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DISABILITY: Disability Evaluations and Aging

Many variables need to be considered when determining the extent and presence of disability. Physical, cognitive and emotional injury influence one another when assessing initial disability level and the ultimate extent of recovery. Age and illness are

By B.E.R., Ed.D.

 

Many variables need to be considered when determining the extent and presence of disability.  Physical, cognitive and emotional injury influence one another when assessing initial disability level and the ultimate extent of recovery.  Age and illness are added factors. A person’s age and stage of life at the time of the mishap can deeply influence the emotional perspective about what has occurred.  This perspective, in turn, greatly influences the motivation to recover.  Age related physical-rejuvenation capacities also can affect speed and extent of recovery.

Age can greatly influence how distraught the person will be about their injury.  For example: a married 57 year old master carpenter is involved in a motor vehicle accident, causing brain trauma, pain and the (possibly permanent) inability to walk.  He has two children still in college and his retirement account crashed in a recent recession.  Due to these age and stage of life circumstances, he is very anxious and depressed about how he and his family will cope with his disability. 

This upset causes a further deterioration of his attention and concentration.  Even with quality psychotherapy (and medication support for depression and anxiety), these age-related issues will likely remain major factors in his coping and recovery from the disability. 

After the age of 55, there is often a noticeable lessening of short-term memory capacities. Short-term memory already being a problem, plus the added burden of brain trauma (and bodily damage), an older person may be doubly depressed about the situation. Depression effects both cognitive functioning and the motivation to apply oneself to rehabilitation.  All these factors intertwine in evaluation conclusions. 

To properly assess disability and extent of recovery or compensation, all these factors need to be considered.  This becomes particularly important when the purpose of the evaluation is to determine financial compensation for present and future injury or loss.  The length of time to wait for a future reassessment (to determine maximum recovery and compensation status) will also be affected.

One’s age is a factor in healing rates and capacity.  How motivated is someone of an older age to fully engage in rehabilitation? Does a 60 or 79 year old person’s pre-accident emotional and physical health have an effect on their recovery?  Was the person planning on retiring soon, or were they hoping to continue working for another five to ten years?  Depending on these variables, the older person might feel either invigorated to regain as much of their work life as possible, or feel resigned to never work again.

The older the person is, the more they have ongoing physical infirmities.  For many people this increases levels of anxiety and depression. When an auto accident’s physical and cognitive burdens are added on top of this, the aging person’s normal emotional problems will be exacerbated.  How much of their current emotional disability was caused by the accident?  How much had their pre-existing issues already disabled them?  Did the accident tip an already precarious scale of a deteriorating emotional state?  A competent evaluator can separate these age-related factors with proper care and attention.

Some suggestions to develop a deeper understanding of your client’s disability:

  1. Do an extensive clinical interview asking the subject (in a number of different ways) their emotional and “meaning-of-life” reactions about what has happened to them.  Ask questions like, “How well do you think you can adapt to enjoy your life within different restrictions scenarios?” “What work would you like to consider if you can’t do your former job?” 
  2. Explore how emotionally resilient the subject is by asking, “What do you think you have to say to yourself to be less depressed about what happened to you?” “How easy or hard do you think it will be to do the various physical, cognitive and emotional rehabilitation exercises you’ll need to do every day to fully recover?”
  3. Do both objective and subjective personality assessment tests.
  4. Do enough cognitive assessment tests to properly analyze all aspects of thinking and memory capacities.