Environmental Modifications and Supports for Participation Among Adults Aging With Intellectual and Developmental Disabilities: A Scoping Review

Abstract

Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face barriers to participation in meaningful occupation; moreover, the increased life expectancy of adults with IDD intensifies the need for age- and environment-specific support. Objective: To map and categorize transdisciplinary literature on environmental modifications and supports for adults aging with IDD. Data Sources: Studies published between January 1, 2000, and January 1, 2019, identified through PubMed and Scopus. Study Selection and Data Collection: Eleven articles met the inclusion criteria and contained information specific to occupational participation based on environmental modification (e.g., physical space, technology, universal design, type of living setting), social supports (e.g., family members, caretakers, peer groups, health care professionals, policies, organizational infrastructure), or both and adults age ≥35 yr with IDD. Findings: Eleven studies met the criteria for this scoping review. Thematic coding was used to examine the articles within one or more themes: definition of need, environmental risk and assessment, environmental setting, intervention and program planning, use of technology, and bureaucracy. Conclusions and Relevance: This review highlights collective and individual outcomes in the areas of assessment, intervention, and advocacy. Further research is needed within the scope of occupational therapy and disability studies that examines environmental factors and participation outcomes in this population. What This Article Adds: The authors define the interconnectedness of adults aging with IDD and environmental factors, identify barriers to participation, and guide occupational therapy practitioners’ logic on how to positively affect environmental change and supports through intervention.

Predictors of Productivity and Leisure for People Aging with Intellectual Disability

“…In recent years, increased attention has been given to models that support a person to continue living in their preferred living environment, often known as “aging in place.” Washington et al (2021) concluded that occupational therapists have an important role in supporting adults aging with ID to age in place. In Ireland, this is reflected in policies such as the National Positive Aging Strategy (Department of Health, 2013).…”

“…Descriptive statistics in this study showed many people aging with ID don't have friends outside of their home, and require support for ADL. Washington et al (2021) reported there are opportunities for occupational therapists to work with adults aging with ID to focus on developing friendships in and outside the home, and supporting participation within the community. Leisure activities are a valuable way to maintain and expand social networks through participation in occupation within communities.…”

“…These studies examined adults aged 18 years and older with an ID, and focused on identifying current and future areas for occupational therapy practice development. Other scoping reviews have explored the role of environmental supports in the lives of people aging with ID (Washington et al, 2021). Mahoney et al (2016) examined the occupational engagement of adults with ID participating in a day program in the United States.…”

Disability Studies and Occupational Therapy: Renewing the Call for Change

“…Critical theories used in research turn the gaze from the individual to society, thereby illuminating social structures that "maintain a status quo of power" (Scotland, 2012, p. 13). Studies in this special issue take a critical approach that interrogates broadly accepted concepts or practices in the field or acknowledges power structures, such as ableism and sanism, that oppress disabled people (Bathje et al, 2021;Holler et al, 2021;Magasi et al, 2021;McArthur & Gill, 2021;Rabaey et al, 2021;Sheth et al, 2021;VanPuymbrouck et al, 2021;Washington et al, 2021).…”

“…Implications for occupational therapy outlined across the articles in this special issue call on the profession and individual practitioners to engage in advocacy. The authors recommend facilitating the development of client selfadvocacy (Bathje et al, 2021;Rabaey et al, 2021;Stasell & Bathje, 2021), collaborating with and referring to programs and organizations that support community participation and occupational justice (Bathje et al, 2021;Sheth et al, 2021;Wasmuth et al, 2021), and advocating for disability benefits, accessible community and health care services, and equitable policies (McArthur & Gill, 2021;Njelesani et al, 2021;Stasell & Bathje, 2021;VanPuymbrouck et al, 2021;Washington et al, 2021). In addition, some authors call for the profession and its educators, researchers, practitioners, and students to confront implicit bias (Friedman & VanPuymbrouck, 2021) and power dynamics (Magasi et al, 2021) to more authentically infuse DS priorities into practice.…”