Disability-adjusted Life Expectancy: From 1 Different Sources
A modification of conventional life expectancy to account for time lived with disability. It is the number of healthy years of life that can be expected on average in a given population. It is generally calculated at birth, but estimates can also be prepared at other ages. It adjusts the expectation of years of life for the loss on account of disability, using explicit weights for different health states.
Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner, or within the range, considered to be normal for a human being. The term disability reflects the consequences of impairment in terms of functional performance and activity by the individual. Disabilities thus represent disturbances at the level of the person. See also “handicap”; “impairment”.... disability
The average number of years of life remaining to a person at a particular age based on a given set of age-specific death rates, generally the mortality conditions existing in the period mentioned.... life expectancy
Emergency mouth-to-mouth resuscitation of an unconscious person (see APPENDIX 1: BASIC FIRST AID).... kiss of life
Learning disability, previously called mental handicap, is a problem of markedly low intellectual functioning. In general, people with learning disability want to be seen as themselves, to learn new skills, to choose where to live, to have good health care, to have girlfriends or boyfriends, to make decisions about their lives, and to have enough money to live on. They may live at home with their families, or in small residential units with access to work and leisure and to other people in ordinary communities. Some people with learning disabilities, however, also have a MENTAL ILLNESS. Most can be treated as outpatients, but a few need more intensive inpatient treatment, and a very small minority with disturbed behaviour need secure (i.e. locked) settings.
In the United Kingdom, the 1993 Education Act refers to ‘learning diffculties’: generalised (severe or moderate), or speci?c (e.g. DYSLEXIA, dyspraxia [or APRAXIA], language disorder). The 1991 Social Security (Disability Living Allowance) Regulations use the term ‘severely mentally impaired’ if a person suffers from a state of arrested development or incomplete physical development of the brain which results in severe impairment of intelligence and social functioning. This is distinct from the consequences of DEMENTIA. Though ‘mental handicap’ is widely used, ‘learning disability’ is preferred by the Department of Health.
There is a distinction between impairment (a biological de?cit), disability (the functional consequence) and handicap (the social consequence).
People with profound learning disability are usually unable to communicate adequately and may be seriously movement-impaired. They are totally dependent on others for care and mobility. Those with moderate disability may achieve basic functional literacy (recognition of name, common signs) and numeracy (some understanding of money) but most have a life-long dependency for aspects of self-care (some fastenings for clothes, preparation of meals, menstrual hygiene, shaving) and need supervision for outdoor mobility.
Children with moderate learning disability develop at between half and three-quarters of the normal rate, and reach the standard of an average child of 8–11 years. They become independent for self-care and public transport unless they have associated disabilities. Most are capable of supervised or sheltered employment. Living independently and raising a family may be possible.
Occurrence Profound learning disability affects about 1 in 1,000; severe learning disability 3 in 1,000; and moderate learning disability requiring special service, 1 per cent. With improved health care, survival of people with profound or severe learning disability is increasing.
Causation Many children with profound or severe learning disability have a diagnosable biological brain disorder. Forty per cent have a chromosome disorder – see CHROMOSOMES (three quarters of whom have DOWN’S (DOWN) SYNDROME); a further 15 per cent have other genetic causes, brain malformations or recognisable syndromes. About 10 per cent suffered brain damage during pregnancy (e.g. from CYTOMEGALOVIRUS (CMV) infection) or from lack of oxygen during labour or delivery. A similar proportion suffer postnatal brain damage from head injury – accidental or otherwise – near-miss cot death or drowning, cardiac arrest, brain infection (ENCEPHALITIS or MENINGITIS), or in association with severe seizure disorders.
Explanations for moderate learning disability include Fragile X or other chromosome abnormalities in a tenth, neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE), fetal alcohol syndrome and other causes of intra-uterine growth retardation. Genetic counselling should be considered for children with learning disability. Prenatal diagnosis is sometimes possible. In many children, especially those with mild or moderate disability, no known cause may be found.
Medical complications EPILEPSY affects 1 in 20 with moderate, 1 in 3 with severe and 2 in 3 with profound learning disability, although only 1 in 50 with Down’s syndrome is affected. One in 5 with severe or profound learning disability has CEREBRAL PALSY.
Psychological and psychiatric needs Over half of those with profound or severe – and many with moderate – learning disability show psychiatric or behavioural problems, especially in early years or adolescence. Symptoms may be atypical and hard to assess. Psychiatric disorders include autistic behaviour (see AUTISM) and SCHIZOPHRENIA. Emotional problems include anxiety, dependence and depression. Behavioural problems include tantrums, hyperactivity, self-injury, passivity, masturbation in public, and resistance to being shaved or helped with menstrual hygiene. There is greater vulnerability to abuse with its behavioural consequences.
Respite and care needs Respite care is arranged with link families for children or sta?ed family homes for adults where possible. Responsibility for care lies with social services departments which can advise also about bene?ts.
Education Special educational needs should be met in the least restrictive environment available to allow access to the national curriculum with appropriate modi?cation and support. For older children with learning disability, and for young children with severe or profound learning disability, this may be in a special day or boarding school. Other children can be provided for in mainstream schools with extra classroom support. The 1993 Education Act lays down stages of assessment and support up to a written statement of special educational needs with annual reviews.
Pupils with learning disability are entitled to remain at school until the age of 19, and most with severe or profound learning disability do so. Usually those with moderate learning disability move to further education after the age of 16.
Advice is available from the Mental Health Foundation, the British Institute of Learning Disabilities, MENCAP (Royal Society for Mentally Handicapped Children and Adults), and ENABLE (Scottish Society for the Mentally Handicapped).... learning disability
Care of older persons who are dying.... end-of-life care
The time taken for the PLASMA concentration of an administered drug to decline by half as a result of redistribution, METABOLISM and EXCRETION.... half life
A colloquial description of the feelings of anxiety and distress experienced by some individuals in early middle age. They realise that by 45 years of age they are no longer young, and men in particular try to turn the clock back by changing jobs, dressing trendily, taking up energetic or unusual sports or engaging in extramarital liaisons. Sometimes those in mid-life crises develop mild or even serious DEPRESSION. The feelings of anxiety and insecurity usually disappear with time but some people may bene?t from counselling.... mid-life crisis
The product of the interplay between social, health, economic and environmental conditions which affect human and social development. It is a broad-ranging concept, incorporating a person’s physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to salient features in the environment. As people age, their quality of life is largely determined by their ability to access needed resources and maintain autonomy and independence.... quality of life
1 The entire course of a person’s life – from infancy to old age. 2 The genetically prescribed course followed by all living organisms, including humans.... life cycle
See ALTE.... acute life-threatening event (alte)
See CLIMACTERIC; MENOPAUSE.... change of life
A severe, chronic disability which is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains the age of 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self care, receptive and expressive language, learning, mobility, self direction, capacity of independent living, economic self-sufficiency; and reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care treatments or services which are of lifelong or extended duration and are individually planned and coordinated.... developmental disability
Measures that can be initiated among those with a disease, usually a chronic disease, to lessen or delay the impact of disability from that disease, e.g. averting renal complications among those with diabetes.... disability postponement
The number of healthy years of life lost due to premature death and disability.... disability-adjusted life years (dalys)
The average number of years an individual of a given age is expected to live if current mortality rates continue to apply. See “life expectancy”.... expectation of life
A population-based measure of the proportion of the expected life span estimated to be healthful and fulfilling, or free of illness, disease and disability.... health expectancy
Individual outcome measure that extends beyond traditional measures of mortality and morbidity to include such dimensions as physiology, function, social activity, cognition, emotion, sleep and rest, energy and vitality, health perception and general life satisfaction (some of these are also known as health status, functional status or quality-of-life measures).... health-related quality-of-life (hrql) measure
See “disability-adjusted life expectancy”.... healthy life expectancy
Classification of health and health-related domains that describe body functions and structures, activities and participation. The domains are classified from body, individual and societal perspectives. Since an individual’s functioning and disability occurs in a context, this classification includes a list of environmental factors.... international classification of functioning, disability and health (icf) a
The longest period over which the life of any plant or animal organism or species may extend, according to the available biological knowledge concerning it.... life span
Drugs, medical devices, or procedures that can keep alive a person who would otherwise die within a foreseeable, though usually uncertain, time. Examples include cardiopulmonary resuscitation, mechanical ventilation, renal dialysis, nutritional support (i.e. tube or intravenous feeding) and provision of antibiotics to fight life-threatening infections.... life-sustaining treatment
Years of life saved by a medical technology or service, adjusted according to the quality of those years (as determined by some evaluative measure). QALYs are the most commonly used unit to express the results in some types of cost-effectiveness analysis.... quality-adjusted life years (qalys)
See “life cycle”.... life course
Longevity, Health, Healing... life everlasting
Insurance providing for payment of a stipulated sum to a designated beneficiary upon death of the insured.... life insurance
See “well-being”.... life satisfaction
(ALS) a structured and algorithm-driven method of life support for use in the severest of medical emergencies, especially cardiac arrest. Doctors, nurses, and paramedic personnel involved in ALS receive special training in the use of equipment (e.g. defibrillators and appropriate drugs). Paediatric advanced life support (PALS) is ALS for use in severe medical emergencies in children, while advanced trauma life support(ATLS) is specifically for patients who have been subjected to major trauma, such as a serious road accident. Compare basic life support.... advanced life support
the provision of treatment designed to maintain adequate circulation and ventilation to a patient in *cardiac arrest, without the use of drugs or specialist equipment. Compare advanced life support.... basic life support
(DLQI) a validated questionnaire designed by Finlay in 1994 to assess the impact of skin diseases on psychological and social wellbeing. It is the most common *quality of life tool used as an endpoint in dermatology clinical trials. DLQI scores of more than 10 (indicating a severe impact on life) are required before biological treatments for psoriasis may be administered in the UK.... dermatology life quality index
(DALY) a common research measure of disease burden that accounts for both morbidity and mortality. One year lived in full health is equivalent to one DALY. Disabilities and disease states are assigned a weighting that reduces this figure, such that a year lived with disability is equivalent to less than one DALY. Some studies also use social weighting, in which years lived as a young adult receive a greater DALY weight than those lived as a young child or older adult. See also health-adjusted life expectancy; quality of life.... disability-adjusted life year
(DLA) (in Britain) a state benefit payable to help with the extra costs of looking after a child under the age of 16 with special needs. It has two components: a care component, payable at three rates to children needing help with personal care; and a mobility component, payable at two rates to those aged 3 years or over who need help with walking. The rates depend on the level of help required. DLA for adults aged 16–64 years has been replaced by the *personal independence payment (PIP). People aged over 65 years with a disability and requiring help may be eligible for the attendance allowance.... disability living allowance
see Equality and Human Rights Commission.... disability rights commission
a measure developed by the World Health Organization to capture life expectancy in terms of both morbidity and mortality. The number of years lived with ill-health, weighted according to severity, are subtracted from the overall life expectancy. Previously known as disability-adjusted life expectancy, it is sometimes referred to as healthy life expectancy. See also disability-adjusted life year.... health-adjusted life expectancy
an actuarial presentation of the ages at which a group of males and/or females are expected to die and from which mean life expectancy at any age can be estimated, based on the assumption that mortality patterns current at the time of preparation of the table will continue to apply.... life table
the religious or moral belief that all life – and especially all human life – is intrinsically valuable and so should never be deliberately harmed or destroyed. Many of those who hold such a view will have ethical objections to *euthanasia, *abortion, and *embryo research. The phrase may also be used to denote that the value of life should always be respected, whatever the perceived quality of that life. See also humanity; personhood.... sanctity of life
(YLL, years of potential life lost, YPLL, potential years of life lost, PYLL) a measure of premature mortality that calculates the number of additional years a person could have expected to live, on average, had they not died prematurely. A reference age intended to represent the total number of years a person can expect to live, on average, is required for the calculation: this is often given in square brackets after YLL. Negative values for YLL are not used: if somebody survives longer than the reference age, their YLL is calculated as 0. YLLs for different diseases can be compared across populations to give an indication of which diseases carry the greatest burden of premature mortality.... years of life lost
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