1. Classen, Sherrilene PhD, MPH, OTR/L, Issue Editor

Article Content

Until recently, we have thought about the rehabilitation disciplines and public health as 2 entities, each operating from its own ethical codes and scope of practices, yet both contributing services to clients, communities, and the population at large. However, in this {issue on public health, disability, and aging}, we are suggesting that rehabilitation professions and public health can be integrated for the benefit of both disciplines but, most importantly, for the benefit of the public. Estimates suggest that the number of older adults with impairments or functional limitations will increase from approximately 14 million today to more than 28 million in 2030. We believe that to maximize our effectiveness in addressing the many challenges associated with an aging population, we must rethink how to optimize the impact of our traditional clinical services to better secure the health of aging Americans.


This special issue of Topics in Geriatric Rehabilitation introduces 7 articles that underscore the essence, or importance, of practicing rehabilitation services from a broader public health orientation. First, from the University of Florida's College of Public Health and Health Professions, Erin DeFries and colleagues illustrate the place of public health and population-level data in understanding current and future impacts of rehabilitation practitioners, the services they provide, and the clients they serve. Through accessing public health data, they explain how rehabilitation professionals can use these data to improve on their planning for comprehensive service delivery. They also explain basic public health concepts by way of disability and aging examples.


Diane Smith from the University of Illinois at Urbana-Champaign reminds us that Healthy People 2010 includes access to healthcare as 1 of the 10 public health priorities. Using 1997-2006 data from the National Health Interview Survey (NHIS), she focuses on determining the effect of disability and age on healthcare access and the impact of policies designed to ensure healthcare access. The results showed that older adults with disabilities exhibit disparity when accessing healthcare services compared with older adults without disabilities. Using these findings, she discusses the implications for public health, rehabilitation professionals, and policymakers.


The link between older driver safety and public health has been established in 2 previous special issues of this journal: January-March 2006 and April-June 2006. It is therefore exciting to include 3 driving studies that further examine older driver safety within a public health context. Anita Meyers and colleagues from Waterloo, Ontario, Canada, performed a process evaluation on Roadwise Review-a self-assessment tool for older drivers. They found that impressions were generally favorable, but researcher observations and participant feedback raised a number of concerns, prompting them to provide recommendations to the AAA/CAA for modifying the program. Being concerned about reducing motor vehicle crashes, injuries, and fatalities among older drivers, Lisa MacDonald and colleagues, also from Waterloo University, suggest assessing not only driving-related abilities but also perceptions and comfort level of older drivers.


Matthew Baldock and colleagues from the Centre for Automotive Safety Research at the University of Adelaide in Australia elucidate functional deficits of older drivers associated with driving errors. From a public health perspective, their study provides a starting point for guiding fitness to drive assessments, which plays a crucial role in ensuring the mobility and safety of older adults.


From Rush University and Medical Centre, Clare Giuffrida and colleagues studied, in a group of senior adults, 2 essential motor control functions: pointing and aiming. Such functions are embedded in everyday activities, for example, pushing the elevator button or manipulating a keyboard. Their study provides essential suggestions for universal design planners to optimize environments, and in so doing potentially enhancing senior adults' participation in these environments.


Representing the North Florida and South Georgia Veteran's Administration and the University of Florida, Sandra Hubbard Winkler and her research team draw parallels between the quality of wheelchairs and the quality of life in aging veterans. Results suggest that compared to those veterans who received nonadjustable, depot chairs, veterans who received higher-quality manual wheelchairs had lower physical function scores (an indicator of disability) yet higher mental function, general health, and mental component summary scores (indicators of quality of life).


These articles therefore embody an important concept, that is, the essence of starting a new dialogue between rehabilitation and public health professionals. Together, these respective disciplines may create plausible research, practice, and policy-making opportunities in embracing a collaborative approach to advancing the health of aging Americans.


Sherrilene Classen, PhD, MPH, OTR/L


Issue Editor