When Walking Fails: Mobility Problems of Adults with Chronic Conditions (California/Milbank Books on Health and the Public) - Hardcover

Iezzoni, Lisa

Hardcover

ISBN 10: 0520237420 ISBN 13: 9780520237421

Publisher: University of California Press, 2003

Synopsis

Roughly one in ten adult Americans find their walking slowed by progressive chronic conditions like arthritis, back problems, heart and lung diseases, and diabetes. In this passionate and deeply informed book, Lisa I. Iezzoni describes the personal experiences of and societal responses to adults whose mobility makes it difficult for them to live as they wish―partly because of physical and emotional conditions and partly because of persisting societal and environmental barriers.

Basing her conclusions on personal experience, a wealth of survey data, and extensive interviews with dozens of people from a wide social spectrum, Iezzoni explains who has mobility problems and why; how mobility difficulties affect people's physical comfort, attitudes, daily activities, and relationships with family and friends throughout their communities; strategies for improving mobility; and how the health care system addresses mobility difficulties, providing and financing services and assistive technologies.

Iezzoni claims that, although strategies exist to improve mobility, many people do not know where to turn for advice. She addresses the need to inform policymakers about areas where changes will better accommodate people with difficulty walking. This straightforward and engaging narrative clearly demonstrates that improving people's ability to move freely and independently will enhance overall health and quality of life, not only for these persons, but also for society as a whole.

About this title

About the Author

Lisa I. Iezzoni is Professor of Medicine at the Harvard Medical School and the Beth Israel Deaconess Medical Center, Division of General Medicine and Primary Care. She is the editor of Risk Adjustment for Measuring Healthcare Outcomes (1997).

From the Back Cover

"In this warm and engaging book, Lisa Iezzoni sends the important message that life should not stop when walking fails. Using the stories of ordinary people, she suggests strategies for remaining active and independent. Iezzoni's book will inspire families, health care professionals, and political representatives to help remove the barriers and enable all those with mobility challenges to lead full and productive lives."―Rosalynn Carter

"Iezzoni turns a spotlight on the sociocultural and policy shadows that must be illuminated to address the growing needs of Americans with mobility limitations. Her evocative portrait of the challenges faced by both those with walking difficulties and the clinicians who try to serve their needs is a compelling wake-up call for Americans and a must-read for all health professionals and policy makers."―Alan M. Jette, Dean, Sargent College of Health and Rehabilitation Sciences, Boston University

"Blending an epidemiologist's hard data with a reformer's passionate, personal appeals, Iezzoni leads us through the parallel universe of people with mobility problems―a dimension largely invisible to those of us who can move around without even thinking about it, but all too real to those who live there."―Frank Davidoff, Editor Emeritus, Annals of Internal Medicine

"Lisa Iezzoni has written a truly remarkable book. She takes the proposition that health professionals need to worry about their patients' functional capacities as well as their illnesses, and uses that as the basis for a pathbreaking analysis of the effects of failure in one of the basic human functions―walking. Everyone involved in providing, studying, analyzing, administering, or making policy about health care for those with chronic illnesses or disabilities should read this book."―Bruce C. Vladeck, Senior Vice President and Professor, Mount Sinai Medical Center

"From both a personal and professional perspective, Lisa Iezzoni opens the hidden world of mobility problems, revealing the creative ways in which individuals adjust emotionally and practically, and the mostly short-sighted and frustrating ways in which health professionals, policy makers, and insurers have responded to their needs. This book is an essential resource for everyone who has or may have a problem walking, as well as for their family members and doctors."―Carol Levine, Director, Families and Health Care Project, United Hospital Fund of New York

"Thoughts and emotions associated with the loss and restoration of mobility are presented through users’ and rehabilitation professionals’ words, which makes this a reader-friendly book."―Catherine A. Trombly, Professor Emerita of Occupational Therapy, Sargent College of Health and Rehabilitation Services, Boston University

"Dr. Iezzoni has accomplished the daunting task of explicating the experience of people with mobility problems as they have lived it in the context of health care and public policy. Part autobiography, part interview, she unsentimentally tells her own story and the stories of others who have been challenged by a world that too often presumes the ability to walk. Dr. Iezzoni also succinctly exposes the challenges to individuals with mobility problems created by policies that may not be in anyone's interest. An important contribution to the study of disability and ability, this book has valuable insights for patients, health professionals and policy makers."―Andrew A. Guccione, Senior Vice President, Division of Practice and Research, American Physical Therapy Association

From the Inside Flap

"In this warm and engaging book, Lisa Iezzoni sends the important message that life should not stop when walking fails. Using the stories of ordinary people, she suggests strategies for remaining active and independent. Iezzoni's book will inspire families, health care professionals, and political representatives to help remove the barriers and enable all those with mobility challenges to lead full and productive lives."—Rosalynn Carter

"Iezzoni turns a spotlight on the sociocultural and policy shadows that must be illuminated to address the growing needs of Americans with mobility limitations. Her evocative portrait of the challenges faced by both those with walking difficulties and the clinicians who try to serve their needs is a compelling wake-up call for Americans and a must-read for all health professionals and policy makers."—Alan M. Jette, Dean, Sargent College of Health and Rehabilitation Sciences, Boston University

"Blending an epidemiologist's hard data with a reformer's passionate, personal appeals, Iezzoni leads us through the parallel universe of people with mobility problems—a dimension largely invisible to those of us who can move around without even thinking about it, but all too real to those who live there."—Frank Davidoff, Editor Emeritus, Annals of Internal Medicine

"Lisa Iezzoni has written a truly remarkable book. She takes the proposition that health professionals need to worry about their patients' functional capacities as well as their illnesses, and uses that as the basis for a pathbreaking analysis of the effects of failure in one of the basic human functions—walking. Everyone involved in providing, studying, analyzing, administering, or making policy about health care for those with chronic illnesses or disabilities should read this book."—Bruce C. Vladeck, Senior Vice President and Professor, Mount Sinai Medical Center

"From both a personal and professional perspective, Lisa Iezzoni opens the hidden world of mobility problems, revealing the creative ways in which individuals adjust emotionally and practically, and the mostly short-sighted and frustrating ways in which health professionals, policy makers, and insurers have responded to their needs. This book is an essential resource for everyone who has or may have a problem walking, as well as for their family members and doctors."—Carol Levine, Director, Families and Health Care Project, United Hospital Fund of New York

"Thoughts and emotions associated with the loss and restoration of mobility are presented through users’ and rehabilitation professionals’ words, which makes this a reader-friendly book."—Catherine A. Trombly, Professor Emerita of Occupational Therapy, Sargent College of Health and Rehabilitation Services, Boston University

"Dr. Iezzoni has accomplished the daunting task of explicating the experience of people with mobility problems as they have lived it in the context of health care and public policy. Part autobiography, part interview, she unsentimentally tells her own story and the stories of others who have been challenged by a world that too often presumes the ability to walk. Dr. Iezzoni also succinctly exposes the challenges to individuals with mobility problems created by policies that may not be in anyone's interest. An important contribution to the study of disability and ability, this book has valuable insights for patients, health professionals and policy makers."—Andrew A. Guccione, Senior Vice President, Division of Practice and Research, American Physical Therapy Association

Reviews

In this wonderful book, Lisa Iezzoni opens a window to the overlooked world of people with mobility problems. She draws from extensive interviews of 119 mobility-challenged people (whose insights she quotes liberally), undertaken during her many months of policy research as a Robert Wood Johnson Health Policy Fellow. Her material is also a product of her experiences with her own mobility problems, which developed during medical school, where she experienced distressing prejudice and intolerance. Few physicians have received training in this area or know how to discuss mobility problems with patients and where to refer them. Many people live with impaired mobility, and there are many effective interventions and approaches for improving their lives, yet only a small fraction of these people receive the assessment and care that they need. It is important for all health care professionals to be aware of and deal with issues related to problems of mobility in adults. The book begins with a systematic survey of the epidemiology of mobility problems (which affect about 10 percent of the adult population), the conditions that cause them, and the effects of these problems on health care and costs to society. Iezzoni liberally intersperses facts with often heart-wrenching quotations from patients and anecdotes of her personal experiences. She describes the normal gait cycle and how it is affected by a number of disabling conditions. She explores the ways that people conceptualize their disabilities and the ways that families and society react to the disabilities. Furthermore, Iezzoni relates the history of social programs, geared toward improving the lives of disabled people, that emerged from neglect in the early 20th century. These include the Social Security Act of 1935, Medicare and Medicaid in the mid-1960s, and programs associated with the Americans with Disabilities Act of 1990 (spurred on by the disability-rights movement), along with more recent reactions and retrenchments. Iezzoni gives a tour through the sometimes Kafkaesque labyrinth of entitlement programs and government regulations, which reflect the good intentions of their designers but are often difficult to maneuver and make sense of. People with disabilities cope in a variety of ways, and their methods of coping can affect functional outcomes. Some people are able to accept major limitations with positive inner strength, but regardless, most face a variety of setbacks and disappointments. Life for them has changed, and they face the reality of major loss of independence in an often cruel and intolerant society. Simply performing activities of daily life involves large expenditures of energy and requires creative adaptations. This book does much more than make health care professionals aware of the mobility problems of adults. It contains useful and practical information that can help all of us to provide care more effectively. Iezzoni suggests ways that patients can help physicians be more responsive to the patients' needs. She describes the programs that are available to people with disabilities and also analyzes the treacherous disincentives for their use that discourage people from getting the help they need. Many public disability welfare programs pay people not to work but give almost nothing for adaptive equipment that would enable them to work. And the benefits often stop completely if the person can somehow become employed. Iezzoni explores the difficulties of driving and the factors involved in deciding whether to drive with adaptive equipment or to stop altogether. She suggests ways to benefit from physical therapy, occupational therapy, and prosthetics, and she discusses the major types of assistive devices, including canes, crutches, walkers, wheelchairs, and motorized scooters. In addition, she describes the insidious tendency for physicians and patients alike to delay using assistive and adaptive equipment, particularly wheelchairs, because of the fear of hastening the progression of the disability. But these devices can vastly improve the quality of life in many ways not imagined by people who have been barely getting by without them. Iezzoni's chapter on wheeled mobility is an eye-opening essay on the amazing benefits enjoyed by people who use wheelchairs and scooters, as well as the major impediments that people face when deciding to start using them. She discusses who will pay for mobility assessments and aids, which is often a major stumbling block but one that can usually be surmounted with knowledge of the available programs and with persistence. In the last chapter, Iezzoni describes her fantasy of a one-stop Mobility Mart that would solve most of the problems identified in her book. It would provide an interdisciplinary team of professionals to assess needs and prescribe the full spectrum of mobility aids and assistive devices, networks of peer counselors or support groups, information about community resources, and insurance advisers. An appendix of resources enhances this useful, interesting, and well-written book, which contains more than enough information to qualify as a textbook but is fast and enjoyable to read. It will appeal to professionals and laypeople alike. Laurence Z. Rubenstein, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Edition details

• Publisher: University of California Press
• Publication date: 2003
• Language: English
• ISBN 10: 0520237420
• ISBN 13: 9780520237421
• Binding: Hardcover
• Edition number: 1
• Number of pages: 380