THE DISABLEMENT PROCESS
THE DISABLEMENT PROCESS
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DOI：
10.1016/0277-9536(94)90294-1
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发表时间：
1994-01-01
影响因子：
5.4
通讯作者：
JETTE, AM
中科院分区：
文献类型：
--
作者：
VERBRUGGE, LM;JETTE, AM
基于先前的概念方案，本文提出了一种残疾的社会医学模型，称为“残疾过程”，该模型对于流行病学和临床研究特别有用。残疾过程：(1) 描述慢性和急性疾病如何影响特定身体系统的功能、一般的身体和精神行为以及日常生活活动，(2) 描述加速或减缓残疾的个人和环境因素，即风险因素、干预措施和加重因素。阐明了连接病理学、损伤、功能限制和残疾的主要途径。残疾被定义为由于健康或身体问题而难以在生活的任何领域（从卫生到爱好、办事到睡眠）进行活动。模型中包含反馈效应，以涵盖功能障碍螺旋（功能障碍的恶性循环）和次要条件（由给定的残疾过程引发的新病理）。我们区分内在残疾（没有个人或设备援助）和实际残疾（有此类援助），并指出衡量两者的科学和政治重要性。残疾不是个人特征，而是个人能力与环境需求之间的差距。调查研究人员和临床医生往往关注个人能力，忽视人们通常通过活动调节、环境改变、心理应对和外部支持来减少需求的努力。我们比较了早年患慢性病（终身残疾）和中晚年患慢性病（晚年残疾）的人的残疾经历。残疾流程可以帮助为研究（残疾流行病学）和公共卫生（残疾预防）活动提供信息。
Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicans tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.