The LOS Wave Two Report, Part I has highlighted the dynamic nature of the population with impairment. Rather than considering the characteristics and experiences of disabled people at one point in time, the LOS longitudinal data allow the examination of changes associated with impairment onset and offset, as well as changes over time for those who have continually experienced impairments.
In general, analyses in this report have shown similarities between the onset-acquired and offset adults in terms of the impairments and severity of these impairments they had reported, as well as their economic activity status and income over the two waves. Analyses of participation restriction revealed that onset-acquired adults and offset adults reported different experiences in terms of changes in the barriers they faced at Wave One and Wave Two. The contrast between onset-acquired adults and offset adults on the one hand, and adults with impairments at both waves on the other, are discussed in the following sections. The chapter will conclude with a discussion about Wave Three and the future direction of the LOS.
The four most commonly-reported impairment types were identical across adults with impairment at both waves, onset-acquired adults, and offset adults. These four impairment types were long-term pain, chronic health condition, mobility impairment and dexterity impairment. This finding suggests that these four impairments are the most widely experienced by the general population1, and therefore the likelihood of acquiring any of these conditions by the onset-acquired group at Wave Two was also high. Additionally, most of the adults who have offset from impairment had previously reported these impairments at Wave One. However, the offset rates by impairment types, which indicate the probability of offsetting from a particular impairment at Wave Two, showed that dexterity and mobility impairments were among those impairments with the lowest offset rates (see section 3.3, Table 3.7).
As illustrated by analyses of the changes of impairment type reported by adults with impairments at both waves (see section 2.3), it is important to bear in mind the dynamic nature of this group in terms of the impairments experienced between the two waves. Specifically, it was clear from the onset rates and offset rates (Tables 2.9 and 2.10) that a substantial proportion of adults with impairments at both waves were reporting new impairments at Wave Two that had not previously been reported at Wave One, and/or were no longer reporting impairments at Wave Two that were previously reported at Wave One.
Most onset-acquired adults and offset adults reported one impairment (at Wave Two and Wave One respectively), with a lower percentage reporting three or more impairments. These findings make intuitive sense as it is unlikely for an individual with no impairments at Wave One to acquire a large number of impairments over the period of one year (the time between Wave One and Wave Two). Conversely, those who have offset from impairment (having at least one impairment at Wave One to no impairments at all at Wave Two), would be more likely to be classified in this group if cessation of only one impairment was required, rather than three or more.In contrast, those with impairments at both waves showed that around half of the group reported three or more impairments at Wave Two. The higher proportion of this group reporting two, or three or more impairments meant that it was less likely for these adults to be offset from impairment entirely.
Severity ratings for the four most commonly-reported impairments also showed a similar pattern for onset-acquired and offset adults. For all four impairments, most adults in these two groups reported moderate level of difficulty, and rated the frequency of limitations posed by these impairments as “sometimes”. These findings suggest that recently acquired impairments tend to be less severe, and implies that the onset of impairment experienced, in terms of severity, maybe gradual. For the offset adults, the results suggest that having less severe impairments at Wave One led to impairment offset at Wave Two.
The gradual onset of impairments can be seen in the number of adults reporting mild difficulty for an impairment at Wave One, who subsequently reported more severe difficulty at Wave Two and therefore were classified as onset-acquired for that impairment. (Based on the LOS definition, an adult is classified as having a particular impairment if the difficulty experienced is more than “mild”). This was particularly evident for long-term pain and chronic health condition. On the other hand, using the LOS definition, an adult could be classified as offsetting from an impairment if the level of difficulty rated for that impairment changed from more severe levels to “mild”. This was observed for a proportion of offset adults who reported chronic health condition and sight impairment at Wave One.
In contrast, adults with impairments at both waves had higher severity ratings for the four most commonly-reported impairment types than seen in the onset-acquired adults and adults who have offset from impairment. Compared with onset-acquired and offset adults, a higher percentage of adults with impairments at both waves rated the level of difficulty experienced for the impairment as “severe” or higher, and the frequency of limitation as “always”.
In Chapters 3 and 4, the onset rates for onset-acquired adults and the offset rates of offset adults were examined across a selection of demographic characteristics. Onset rates were found to vary across age groups, with older adults more likely than younger adults to report an impairment at Wave Two. The situation was reversed for offset rates, where the likelihood of offsetting completely from impairments was higher for younger than older adults.
Similar patterns of onset and offset rate variations within a demographic characteristic could be seen in the highest qualifications attained, and its related characteristic, socio-economic classification (based on occupation). Onset rates were found to decrease with higher levels of qualification. On the other hand, offset rates tended to increase with higher levels of qualifications. These findings conform with existing evidence of a relationship between good general health and higher levels of education.
The similarity between onset-acquired and offset adults, and their distinction from adults with impairments at both waves, were again seen in their economic activity status1 and income distributions. Most onset-acquired and offset adults were found to be employed at both waves, with a smaller proportion being economically inactive at both waves. These groups could be contrasted with adults with impairment at both waves, where a lower proportion of the group were employed at both waves, and a larger proportion were economically inactive at both waves.
Onset-acquired and offset adults showed similar income distributions, with around 35 per cent of working age (16-64) adults in both groups on an income of £200 or less per week at each wave. A higher percentage of working age adults with impairment at both waves (around 50 per cent)had an income of £200 or less per week. These findings are consistent with the economic activity data which showed that a greater proportion of the onset-acquired and offset adults, than adults with impairments at both waves, were in employment at both waves.
Overall, there has been a large degree of stability across the two waves in both economic activity status and income distributions for all groups examined in this report. The lack of change could partly be due to the short gap (of one year) between the two waves. Wave Three of the LOS will revisit respondents after a gap of two years. More substantial changes may be apparent when data from Wave Two and Wave Three are compared.
For all adults who had reported at least one impairment at one or both waves of the LOS, the most commonly-cited life areas in which a barrier was experienced were transport and leisure activities. Adults with impairment at both waves, compared with onset-acquired and offset adults, were more likely to report a barrier in the life area of work.
Overall, the findings relating to changes in the number of life areas in which a barrier was experienced are consistent with the notion that the existence of impairment is associated with participation restriction. For onset-acquired adults, the average number of life areas in which barriers were experienced at Wave Two had increased from Wave One, whereas for offset adults, this figure had decreased from Wave One to Wave Two. There has been little change between waves in the average number of life areas where barriers were experienced for adults with impairment at both waves. Furthermore, across six of the eight life areas, a higher percentage of onset-acquired adults experienced a barrier at Wave One than at Wave Two. In contrast, across seven of the eight life areas, the percentage of offset adults experiencing a barrier decreased between Wave One and Wave Two.
Data from Wave Three of the LOS will further our understanding of the dynamic nature of the population with impairment over a longer period of time. It will help us understand the movements in and out of impairment. It will allow us to explore whether or not the onset-acquired adults continue to experience impairment and how the severity of these impairments changes; also whether adults who experienced an offset of impairment remain without impairment or whether they will move back into impairment.
Evidence from Australia has shown that over a five year period 38 per cent of the overall population fluctuated between the disabled and non-disabled populations1.
However, it is important to note at this juncture that the population covered by the LOS form a very diverse group with respect to the impairments they report and the severity of those impairments, and a simple picture that covers all impairments is unlikely to appear. This diversity, and the dynamic nature of impairments experienced mean that personal perception is also likely to play a key role in how impairments are reported. Earlier research found that only 48 per cent of disabled people actually consider themselves to be disabled2.
We also note that this report has not examined the specific barriers experienced by adults at Wave One and Two, or any changes in the reasons causing the barrier. Similarly, analyses on reasons why changes have occurred in the types of impairments reported between waves, and the effect of these changes on the experience of barriers have not been explored in this report. The LOS Wave Three questionnaire will look at the reasons why respondents experience changes in their impairments and/or participation restrictions.
Findings from the LOS should further be considered in conjunction with research from the wider field of disability, and together these could help identify successful interventions and the effectiveness of these interventions in terms of people’s perception about their impairment and the barriers experienced.
The LOS Wave Two Report, Part II, is planned for publication in 2013. The report will provide prevalence estimates of people experiencing impairments at Wave Two, as well as prevalence estimates of impairment types at Wave Two. The report will also include further longitudinal analyses on participation restrictions, and changes experienced by those adults who did not report any impairments at both Wave One and Wave Two.
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