No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

This thesis is about impairment, disability and health. Placed in the context of Disability Studies, it engages with the theoretical debates about how disability and impairment should be conceived. In doing so it pays particular attention to the embodiment of impairment and its relation to health matters. It also identifies and discusses the reasons for the apparent reluctance of Disability Studies to engage with health issues. The main source of data is interviews with 28 disabled people from Edinburgh and the Lothians. Using semi structured interviews, participants were encouraged to talk about their experiences of using healthcare including the access barriers they faced, the expertise they developed to manage their health care encounters and how these encounters mediated and were mediated by their lived experience as disabled people. A secondary source of data is autoethnographic writing. Through reflexivity, an assessment is made of the value and validity of using this method to explicitly incorporate the researcher’s own experiences in to the data and its analysis. Similarly reflexivity is deployed to consider the methodological issues that arise from the researcher being disabled and encountering access barriers during the research process. There were three sets of findings from the research. First, participants’ body talk suggested that in everyday life impairment and maintaining good health can be understood as something which is done by the embodied self to the body. This doing is often a taken-for-granted activity. It is also mediated through a number of factors including emotions, disabling barriers and broader social and economic structures. Second, participants’ accounts of the access barriers they faced when using the NHS suggested that there are two categories of access needs, the macro and micro. While macro needs such as ramped or flat access to premises were anticipated and routinely met without participants having to take any action, participants often felt they had to take the initiative to ensure their micro needs, such as the need for a hoist, were met. Some micro access needs were particular to a healthcare context and often emerged during diagnostic tests or treatment procedures. Healthcare professionals had to have sufficient skills and confidence to respond effectively to these clinical micro needs. The third set of findings was that some participants developed expertise to enable them to access the appropriate services to meet their needs and form a high quality relationship with healthcare professionals. However, other participants recalled situations where their expertise was not respected and felt abandoned by the NHS. The first set of findings has implications for theoretical development in Disability Studies. More work is needed to connect the doing of impairment to theoretical approaches found in sociology of the body and to empirically explore the nature and scope of impairment doing, The second and third set of findings have implications for current healthcare practice particularly in the context of the NHS’ responsibility under the Disability Discrimination Act.

Currently, about one in every eight Americans is age 65 or older; by the year 2050, it will be one in five people. Given this “graying” of the population, research into successful aging is of increasing relevance. The question of how to precisely define successful aging, however, has not been completely answered. Likewise, the role of vascular risk factors, subclinical vascular brain damage, and other biopsychosocial characteristics in normal cognitive aging are not well understood. This Dissertation focused on the identification of some of the physiological, behavioral, and social risk factors that distinguish people able to maintain extraordinary health at an advanced age. Specifically, we aimed to create an ecologically valid definition of successful aging that incorporates both physical well-being and cognitive abilities, and to report the prevalence of successful cognitive aging in a population-based multi-ethnic cohort of older adults. We sought to describe how the prevalence varies by several sociodemographic and psychosocial determinants, and to investigate global vascular risk, depressive symptomatology, and MRI markers of subclinical vascular brain damage as correlates of successful cognitive aging. We observed the prevalence of successful cognitive aging to be 37% in the study sample (N=1,162) of a diverse racial/ethnic population in Northern Manhattan (NYC, NY). The prevalence decreased with increasing age; we did not observe any differences by racial/ethnic group, but did note a lower prevalence with lower socioeconomic status. Several social resources and self-reported quality of life were related to successful cognitive aging, and appeared more important than demographic variables alone. We found that the likelihood of successful cognitive aging decreases with increasing global vascular risk score, more severe depressive symptomatology, and greater white matter damage. The field of successful aging requires further study. Consideration of such biopsychosocial factors as socioeconomic status, social support, quality of life, and depressive symptoms alongside novel indicators of disease and disability including global vascular risk and white matter hyperintensity burden is essential. It may lead to a more robust definition of successful cognitive aging replete with opportunities to modify the aging process, as many of the factors investigated in this study are modifiable.

Visual short-term memory (VSTM) is a vital cognitive ability, allowing us to hold online the contents of visual awareness. Healthy older adults have reduced VSTM capacity compared to young adults; however recent evidence suggests that their performance may be improved by the use of a retroactive cue (“retro-cue”). The retro-cue reduces interference from irrelevant items within VSTM. Mild cognitive impairment (MCI) patients have reduced VSTM performance, compared to healthy older adults. Here, we examined whether the use of a retro-cue would increase VSTM capacity in MCI patients. By presenting a retro-cue after a to-be remembered array, we direct attention to the to-be probed location, which reduces interference from other items that are no longer relevant. The present findings suggest that VSTM capacity per se is not compromised in MCI patients, but these patients may be more susceptible to the effects of interference.

Visual short-term memory (VSTM) is a vital cognitive ability, allowing us to hold online the contents of visual awareness. Healthy older adults have reduced VSTM capacity compared to young adults; however recent evidence suggests that their performance may be improved by the use of a retroactive cue (“retro-cue”). The retro-cue reduces interference from irrelevant items within VSTM. Mild cognitive impairment (MCI) patients have reduced VSTM performance, compared to healthy older adults. Here, we examined whether the use of a retro-cue would increase VSTM capacity in MCI patients. By presenting a retro-cue after a to-be remembered array, we direct attention to the to-be probed location, which reduces interference from other items that are no longer relevant. The present findings suggest that VSTM capacity per se is not compromised in MCI patients, but these patients may be more susceptible to the effects of interference.