic brain injury, motor neurone disease
Name 3 common musculoskeletal
conditions which are likely to affect ADLs
Musculoskeletal = arthritis, back pain, neck
pain, plantat fasciitis, frozen shoulder,
tendinopathy, tennis elbow, fractures, sprains
etc.
Define:
Impairment
Any temporary or permanent loss or abnormality of a body structure or function whether physiological or psychological. (Eg. Amputated leg)
Define
Disability
Restriction or lack of ability to perform an activity in the manner or within a range considered normal mostly resulting from impairment (E.g. difficulty walking)
Define Handicap
A disadvantage for a given individual, resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal for that individual
What is the role of occupational therapists?
Functional assessment
Goal setting
Occupational issues
Quality of life
What is a SMART goal? (mnemonic)
goals are usually used by allied health professionals such as occupational therapists/physiotherapists etc Specific Measurable Achievable Realistic Time specific
What global measures can be used to assess ADL?
Barthel Index
Functional assessment measure (used in the UK)
Self report questionnaires such as the Nottingham Health Profile
What kinds of things does the Barthel Index measure specifically?
It is out of 100, and each criteria has different points available based on how well the individual can carry out each criteria.
Criteria include: Feeding, bathing, grooming, dressing, bowels, bladder, toilet use, mobility, stairs, transfers from bed to chair etc.
How many working days are lost due to musculoskeletal disorders?
10 million working days equating to a cost of absence of £7Bn (Our aging population will increase this number in the years to come..)
How much do depression, anxiety and stress related health problems cost the NHS per year?
£28Bn
What psychosocial problems could contribute to back pain?
Fear, distress, worry, stress, anxieties, financial issues, concerns about relationship etc.
Why was the medical model detrimental to the
social status and wellbeing of disabled people in
previous years?
The medical model of disability emphasized what
was wrong/abnormal with the person and what
the person could not do. It resulted in separate
education, employment and living situations as
well as exclusion from society.
It had an impact on the language used when
talking about disabled people (‘confined to a
wheelchair/wheelchair bound)
In what decade did disabled rights movements
begin to develop?
1960s
What are some of the critiques of the medical
model?
It individualizes disability and does not account
for social barriers
If treatment of the illness is unsuccessful, the
doctor fills out forms to legitimize the illness as
a disability making it a part of their personal
identity
What does the social model of disability claim, in
regard to the reasons for the disadvantages that
disabled people face?
They do not face disadvantage as a result of their
physical or mental impairments but more likely
face these disadvantages as a result of the way our
society is organized.
This happens if society fails to make education,
work, leisure and public services accessible, fails
to remove barriers of assumption, stereotype and
prejudice and fails to outlaw unfair treatment in
our daily lives.
What aspects of society does the social model put
emphasis on?
Badly designed buildings, segregated
education, poverty and low income,
inaccessible transport, no lifts in certain place
Hypocrisy, lack of awareness, prejudiced and
patronising attitudes
Poor job prospects, lack of enablers such as
interpreters etc.
What are some criticisms of the social model?
It is an image of an idyllic society where
impairments cause individuals no problems at
all
Some argue that the model was developed for white middle class heterosexual men with spinal injuries and so it does not recognise the complexity of different disabled people’s lives
In 2000, WHO produced a document called ‘The
International Classification of Functioning,
Disability and Health’ (ICIDH-2). What did this do?
It showed that disability was a continuum and
people lie on different points of the continuum
It identified 3 factors that affected the disability:
the human body and its organs, the human
being as a whole and the social environment in
which they live
What did the Disability Discrimination Act
(DDA 1995) give disabled people?
Gave new rights to people who have had a
disability in order to make ADLs easier
What does the Equality Act (2010) define
‘disabled’ as?
If you have a physical or mental impairment
that has ‘substantial’ and ‘long term’ negative
effect on your ability to do normal daily
activities
What percentage of people in the world have had
moderate or severe disability?
15.3% - This number is increasing due to the aging
population
What is the ‘radical disability model’?
‘Those who are externally identified as disabled
and those who self identify as not disabled’
Some members of the deaf community have attempted to
distance themselves from other disabled groups by arguing
that ‘there is nothing wrong with them’. They believe that
they are not disabled but instead, are a linguistic minority
and think and experience the world in a different way.
Define ‘justice’
The requirement that we treat other people in
a way that is fair or equitable
Define ‘distributive justice’
How to distribute scarce resources in a way
that is just or fair
Distinguish between moral, legal and human
rights
Human = legal instruments which represent
fundamental human interests and are therefore
aligned with ethical practice. Based on dignity,
fairness, equality, respect and autonomy.
What is a needs based assessment in relation to
resource allocation?
It measures a person’s needs and states that we
should make resource allocation decisions based
on people’s needs: therefore needs should go to
those who need it most
What is the ‘difference principle’ (John Rawls) ?
When joining a society, you would choose the one
where the worst off people were reasonably well
off
What are some objections to needs based
approaches?
‘Needs’ are difficult to measure and define
Who’s needs count?
What types of needs are relevant?
Meeting need is not the only thing to consider- the
well off need healthcare too!
Bottomless pit objection = the very worst off will
absorb almost all of our healthcare resources as we
can always spend a little bit more and make them a
bit better off
What are some criteria for healthcare delivery that
have been suggested or even implemented?
QALY calculation = a measure of the state of health
of a person or group in which the benefits, in terms
of length of life are adjusted to reflect the quality of
life (quality of life adjusted year)
Place on the waiting list (‘first come, first served’)
Likelihood of complying with/responding to
treatment
Types of lifestyle choices that the patient has made
Ability of the patient to pay (private healthcare)
What are some arguments for lifestyle based
assessments?
Those who make bad lifestyle choices are less
deserving of treatment
They are aware of the dangers attached to such
behaviour and so have forfeited their right to
receive treatment or healthcare
They are more likely to be deterred from bad
lifestyle choices if they are not prioritised
Treating those who do not contribute to their ill
health are likely to be more substantial and long
lasting than those with bad lifestyle choices
What are some arguments against lifestyle based
assessments?
Many who engage in high risk behaviour may not
be responsible for their decisions due to lack of
education or bad living environments
It is hard to ascertain whether ill health is directly
a result of the lifestyle choice
It is far from clear that the treat of non treatment
may deter (drug addicts are unlikely to stop
abusing)
Violation of professional codes of ethics (GMC
2013)
What are Positive rights
someone has a duty to do something
What are Negative rights
others have a duty to refrain from doing
something
What are Active rights
allows people to act or not act as they
choose
What are Passive rights
rights not to be done by others in certain
ways
Why are rights important?
Security of expectations
Protective boundaries
Conductive to goods (dignity, respect,
equality)
Minimum standards
Ideal directives
What were the main aims of the Human Rights Act
1998?
To make it possible for people to directly raise
or claim their human rights within complaints
and legal systems in the UK
To bring about a new culture of respect for
human rights in the UK
Which rights from the Human Rights Act are
relevant to healthcare?
Article 2 = Right to life
Article 3 = prohibition of torture (or inhumane/degrading treatment or
punishment)
Article 5 – Right to liberty and security
Article 6 = Right to a fair trial
Article 8 = Right to respect for private and family life
Article 9 = Freedom of thought, conscience and religion
Article 10 = Freedom of expression
Article 12 = Right to marry and found a family
Article 14 = Prohibition of discrimination
What are the 3 types of rights in regard to rules on
their derogation?
Absolute = no derogation is permitted though
even these rights are open to interpretation
(Article 3)
Limited = limitations are explicitly stated in the
wording of the article (Article 2,5,6)
Qualified = derogation is permitted but any
action must be based in law, meet convention
aims and be necessary and proportionate in a
democratic society (Article 8,9,10,11,12)
What percentage of the population of the UK
are carers?
10%
What are the most common carer ethnicities?
Bangladeshi, Pakistani, Indian and finally
White British
Which part of England has the lowest
proportion of carers?
London
In what types of areas do the most carers live?
Places with higher levels of deprivation and
long term illness
What is the definition of an ‘informal carer’?
Someone who, without payment, provides
help and support to a partner, child, relative,
friend or neighbour, who could not manage
without their help (due to age, physical/mental
illness, addiction or disability)
What do carers do?
Provide practical help (preparing food or
shopping), ‘keeping an eye’ on the care
recipient, providing company, providing help
with personal care (bathing, grooming etc),
giving medication, providing physical help
(getting in and out of bed)
What are the effects of caring on the carers
health?
High levels of physical and mental health
problems (2x more likely to have bad health
than non carers)
Co resident carers are more at risk than extra
resident carers
Do not have time to look after their own health
What rights do carers have?
Right to an assessment of needs which must
consider carers’ wishes about employment,
training, education and leisure
Carers special grant = funding for respite and short
breaks
Carers allowance = £61.35 per week for carers who
regularly spend at least 35 hrs per week caring for
someone with a severe disability who receives
disability benefit
Work and families act 2006 = carers of adults can
request flexible work
What are the criteria for carers allowance?
The person you care for is getting attendance
allowance or disability living allowance
You are caring for at least 35 hours a week
You are 16 years old or over
If you are working, earnings must be below £100 a
week
You are not in receipt of overlapping benefit
You are studying no more than 21 hours a week
What are the challenges for carers of:
People with dementia
Practical support, alleviation of emotional
stress, respite care and short term breaks
What are the challenges for carers of:
People with mental health problems
Fluctuating needs, stigma and discrimination,
medication control, confidentiality
What are the main things that carers want and
that we should be able to provide?
Quality of life for the person they care for
Quality of life for themselves
Accurate and honest information about services
and what is on offer
Support and training
To know that someone will take over care in an
emergency
What is a clinical trial?
A planned experiment involving patients,
designed to determine the most appropriate
treatment of future patients with a given medical
condition
Does not assume a control group or randomisation like a
randomised controlled trial
Why do we randomise in randomised controlled
studies?
To eliminate systematic bias in allocation of
interventions
To ensure balance across comparative groups
for known and unknown baseline factors that
may affect outcome
It is more ethical as the placebo/treatment is not
decided by the researcher
What is stratification?
A process that can be built into randomization to
ensure that important factors that affect the
outcome are balanced across the groups being
compared
What is performance bias?
Systematic difference in the care provided to the
participants in the comparison groups other than
the intervention under investigation
what is a right
Justified claims on others: can be legal, moral or
human rights
what is equality
being the same in quantity, amount,
value etc. (The healthcare system should be
EQUITABLE)
what is equity
fairness or impartiality
