Background Data on the development of Covid‐19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic. Methods Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017–2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID‐care services as retrieved from a national database. Results Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID‐cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID‐specific causes. Conclusions During the 2017–2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.
Background: General practitioners (GPs) are increasingly confronted with patients with both intellectual disabilities (ID) and mental health disorders (MHD). Currently, the care provided to these patients is found to be insufficient, putting them at risk of developing more severe MHD. Improving the quality of GP care will improve the whole of mental healthcare for this patient group. Therefore, an overview of the content and quality of care provided to them by the GP might be helpful. Aim: To provide an up-to-date literature overview of the care provided by GPs to patients with ID and MHD, identify knowledge gaps, and inform research, practice, and policy about opportunities to improve care. Design: Scoping review. Method: Pubmed, PsychINFO, Embase, and grey literature were searched for publications concerning patients with ID, MHD, and primary care. Selected publications were analysed qualitatively. Results: One hundred publications met the inclusion criteria. Five overarching themes were identified: GP roles, knowledge and experience, caregiver roles, collaboration, and a standardized approach. The results show GPs’ vital, diverse, and demanding roles in caring for patients with both ID and MHD. GPs experience problems in fulfilling their roles, and gaps are identified regarding effective GP training programmes, applicable guidelines and tools, optimal collaborative mental healthcare, and corresponding payment models. Conclusion: The improvement required in the current quality of GP care to patients with ID and MHD can be achieved by bridging the identified gaps and initiating close collaborations between care professionals, policymakers, and organizational managers.
Increasingly, perspectives of people with intellectual disabilities (ID) are included in research concerning their health (Gibbs, Brown,
T he global COVID-19 pandemic has had a disproportionate effect on persons in long-term care (1), particularly persons with intellectual disabilities (2). Persons with intellectual disabilities experience many limitations in adaptive behavior and intellectual functioning that occur before adulthood (3). Consequently, their ability to understand and adhere to restrictive measures is impaired. Social distancing is challenging for persons with intellectual disabilities living in group homes or during close contact when receiving care (4-8). In addition, genetic syndromes that cause intellectual disabilities, such as Down syndrome, might contribute to the susceptibility to and severity of . Persons with intellectual disabilities often have concurrent conditions, such as diabetes, cardiovascular problems, and being overweight (body mass index [BMI] >25 kg/m 2 ) (10,13-16); they also are at increased risk for death from respiratory problems (17). Furthermore, COVID-19 pandemic risks can exacerbate health disparities among persons with intellectual disabilities (2,18).Previous studies have shown substantially higher COVID-19 case rates, more hospital admissions, and higher case-fatality rates (CFRs) for persons with intellectual disabilities than for the general population, but those studies included relatively small sample sizes or were conducted during distinct periods of the pandemic (6,(9)(10)(11)(19)(20)(21)(22). Besides the identified risk factors, intellectual disability also appeared to be an independent risk factor for severe COVID-19 outcomes, although the extent to which disability severity contributes is still unclear (9,12,19,20). Similarly, whereas pathogenicity of post-COVID-19 conditions is still emerging, specific characteristics among persons with intellectual disabilities and persistent post-COVID-19 symptoms are potentially unrecognized and unclear (23).Because population surveillance for COVID-19 does not include information about disabilities, complete and integrated information about this vulnerable subgroup is lacking and potentially contributing to growing health disparities. To delineate specific factors driving excess risks for persons with intellectual disabilities infected with SARS-CoV-2, more information on the dynamic course of the outbreak, risk
Background General practitioners (GPs) are increasingly confronted with people with both mild intellectual disability (MID) and mental health (MH) problems. Little is known about the type of MH problems for which people with MID visit their GP and the care provided. Objectives To identify the type and prevalence of MH disorders and MH-related complaints in people with MID in primary care and care provided, compared to people without ID. Methods By linking the Netherlands Institute for Health Services Research’s primary care databases, comprising electronic health records, with Statistic Netherlands’ social services and chronic care databases, we identified 11,887 people with MID. In this four-year retrospective study, MH-related International Classification of Primary Care (ICPC) codes and care characteristics were compared between people with MID and without ID. Results Of the people with MID, 48.8% had MH problems recorded vs. 30.4% of the people without ID, with significant differences in substance abuse, suicide attempts, and psychosis. Of the MID group, 80.3% were not registered by their GP with the ICPC code mental retardation. GPs provided more care to people with MID and MH problems than people without ID but with MH-problems regarding consultations (median 6.4 vs. 4.0 per year) and variety of prescribed medications (median 2.7 vs. 2.0 per year). Conclusion In primary care, the prevalence of MH problems and care provided is high in people with MID. To improve primary mental healthcare for this group, it is essential to increase GPs’ awareness and knowledge on the combination of MID and MH.
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