Health characteristics and health services utilization in older adults with intellectual disability living in community residences

Janicki, Matthew P.; Davidson, Philip W.; Henderson, Charles; McCallion, Philip; Taets, J. D.; Force, Lawrence T.; Sulkes, Stephen; Frangenberg, E.; Ladrigan, Phyllis M.

doi:10.1046/j.1365-2788.2002.00385.x

Cited by 231 publications

(192 citation statements)

References 22 publications

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“…Problems in presentation or in the care of mental health concerns in persons with ID include atypical presentation, communication difficulties, lack of continuity of care, no valid diagnostic system, difficulties in accessing care, and inadequate training of health professionals. Several studies noted a decrease in prevalence of mental health concerns with age [Janicki et al, 2002;Merrick et al, 2004], which is consistent with findings for the population of US adults with disabilities generally [Drum et al, 2003], although contradictory findings were noted in Australia [Torr and Chiu, 2002].…”

Section: Mental Healthsupporting

confidence: 74%

“…Two studies used similar surveys completed by caregivers to ascertain health conditions of large samples of older adults with ID in the United States [Janicki et al, 2002] and in Israel [Merrick et al, 2004]. Both studies reported health status ratings decreasing and prevalence of most adverse health conditions increasing with age in a pattern similar to the general population.…”

Section: Studies Using Surveysmentioning

confidence: 99%

“…The potential underdiagnosis of chronic conditions that require ongoing management (e.g., hypertension, diabetes, arthritis) was implicated in several recent studies [Janicki et al, 2002;Lewis et al, 2002;Merrick et al, 2004], validating the earlier findings of Beange et al [1995]. A small sample study of preventive care and health promotion practices in the United Kingdom found that, compared with matched non-ID controls, persons with ID reported more preventive care and health promotion counseling in the past year (health check, blood pressure, eye, hearing, contraception/ sex, smoking, diet, alcohol, and exercise).…”

Section: Disparities In Preventive Care and Health Promotionmentioning

confidence: 99%

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A cascade of disparities: Health and health care access for people with intellectual disabilities

Krahn

Hammond

Turner

2006

Ment. Retard. Dev. Disabil. Res. Rev.

614

534

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People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.

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Section: Mental Healthsupporting

confidence: 74%

Section: Studies Using Surveysmentioning

confidence: 99%

Section: Disparities In Preventive Care and Health Promotionmentioning

confidence: 99%

See 1 more Smart Citation

A cascade of disparities: Health and health care access for people with intellectual disabilities

Krahn

Hammond

Turner

2006

Ment. Retard. Dev. Disabil. Res. Rev.

614

534

View full text Add to dashboard Cite

show abstract

“…Primarily, the included studies were cross-sectional observational (n = 31 81,82,98,[100][101][102]104,106,[109][110][111]114,116,119,121,124,[126][127][128][129][130][131][132][133][134][135]137,139,142,143,145 ). The remaining studies involved retrospective database or medical records data (n = 22 [83][84][85][86][87][88][89]94,95,99,107,113,115,117,118,120,122,123,136,…”

Section: Study Characteristicsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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“…Individuals with MR comprise a subgroup that is considered predominantly sedentary and at elevated risk for health problems associated with inactivity [Rimmer and Braddock, 2002]. People with MR have higher rates of diabetes and high blood pressure than adults without MR [Rimmer et al, 1995;Draheim et al, 2002a;Janicki et al, 2002], low physical fitness levels [Graham and Reid, 2000;Fernhall and Pitetti, 2001], and high obesity rates . These health profiles are attributed to and suggestive of highly sedentary behavior, but there is a paucity of data to support this conclusion.…”

mentioning

confidence: 99%

Health‐promoting physical activity of adults with mental retardation

Stanish

Temple

Frey

2006

Ment. Retard. Dev. Disabil. Res. Rev.

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This literature review describes the physical activity behavior of adults with mental retardation consistent with the U.S. Surgeon General's recommendation of 30 minutes of moderate intensity physical activity on 5 or more days per week. The proportion of participants achieving this criterion ranges from 17.5 to 33%. These data are likely to be generous estimates of activity as individuals included in physical activity studies to date have been relatively young and healthy volunteers with mild to moderate limitations. Major sources of physical activity were walking and cycling for transport, chores and work, dancing, and Special Olympics. There is a pressing need to conduct studies using appropriately powered representative samples and to validate measures that assess physical activity less directly; including methodologies in which proxy respondents are used. Accurate information about existing patterns of behavior will enhance the development of effective strategies to promote physical activity among persons with mental retardation.

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Health characteristics and health services utilization in older adults with intellectual disability living in community residences

Abstract: These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases.

Cited by 231 publications

References 22 publications

A cascade of disparities: Health and health care access for people with intellectual disabilities

A cascade of disparities: Health and health care access for people with intellectual disabilities

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Health‐promoting physical activity of adults with mental retardation

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