The Disablement Process

As we get older, we tend to gain more wrinkles, wisdom, and unfortunately more chronic conditions. The most common chronic conditions include type 2 diabetes, high blood pressure, arthritis, back pain, atherosclerosis and ischemic heart disease.  Due to advances in medical research, we can live with these conditions for a long time. The symptoms and disability from these conditions becomes the focus of medical care.

In 1994 Verbrugge & Jette (1) presented the disablement process, a simple socio-medical model of disability that has been extremely useful for epidemiological and clinical research over the years.  “Disablement” refers to impacts that chronic and acute conditions have on the functioning of specific body systems, and the carrying out of activities in daily living. “Process” is in regards to the factors that affect their direction, pace and patterns of change. It is important to remember that disability is not a personal characteristic. It is instead a gap between personal capability and environmental demand.

I will provide a common example. A man aged 70 with osteoarthritis of both knees (pathology) has restricted flexion of the knee joint and weak muscles surrounding the knee (impairments). This causes difficulty in walking, getting out of the chair and bending down (functional limitations). Eventually he is forced to stop playing bowls and requires a walking aid (disability).

Something that absolutely amazes me is that a lot of people are quite content with having these medical conditions, and they only act on them once they are causing significant functional limitations or disability. Instead, we should be giving ourselves the best possible opportunity throughout life, to prevent these acute and chronic conditions from occurring in the first place.

For me, the following quote by Hippocrates (460–377 BC) sums up the disablement process perfectly. It also reminds me, in a very simple way, why I make time for regular exercise and ensure that I eat a healthy and well-balanced diet. I hope you can gain something from it as well…

“All parts of the body which have a function, if used in moderation and exercised in labours in which each is accustomed, become thereby healthy, well-developed and age more slowly. But if unused and left idle they become liable to disease, defective in growth and age quickly.”

References:

1) Verbrugge, L., and Jette, A. The Disablement Process. Social Science and Medicine 38(1):1–14,1994

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