Impaired Research Articles

Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study

BackgroundCognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, and it is associated with adverse health outcomes. Older adults are particularly vulnerable to CF due to factors such as age-related brain changes and the presence of comorbidities.ObjectiveTo investigate the effect of preoperative CF on postoperative complications in older patients.MethodsThis prospective cohort study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (with a postoperative hospital stay of ≥ 3 days) at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. CF was assessed using the Montreal Cognitive Assessment (MoCA) for the cognitive status and the Fried criteria for five frailty scales. Participants were split into four groups: Group A (neither frailty nor cognitive impairment), Group B (frailty without cognitive impairment), Group C (cognitive impairment without frailty), and Group D (cognitive frailty). The primary outcome was postoperative complications, while secondary outcomes included mobility disability, prolonged hospital stay (PLOS), re-operation and 90-day readmission.ResultsThe median age (interquartile range) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of CF was 17.8%. The incidence of postoperative complications was 18.2% in Group A, 50.0% in Group B, 37.4% in Group C, and 75.6% in Group D. Multivariate analysis revealed that, compared to the control group (without cognitive impairment or frailty), patients with CF had a significantly higher risk of postoperative complications (OR, 12.86; 95%CI, 4.23–39.08). “Patients with frailty without cognitive impairment” had an increased risk (OR, 6.53; 95%CI, 2.04–20.9), while “those with cognitive impairment without frailty” also showed a higher risk (OR, 3.46; 95%CI, 1.57–7.64).ConclusionsCognitive frailty is significantly associated with an increased risk of postoperative adverse outcomes in older patients undergoing orthopedic and abdominal surgeries with general anesthesia. It indicates that clinicians should pay much attention to these older adults with CF.

Assessment of structural and functional profile of dental centers for people with disabilities.

People with disabilities (PWD) often face more significant oral healthcare needs than the general population. This study, conducted in response to the urgent and pressing need for improved dental care for PWD, aims to assess the infrastructural and work process flow of dental centers in Delhi that provide specialized dental care for PWD. A descriptive cross-sectional study was conducted across primary, secondary, and tertiary healthcare centers in Delhi, evaluating their infrastructure adaptations and work processes in delivering oral healthcare to PWD. The findings, which highlight the disparities in adaptations and work processes among different healthcare centers, are crucial for understanding the current state of oral healthcare for PWD in Delhi. The study reveals that while secondary and tertiary healthcare centers exhibit better adaptations for PWD than primary centers, challenges persist with insufficient accessibility and smooth functioning of the work process. This study underscores the need for dentists to be equipped with the competence to address the unique needs of PWD. It also highlights the significant potential for improvement in oral healthcare for PWD, as dentists should become more aware of the importance of designing clinics that are accessible for PWD.

Effectiveness of a Disability Liaison Officer service in a metropolitan emergency department.

To identify the influence of a Disability Liaison Officer (DLO) service in the ED setting on people with disability (PWD). For this project, PWD included adults with communication disability, intellectual disability or autism spectrum disorder. This was a single-centre retrospective cohort study, at an adult major referral ED in Melbourne, Australia. Patients were eligible for inclusion if they were ≥18 years of age, presented to the ED between 1 April 2022 and 30 April 2023, and had a disability alert in their electronic medical record. Eligible patients were divided into two cohorts: (i) patients managed using standard ED care and (ii) patients managed using DLO model. ED length of stay (LOS) was the main outcome measure. After adjusting for baseline differences in age, initial GCS and disability type, the DLO service was associated with earlier disposition from the ED (adjusted hazard ratio [aHR] 1.44; 95% confidence interval [CI]: 1.23-1.69; P < 0.001). For the subgroup of patients discharged directly from the ED, the association of DLO service and earlier disposition remained statistically significant (aHR 2.47; 95% CI: 1.83-3.33; P < 0.001). Among patients admitted to the emergency short stay unit (aHR 1.67; 95% CI: 0.99-2.80; P = 0.06), and those admitted to inpatient wards (aHR 0.89; 95% CI: 0.65-1.23; P = 0.50), there was no significant association of the DLO service with time to disposition. The DLO service was associated with a reduction in ED LOS for PWD. Further assessment of the service using patient- and carer-reported outcome measures and cost-effectiveness studies are indicated.

Neuro-modelling and fuzzy logic control of a two-wheeled wheelchair system

Two-wheeled wheelchairs have been used as alternatives for the elderly and disabled people to perform physical activities due to their restriction of movement. Significant challenges posed by two-wheeled wheelchairs control due to their inherent instability, resembling that inverted pendulum system. This research addresses these challenges by developing a dynamic non-linear model and stability control using computational algorithms. A neural network-based Nonlinear Autoregressive model with Exogenous Inputs (NARX) was developed, capturing and behaving similar to the complex dynamics of the wheelchair system with the identification on the experimental input–output data. Ensuring stable and responsive control, design of optimized PD-type and PID-type fuzzy logic controllers using Particle Swarm Optimization (PSO) were established and were tested under a simulation environment. The performance was evaluated across various metrics, including Integral Squared Error (ISE), Integral Absolute Error (IAE), Mean Squared (MSE), and Integral Time Absolute Error (ITAE). The result demonstrates that the PSO Optimized PID-type fuzzy logic controller with scaling factor from MSE index performance come out as best overall, significantly outperforms PD-type fuzzy logic controller, reducing its settling time by 12.5% to 35 s, minimizing overshoot to 0.81°, and achieving a negligible steady-state error of 0.046%. These results highlight the significant of integrating fuzzy logic control and PSO to the neural network model in enhancing the stability and performance of two-wheeled wheelchair systems, offering user safety and comfort.

Exploring Indoor Home Environment Factors Influencing Fear of Falling: A Systematic Review.

In-home falls and fear of falling (FOF) are significant concerns among older adults and people with disabilities (PwD), impacting independence in daily lives. The indoor home environment (IHE) plays an important role in influencing FOF, as it is influenced by barriers and facilitators within the home. This systematic review provides an evidence-based list of IHE factors and investigates their association with FOF, especially in older adults, PwD, and wheelchair users. Examining 24 studies, we found associations between IHE factors and FOF, suggesting the importance of home modifications to live in a supportive environment to reduce FOF. Most studies were experimental and intervened for either single or multiple IHE factors, indicating reasonably strong evidence. Our findings highlight the importance of considering psychological factors when evaluating home environments to reduce FOF. The list of barriers and facilitators we provide can help healthcare professionals conduct evidence-based home assessments.

Studies of the Vulnerability of Disabled People to HIV Infection in Senegal: Review of Literature

This article presents the results of the literature review of studies on the vulnerability of disabled people to HIV and AIDS in Senegal. She has focused on educational resources such as PubMed, Google scholar, CAIRN INFO and the UCAD Digital Library. The results of the studies selected for the review are unanimous on the lack of an inclusive policy targeting people with disabilities in the fight against HIV in Senegal. The review also found that a multitude of factors are associated with the vulnerability of persons with disabilities. These include: economic, socio-cultural, systemic and gender-related factors. These results were used to develop a conceptual framework for a study of HIV-related knowledge, perceptions and risk practices among people with motor disabilities in Keur Massar.

Health disparities in the risk of severe acidosis: real-world evidence from the All of Us cohort.

To assess the health disparities across social determinants of health (SDoH) domains for the risk of severe acidosis independent of demographical and clinical factors. A retrospective case-control study (n = 13310, 1:4 matching) is performed using electronic health records (EHRs), SDoH surveys, and genomics data from the All of Us participants. The propensity score matching controls confounding effects due to EHR data availability. Conditional logistic regressions are used to estimate odds ratios describing associations between SDoHs and the risk of acidosis events, adjusted for demographic features, and clinical conditions. Those with employer-provided insurance and those with Medicaid plans show dramatically different risks [adjusted odds ratio (AOR): 0.761 vs 1.41]. Low-income groups demonstrate higher risk (household income less than $25k, AOR: 1.3-1.57) than high-income groups ($100-$200k, AOR: 0.597-0.867). Other high-risk factors include impaired mobility (AOR: 1.32), unemployment (AOR: 1.32), renters (AOR: 1.41), other non-house-owners (AOR: 1.7), and house instability (AOR: 1.25). Education was negatively associated with acidosis risk. Our work provides real-world evidence of the comprehensive health disparities due to socioeconomic and behavioral contributors in a cohort enriched in minority groups or underrepresented populations. SDoHs are strongly associated with systematic health disparities in the risk of severe metabolic acidosis. Types of health insurance, household income levels, housing status and stability, employment status, educational level, and mobility disability play significant roles after being adjusted for demographic features and clinical conditions. Comprehensive solutions are needed to improve equity in healthcare and reduce the risk of severe acidosis.

Lighting Features Affecting the Well-Being of Able-Bodied People and People with Physical Disabilities in the Park in the Evening: An Integrated and Sustainable Approach to Lighting Urban Green Areas

This study focuses on the analysis of lighting in night conditions to explain what lighting in parks should look like and how parks should be lit from the point of view of people’s perceptions. It addresses the impact of the lighting configuration of urban parks on preference, safety, mystery, legibility, and contact with the environment. The feelings of wheelchair users and able-bodied people were measured. The respondents assessed park landscapes presented in visualisations that varied in terms of lighting features and spatial contexts. This research showed, inter alios, that the participants rated evenly lit spaces more highly than those featuring spot lighting. In unevenly lit spaces, the lighting of the surroundings turned out to be crucial import for able-bodied people, while for the disabled respondents, a combination of lighting of the surroundings and of paths was significant. For evenly lit spaces, path lighting is less important for disabled people than for those without disabilities. These insights can help researchers to look at lighting solutions in a more human-centered way and take into account the environment in which they are used. This allows the design of night lighting in parks to be socially sustainable and promotes access to urban green spaces for all citizens. The study emphasises that the provision of sustainable lighting in parks should take into account different social groups, making light a common good.

Connecting the experiences of persons with disabilities and social workers in Nigerian care institutions regarding COVID-19 vaccine uptake: a qualitative descriptive-interpretive design.

During the COVID-19 pandemic, persons with disabilities (PWDs) have faced additional disadvantages that have exacerbated their physical and mental health challenges. In Nigeria, where cultural, religious, and informational barriers persist, understanding these factors is critical for improving health interventions, including vaccine uptake among PWDs. This study employed a qualitative descriptive-interpretive design to explore the perceptions of PWDs regarding the COVID-19 pandemic and the vaccine, alongside social workers' views on their roles in facilitating vaccine uptake. We conducted in-depth semi-structured telephone interviews with 20 participants, comprising 16 PWDs and four social workers in Nigerian rehabilitation homes. Data were analyzed using critical thematic analysis to identify key themes influencing attitudes toward the pandemic and vaccine uptake. The study uncovered significant barriers to COVID-19 vaccine uptake among PWDs, primarily driven by mistrust in government initiatives, widespread conspiracy theories, and deeply held cultural and religious beliefs. Additionally, while social workers played crucial roles as community surveillance officers, in-house educators, and community referral agents, their interventions lacked specific strategies aimed at increasing vaccine uptake among PWDs. Their efforts were more focused on addressing the psychological impacts of the pandemic rather than fostering behavioral changes toward vaccine acceptance. To enhance COVID-19 vaccine uptake among PWDs in Nigerian rehabilitation homes, targeted interventions that address the identified barriers are essential. These should include trust-building measures, culturally and religiously sensitive communication strategies, and tailored educational programs by social workers. Moreover, training social workers in specific, evidence-based strategies to increase vaccine uptake is crucial for mitigating the pandemic's impact on this vulnerable population.

Testing Interventions for Mobility through Exercise (TIME): Study protocol for a randomized trial comparing a novel, brief home-based exercise program and a standard home-based group exercise for older adults with mobility disability

One in four older adults report difficulty walking, greatly increasing the risk of future disability and death. Though exercise improves mobility, too few older adults do it. While studies show that brief exercise sessions provide most of the benefit of longer sessions and that older adults note that “time” is a critical barrier to being active, what remains unknown is whether briefer RT sessions can improve mobility as well as, or better than, longer traditional sessions, possibly due to greater adherence. We present the design of a 12-month randomized controlled trial of 700 older adults with self-reported walking difficulty. Participants will be randomly assigned, in a 2 × 2 factorial design, to one of two home-based exercise programs: 1) Standard of Care: 45-min, three-times weekly sessions or 2) Experimental: 5-min daily sessions and to one of two doses of behavior change techniques (Standard or Enhanced) as part of their exercise program. The primary outcome measure is self-reported physical function. Secondary outcome measures include objectively measured lower extremity physical performance, walking endurance, balance, walking speed, strength and physical activity as well as self-reported falls, pain, fatigue and balance. This is one of the first studies to examine the clinical outcomes of brief exercise sessions, which may lead to a new generation of exercise programs that are optimized not only for impact, but for adherence as well.

Personal reflections on inclusion

AbstractThe Special Educational Needs and Disability (SEND) landscape in England is bleak. Since the COVID‐19 pandemic, the number of pupils with SEND has increased. There is a shortage of places available in specialist SEND provision, and many pupils with SEND are being educated in alternative provision settings which arguably do not meet their needs. Mainstream schools are struggling to meet the needs of pupils with increasingly complex needs and there has been a lack of financial investment in specialist support services, resulting in delays to assessments and interventions. Drawing on personal and lived experience, I argue that impairment can be painful and sometimes disabling. I argue that although social model has made a significant difference to the lives of disabled people, its ambition has not been fully realised. Disabled people still experience discrimination within education, housing, employment and in other areas. I argue that impairment is real, painful and disabling and can result in personal struggle. I therefore make the case that people with impairments require additional support as a ‘step up’ to guarantee equality of opportunity. Urgent investment is required in specialist SEND services to ensure that unnecessary struggle is avoided.

Accessibility Design Research: Redesign of the Canterbury Square

Accessibility for disabled individuals in urban environments is a fundamental aspect of inclusive design and social equity. When investigating a suitable site for this redesign project as a group, it is found some iconic outdoor barrier-free designs. Conducted the research in China, the examples include ramps, curb ramps, blind access, and other auxiliary facilities, and most of the specific relevant technologies should comply with the relevant provisions of the Code for Barrier-free Design of Urban Roads and Buildings. Despite progress in awareness and legislation, many cities around the world still face significant challenges in providing adequate access for disabled people. This essay will explore the current state of accessibility for disabled individuals in cities, focusing on the barriers they encounter, and the efforts being made to overcome them. Subsequently, this essay will also examine several exemplary architectural designs that prioritize accessibility and inclusivity, providing real-world examples of innovative solutions that enhance the quality of life for disabled individuals, which give insight into the ongoing redesign project of the Canterbury Lane Square near the Canterbury City Centre.

Centering Social Justice and Equity in Research on Accessibility to Public Buildings for Individuals with Mobility Disabilities: A scoping review.

To explore how principles of social justice and equity are integrated into research concerning accessibility to public buildings for individuals with mobility disabilities. Utilising a scoping review methodology to assess literature based on the criteria set by the Joanna Briggs Institute, seven databases were screened. Studies were selected using the framework: "persons with mobility disabilities" AND "accessibility" AND "public buildings". A theoretical framework helped to extract codes and develop themes through an inductive-deductive analysis method. The results are presented descriptively. The examination of 84 studies uncovered a complex interplay between agencies, systemic challenges, discriminatory practices, and societal attitudes perpetuating marginalisation of individuals with mobility disabilities in their access to public buildings. The recommendations emphasize importance of practical measures, research imperatives, and policy developments to promote inclusivity. We present a 'Ten-step approach' to integrate social justice and equity into research on accessibility in public buildings for people with mobility disabilities. Integrating diversity, active participation, and inclusive methodologies are essential to address systemic issues, discriminatory practices, and societal attitudes that hinder accessibility and inclusion. Collaborations with diverse stakeholders are crucial for policy changes, resource allocation, and advancing social justice and equity in accessibility research and practice.

Justice-centered best practices for accessibility to public buildings in a tier II city: Insights from a Delphi expert consensus

Background Despite beneficial progress in policies, awareness and advocacy, accessibility gaps exist in public buildings in India. Challenges achieving full inclusivity still exist, due to a lack of clear guidance for implementing accessible solutions. Retrofitting older buildings, particularly in developing tier II cities is a major challenge. The authors of this paper aimed to address this issue using a four-round Delphi method to generate a Justice-Centered Best Practices (JCBPs) for accessibility provisions for individuals with mobility disabilities. Methods Conducted in Udupi, the study involved experts including administrators, policy implementers, auditors, advocates, healthcare professionals, individuals with disabilities and their caregivers. In the first round, a 117-item list was generated through triangulation of three methods. In subsequent rounds, experts rated each item using a 5-point Likert scale on feasibility, affordability and priority. Responses were considered valid if the agreement reached ≥80% on the total score. The prioritised list of JCBPs was finalised at a consensus meeting. Results Out of forty-eight experts who began the study, 16 participated in the final meeting. The Wilcoxon signed rank test (p value&gt;0.05) of expert ranking indicated that the scoring of items remained consistent between the two rounds. A machine learning decision tree analysis identified items securing ≥ 80% agreement as the most reliable decision with an accuracy=71.43%. The McNemar’s Test p value=0.79 confirmed consistency of expert scoring on the items with high agreement rates. Conclusion Finally, 33 built and non-built environment items scored highest rank. Stakeholder engagement, use of low-cost technology solutions, coordination between public administrations, funding, good governance practice, awareness, and advocacy were few of the solutions that can help ensure accessibility is in place for individuals with mobility disabilities. The study methodology and findings create a robust foundation for evidence-based JCBPs for accessibility provisions for individuals with mobility disabilities.

Raising relational legal consciousness through co‐production research? Making law more accessible

AbstractThis article offers co‐production as a new methodology for relational approaches to legal consciousness studies that allows for deeper analysis of and engagement with the everyday experience of law. We argue that the inherent relationality of co‐production has the potential to both expose and change legal consciousness. As an approach that equalizes status in the co‐production of knowledge, social structures and hierarchies are reproduced in real time, allowing the relational networks through which legal consciousness is formed to emerge. We demonstrate both the possibility and the value of this approach through a discussion of early findings from a co‐produced project focused on accessible legal information for disabled people with cognitive impairments. Our emerging data show that disabled people's experience as ‘outsiders’ in their communities, and the barriers to justice that they encounter through being not believed or information being given in inaccessible formats, creates uncertainty and distrust of the utility of legal professionals as routes for resolution – even as they express a desire for formal legal process. These data also show that engaging with co‐production work can increase the legal confidence of people from marginalized groups.

“I Don’t Know Whether It’s Priority, or Capacity, or Both”: Implementation Gaps in Employment Policies Targeting People with Disabilities in Kenya and Bangladesh

Disabled people are often excluded from employment, particularly in accessing waged employment. This exclusion persists despite enabling policies and legislature, indicating a need to address gaps in implementation. To improve policy implementation, it is crucial to better understand the gap between policy intention (what was planned) and effect (what happens), including reasons that widen this gap (what explains what happened). This study explores this in the context of Kenya and Bangladesh, drawing on key informant interviews and analysis of policies and programmes related to employment, social protection, and disability. Using the policy triangle framework, we analysed the policy context, process, actors, and content of relevant policies and programmes. The study identified key policy provisions on employment quota, social assistance, job placement services, tax incentives, and training opportunities, all of which were designed to promote employment for disabled people. However, implementation is limited in both countries, for reasons including ambiguity in policies, unavailability of data for monitoring, and lack of transparency among implementers. The data suggest that addressing these aspects would promote accountability among duty-bearers, advocacy power among rights-holders, and ultimately improve implementation and inclusion of disabled people in employment.

Redefining Family Relationships: The Impact of Disability on Working-Class Families during the Industrial Revolution in Britain

The Industrial Revolution traditionally has been seen in Disability Studies as marking a decisive shift in the lives of disabled people. It is argued that the rise of mechanisation, time discipline and standardisation made the industrial workplace a hostile environment for people with non-standard bodies. According to this view, increasing demands to work outside the home also meant that families were less capable of caring for older and disabled members, leading to greater institutionalisation. This view of increasing segregation of disabled people from home and work has dominated understanding of disability in the British Industrial Revolution, but it does not reflect the variability of disabled people's experiences at the time. Drawing on official enquiries, fictional literature, journalism and social commentary from the 1830s and 1840s – a time when the impact of industrialisation on the bodies and family relationships of workers became matters of public, political concern – this article shows the continuing importance of family in the lives of disabled people. The legal duty of families to care for sick and disabled relatives was an enduring social principle throughout this period. Interpersonal relations were tested and sometimes re-drawn by disability, forcing a change in traditional familial roles and expectations. For working people and their families, the potentials for poverty resulting from disability could be great. However, disabled people continued to play significant roles in the lives of their families, and where possible continued to contribute to the domestic economy. Taking a disability perspective on the history of the family highlights the interdependence between family members in industrialising Britain.

Discerning personhood through lena‐dena: Disability professionals, ethics, and communication

AbstractThis article looks at practices of discernment in disability spaces in India by analyzing (hierarchical) relational contexts in which disability professionals and disabled people in India interact. We argue that discernment, which we explore through lena‐dena (giving and taking), allows us to analyze the ethical stakes of processes of communication, interpreting, and facilitation. Vaidya analyzes how special educators make broad discernments about intellectually disabled people by interpreting their unconventional and nonlinguistic communicative cues. In contrast, Friedner examines how speech and language therapists that work with deaf children make narrow discernments regarding what counts as language and perform the labor of training deaf children to communicate in the normatively correct way—that is, using speech. While disability professionals produce specific kinds of personhood for disabled people through their practices of discernment, they also end up discerning themselves in the process as professionals with difficult yet rewarding jobs. We conclude by discussing a program for individuals with intellectual disabilities where both authors conducted ethnographic research wherein disability professionals discerned disabled people as having social needs and desires on par with nondisabled people and created enabling environments, scaffolded activities, and facilitated conversations to produce and enable complex personhood for them.

Sociodemographic, mental health, education, employment and income characteristics of adults with obsessive–compulsive disorder who accessed secondary health services in Aotearoa | New Zealand

ABSTRACT Little is known about New Zealanders who experience obsessive–compulsive disorder (OCD). Using population-level data for people aged 18–64 years, we identified a cohort of 5559 people who accessed secondary health services and had a diagnosis of OCD. We explored their characteristics in comparison to people without OCD. The rate of OCD per 10,000 people differed by ethnicity (European, 24.7; Māori, 13.4; Pacific Peoples, 5.6; Asian, 5.9). We observed variation in OCD rates by the geographic divisions of the public healthcare provider Health NZ which persisted following standardisation for age, sex, ethnicity and urban vs rural residence (Northern, 14.5; 95% confidence interval (CI) 13.7–15.2; Te Manawa Taki, 10.9; CI 10.0–11.8; Central, 19.7, CI 18.5–20.8; Te Waipounamu, 27.4, CI 26.2–28.7). These disparities suggest inequity of access to healthcare. Individuals in this cohort typically had at least one co-occurring mental health or related condition (78.8%) and were less likely to have at least level 4 educational qualifications (equivalent to first year of an undergraduate degree) (adjusted rate ratio (ARR) 0.94; CI 0.90–0.97), to be employed (ARR 0.69; CI 0.66–0.72) and to belong to a higher income bracket ($40,000 or higher, ARR 0.57; CI 0.53–0.62). These findings suggest wider support needs. What we already know Obsessive–compulsive disorder (OCD) is a mental health condition that is characterised by repetitive intrusive thoughts and compulsive behaviours and has a twelve-month prevalence of around 1–2% in adults. In clinic-based studies, most individuals with OCD have other mental health and related conditions and, to a lesser degree, this is also observed in community surveys. OCD is typically first experienced as a child, adolescent or young adult and can severely impact an individual’s ability to engage in education and employment. What this article adds Using the Integrated Data Infrastructure (IDI), a national collection of linked health and non-health data, we explored the characteristics of working-age adults with OCD who had accessed public secondary health services in Aotearoa | New Zealand (NZ). There were marked differences in the rates of OCD for geographic areas corresponding to the regional divisions of Health NZ | Te Whatu Ora, and, as previously described, by ethnicity. These findings suggest inequity of access to healthcare and merit further investigation. In comparison to other working-age adults, people in the study cohort were moderately less likely to have achieved higher level educational qualifications, and they were markedly less likely to be employed and to belong to a higher income bracket. Accessing public secondary health services is likely to be a proxy for more severe and/or complex psychological disability and many people in this cohort had other mental health and related conditions. Therefore, the characteristics of this cohort cannot be generalised to the entire group of people who experience OCD in NZ.

Workplace Accommodations and the Labor Force Status of Persons with Disabilities.

The aim of the study is to examine the role of unmet needs for workplace accommodations (WPA) in the labor force status of persons with disabilities (PWD) aged 25-64years. The study used data from the 2017 Canadian Survey on Disability and multinomial logistic regressions to estimate the predicted probabilities of employment, unemployment, detachment from the labor force, and retirement. Product terms were used to examine if the association between unmet needs for WPA and these employment outcomes depended on severity of disability and age group. The findings show that the probability of employment was far lower for PWD with unmet needs for WPA than it was for their counterparts without unmet needs, after controlling for disability-related and sociodemographic characteristics. While having more severe disabilities associated with a lower employment rate, this occurred in the context of unmet needs for WPA, as there was no difference between persons with milder and more severe disabilities without unmet needs. Unmet needs for WPA had age-specific consequences and were associated with a higher probability of unemployment and detachment from the labor force among PWDs aged 25-34years and a higher probability of retirement among PWD aged 55-64years. Unmet needs for WPA are a barrier to the employment chances of many PWD and eliminating these unmet needs could increase their inclusion in the labor force.