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Gill and colleagues' study in this issue confirms 2 “inconvenient truths” of aging: Losing the ability to walk even short distances and drive cars is common toward the end of life, and these outcom...

Haiti's earthquake caused untold numbers of new disabilities across the age spectrum, from infants and children to elderly individuals. Amputations, spinal cord and brain injuries, complex multiple fractures, and other massive trauma will leave residual impairments, precipitating pressing needs at both the individual and societal levels. Short-term priorities include clinical stabilization, wound healing, and surgical revisions of suboptimal repairs. Afterward, in the near term, comprehensive rehabilitation must commence to ensure the best possible functional outcomes. Even before the earthquake struck, Haiti had few rehabilitation professionals and little capacity to manufacture essential assistive technologies, including prostheses and wheelchairs. While international organizations are assisting to fill these gaps, ultimately rehabilitation programs and assistive technologies will need to fit the specific demands of Haiti's culture and rugged natural physical environment. As Haiti rebuilds its public and private spaces, ensuring accessibility to persons with disabilities will be critical. Ultimately, one positive legacy of Haiti's earthquake could be the emergence of social attitudes, public policies, and physical environments that more fully accommodate disability across the life span.

Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians.To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals.4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis.Greater Boston, Massachusetts, and Washington, DC, in 2001.14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age).Commonly expressed themes or views organized around dimensions of communication.Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication.As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.

In 1863, Florence Nightingale argued that London hospi­ tals were dangerous, especially compared with provincial facilities. She bolstered this contention with statistics pub­ lished in William Fair's Registrar-General report, which claimed that 24 London hospitals had mortality rates ex­ ceeding 90%, whereas rural hospitals had an average mor­ tality rate of 13%. Farr had calculated mortality rates by dividing the total number of patients who died through­ out the year by the number of inpatients on a single day. When calculated as the annual number of deaths divided by the total number of inpatients during the year, the mortality rate of London hospitals was 10%. A raucous debate erupted in the London medical press over how best to calculate hospital mortality rates. Critics claimed that Farr had not adjusted for differences in severity of illness between urban and rural hospitals and that his figures would mislead the public. Farr and Nightingale, in turn, criticized the poor quality of hospital data. This story rein­ forces the need to understand the methodologic deriva­ tion of statistics intended to compare provider quality.