Research Paper Multidimensional health risk appraisal among adults aging with acquired disabilities Joan Earle Hahn, Ph.D., A.P.R.N., G.C.N.S.-B.C., G.N.P.-B.C., C.D.D.N. a, * , Harriet Udin Aronow, Ph.D. b , Emily R. Rosario, Ph.D. c , and Nancy Guenther, M.S.T. d a Department of Nursing, College of Health and Human Services, University of New Hampshire, 4 Library Way, Hewitt Hall 279, Durham, NH 03824-3563, USA b Nursing Research & Development, Cedars-Sinai Medical Center, USA c Research Institute, Casa Colina Centers for Rehabilitation, USA d Living Healthy with a Disability Program, California Department of Public Health, USA Received 3 March 2012; received in revised form 17 January 2013; accepted 11 February 2013 Abstract Background: The increasing older adult population includes people with disabilities facing added challenges of aging. The Affordable Care Act Section 4103 calls for an annual health risk appraisal (HRA) to be administered with older adults. HRAs show promise when used with older adults, yet little is known about their use with adults aging with acquired disabilities. Objectives: 1) Explore psychometrics of the multidimensional Stay Well and Healthy! Health Risk Appraisal tool (SWH-HRA) among persons aging with disabilities acquired in early or mid-life, and 2) Assess SWH-HRA application to characterize disability subgroup differences. Methods: Psychometric analysis conducted on SWH-HRA interview data collected with 93 participants with an acquired disability of at least five years or more post-onset. ANOVA and Chi-square to explore differences in risks by subgroups identified by etiology (traumatic brain injury, stroke, spinal cord injury, and movement disorders). Results: A high prevalence of health risks was noted. Risks were associated with health, participation and quality of life outcomes. With the exception of independence in basic activities of daily living and incontinence, few statistically significant differences were noted among disability subgroups. Patterns of risk clusters and prevalence within disability subgroup were consistent with findings in the literature. Conclusion: The SWH-HRA provides a valid and comprehensive health risk assessment. When used in annual wellness visits among persons with disabilities, it has the potential to inform the partnership between health providers and individuals with disabilities as they collaborate to promote healthy aging. Ó 2013 Elsevier Inc. All rights reserved. Keywords: Aging; Disability; Health risk appraisal; Health promotion; Wellness The growing population of adults over the age of 65 years in the United States (U.S.) makes up about 13% of the U.S. population. This includes people with disabilities. Aging with disability represents an underexplored research area. Based on the U.S. Census Bureau’s 2009 American Community Survey data, 37% of individuals age 65 year and older in the U.S. have disabilities. 1 This includes adults with disabilities who develop disability in old age and those who have lived with disability from birth or have acquired disabilities in younger or middle years. National health initiatives, such as the Surgeon General’s wellness initia- tive, 2 Healthy People 2010, 3 and Healthy People 2020 4 acknowledge that persons living with disability experience health disparities and vulnerabilities in achieving shared national health goals. An emerging health issue is the inclu- sion of all persons in health promotion efforts. A Healthy People 2020 goal is to ‘‘achieve health equity, eliminate disparities, and improve the health of all groups’’. 4 Aging with disability presents its distinct challenges to individuals, families and the health care system. 4 There has been a growth nationwide in policy strategy that promotes self-management and empowerment. 5e7 This Conflicts of interest: All authors have no conflict of interest to declare. This journal article was supported in part by Cooperative Agreement U59/CCU921228 from the CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. * Corresponding author. Tel.: þ1 603 862 2958. E-mail address: Joan.Hahn@unh.edu (J.E. Hahn). 1936-6574/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.dhjo.2013.02.002 Disability and Health Journal 6 (2013) 195e203 www.disabilityandhealthjnl.com