e5Abstracts / Disability and Health Journal 2 (2009) e1ee15

homelessness, immigrant status and poverty in US and UK newspapers

since 1996.

Results: The merged dataset included 159 individuals who self- or proxy

identified as having dementia. Around 5% had experienced homelessness.

The rapid evidence review produced 48 publications with virtually no

intervention studies. US media reports focused primarily on loss of services

for illegal immigrants, drug benefit coverage, caregiver strains. UK media

discussed economic burden, community support, abuse in nursing care, and

dignity in the care of impoverished older adults with dementia.

Conclusion: Dementia care for socially marginalised groups is a highly

under-researched area. The evidence base is lacking for culturally

sensitive care environments. Interventions are critically lacking that

consider the compound needs of this heterogeneous clinical population.

Application of technology in the management of spinal cord injury:

Findings from a systematic literature review

Thilo Kroll, PhD, School of Nursing & Midwifery, University of Dundee,

Dundee, United Kingdom

Matthew Kehn, BA, National Rehabilitation Hospital, Washington, DC

Objective: Determine scope and use of technological applications to

promote quality-of-life after spinal cord injury (SCI).

Background: Rehabilitative improvements have stemmed from technological

enhancements. Studying rehabilitative outcomes is incomplete without

considering quality-of-life issues. Overlap between quality of life and

technology is unclear. This study seeks to determine scope and use of

technological applications to promote quality-of-life after SCI.

Methods/Design: Systematic search of multiple electronic databases

including MEDLINE, CINAHL, EMBASE and PSYCINFO. Searches

limited to humans, English, and time period: January 1996-September

2007. No additional limits (study design, research) were applied.

Keywords and expert searches were combined.

Results: 824 abstracts were identified after removal of duplicates.

Publications focused on technology have steadily increased over the past

decade. Quality-of-life is mostly undefined and rarely involves consumer

views. Most identified publications were commentaries or discussion

papers. None of the studies exceeded Phase I trial levels. Technological

applications were mostly discussed in terms of acute and rehabilitative

medical management (drug, pain, respiratory, bladder management). Few

publications focused on technology in advancing psychological coping,

adjustment and community integration. Some publications emphasized

potential of technology for supporting social development, health

promotion, and healthy aging. Little cross-disciplinary research was found.

Conclusion: The evidence base for technological applications in SCI

rehabilitation is scarce. There is tremendous scope to expand research into

the role and use of technology in community-based rehabilitation settings

aimed at enhancing quality-of-life. While community-based RCTs may be

difficult to implement, feasible, well-operationalized pre-trial research

studies (Mixed-Method studies; multiple baseline case studies) are needed.

Health Utilty among Community Dwelling Visually Impaired

Individuals

Kevin D. Frick, PhD, Health Policy and Management, Johns Hopkins

Bloomberg School of Public Health, Baltimore, MD

Christine Spencer, ScD, School of Public Affairs, University of Baltimore,

Baltimore, MD

Emily W. Gower, PhD, Dana Center, Johns Hopkins University, Baltimore,

MD

Jennifer L. Wolff, PhD, Department of Health Policy and Management,

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

John H. Kempen, MD,MHS, MPH, PhD, Center for Preventive

Ophthalmology and Biostatistics, University of Pennsylvania,

Philadelphia, PA

Objectives: To determine whether visual impairment and blindness have

independent relationships with health utility as measured by a visual

analog scale (VAS) or if the relationship is mediated by specific health

domains.

Methods: Between 2000 and 2003, Medical Expenditure Panel Survey

respondents aged 18 and older were asked the EuroQOL (EQ-5D)

questions, including the VAS. Respondents also were asked to report

visual impairment or blindness. The analysis included only those aged 40

and over due to the low prevalence of blindness at younger ages.

Regression analyses assessed the relationship between visual impairment

and the VAS, visual impairment and the five EQ-5D domains, the domains

and the VAS response, and the change in the relationship between visual

impairment and the VAS when controlling for the domains.

Results: Blindness and visual impairment were significantly related to the

VAS response when controlling for demographics (B 5 -5.20, SE 5 1.32,

p 5 0.0001 and B 5 -4.64, SE 5 0.33, p!0.0001 respectively). Visual

impairment and blindness were significantly related to each EQ-5D

domain (mobility, pain, usual activities, self-care, and anxiety). Each EQ-

5D domain was significantly related to the VAS response. When

controlling for domains, the relationship between blindness and VAS was

completely mediated (B5-0.39, SE 5 1.00, p 5 0.70) while the visual

impairment relationship was partially mediated (B5-1.77, SE 5 0.28,

p!0.0001).

Conclusion: While there may be a large health utility upon incident visual

impairment, those living with the condition over time may adapt to the

condition and have a relatively small loss of utility due to the visual

impairment itself rather than the effects of visual impairment.

Gender differences in disability and personal care assistance among

older adults with and without diabetes in Mexico

Flavia Andrade, PhD, Department of Kinesiology and Community Health,

University of Illinois at Urbana-Champaign, Champaign, IL

Data from a nationally representative sample of Mexicans is used to

examine the gender differences in disability among older adults with and

without diabetes and to explore the effects of gender on personal care

assistance in Mexico. Disability was measured using three measures:

Activities of Daily Living (ADL), Instrumental Activities of Daily Living

(IADL) and Nagi functional limitations. Results show that Mexican men

at age 50, regardless of their diabetic status, are expected to live about

3 years with at least one ADL. Disability-free life expectancy among men

aged 50 reaches 19.7 years and 28.4 years for diabetic and nondiabetic,

respectively. Women aged 50 are expected to live, on average, 5 years

with at least one ADL regardless of their diabetic status. Disability-free

life expectancy among women aged 50 reaches 21 and 29.2 years for

diabetic and nondiabetic, respectively. Therefore, differences in total life

expectancy among diabetics and nondiabetics are largely due to

differences in disability-free life expectancy. Results from Mexico

contrast with findings from Canada and the United States where effects of

diabetes on total life expectancy and disability-free are more remarkable

among women. However, this study confirms that women face higher

disability burden than men regardless of their diabetic status and they

require personal care assistance for a greater number of years. Finally, the

paper analyzes the extent to which gender differences in personal care

assistance can be explained by the differential social and economic

characteristics of older women and men.

Role of assistance dogs as supportive care providers for disabled

individuals

Viki Hansen, MPH, Health, West Chester University, West Chester, PA

Lynn Carson, PhD, CHES, Health Department College of Health Science,

West Chester University, West Chester, PA