Health Conditions Associated with Aging and End of Life of Adults with Down Syndrome

Abstract

Expectations for the life course of individuals with Down syndrome (DS) have changed, with life expectancy estimates increasing from 12 in 1949 to nearly 60 years of age today (Bittles & Glasson, 2004;Penrose, 1949). Along with this longer life expectancy comes a larger population of adults with DS who display premature age-related changes in their health. There is thus a need to provide specialized health care to this aging population of adults with DS who are at high risk for some conditions and at lower risk for others. This review focuses on the rates and contributing factors to medical conditions that are common in adults with DS or that show changes with age. The review of medical conditions includes the increased risk for skin and hair changes, early onset menopause, visual and hearing impairments, adult onset seizure disorder, thyroid dysfunction, diabetes, obesity, sleep apnea and musculoskeletal problems. The different pattern of conditions associated with the mortality of adults with DS is also reviewed. KeywordsDown syndrome; physical health; aging; mortality A highly significant change in the survival of people with Down syndrome (DS) has occurred during the last two generations. In the 1940s, the average life expectancy for individuals with DS was 12 years (Penrose, 1949). With medical breakthroughs and improvements in services, individuals with DS now enjoy life expectancies into their 60s (Bittles & Glasson, 2004). As a result, we are now witness to the first generation of individuals with DS who have benefited from a revolution during their lifetime of better knowledge, health care, advocacy and services (Yang, Rasmussen & Friedman, 2002). Along with this longer life expectancy comes a larger population of adults with DS who display premature age-related changes in their health. There is thus a need to provide specialized health care to this aging population of adults with DS who are at high risk for some conditions and at lower risk for others. Adults with DS are at age-related increased risk for dementia, skin and hair changes, early onset menopause, visual and hearing impairments, adult onset seizure disorder, thyroid dysfunction, diabetes, obesity, sleep apnea and musculoskeletal problems. Along with these increased risks for some conditions comes a different pattern of conditions associated with the mortality of adults with DS. This review focuses on the rates and contributing factors to medical conditions that are common in adults with DS or that show changes with age. Skin and hair changesAdults with DS experience a number of dermatological and autoimmune symptoms characteristic of accelerated aging, including premature graying of the hair, hair loss and wrinkling of the skin (Lott, 1982). Significant differences in the skin and chronological age of the individual have been found in post-mortem examinations of the skin of adults with DS NIH Public Access

Adults with Down Syndrome: Characterization of a Portuguese Sample

“…17 Comparing to these studies, we found lower rates of osteoporosis (1.7%), obesity (2.3%) and skin conditions (1.1%). DS adults seem to be at lower risk for malignant solid tumours 29 than the general population. In fact, none of our DS patients had been diagnosed with cancer malignancy.…”

“…14,17,28 Other studies have described additional medical issues in DS adults, including skin and hair diseases, early-onset menopause, visual and hearing impairments, pulmonary disease, obstructive sleep apnoea, musculoskeletal disease, type 1 diabetes mellitus, overweight and obesity, gastroesophageal reflux disease, celiac disease and an age-related increased risk for dementia. 14,17,[25][26][27]29,30 The likelihood of epilepsy and seizures increases with age, especially if there is comorbid dementia, but is also related to the age of onset of the disease. 29 In some studies, older adults with DS were found to have a higher incidence of respiratory disease and congenital anomalies, 29 dementia, hypothyroidism, skin problems, 17 cardiac disease, neurologic disease as well as shorter height and stature.…”

“…14,17,[25][26][27]29,30 The likelihood of epilepsy and seizures increases with age, especially if there is comorbid dementia, but is also related to the age of onset of the disease. 29 In some studies, older adults with DS were found to have a higher incidence of respiratory disease and congenital anomalies, 29 dementia, hypothyroidism, skin problems, 17 cardiac disease, neurologic disease as well as shorter height and stature. 24 Osteoporosis was found more frequently in a younger sample (< 50 years old).…”

Szemléletváltozás a Down-szindrómás szívbetegek szívsebészeti kezelésében, 1974–2016

“…A hallás csökkenése, a cataracta kialakulá-sa, az atlantoaxialis gerincinstabilitás is jelentős lehet 30 éves kor előtt, és már ekkor elkezdődhet és fokozódhat a pszichomotoros retardáció és az Alzheimer-kór is. Esbensen [12] vizsgálatai szerint előtérbe kerülnek a bőr-és hajelváltozások, a korai menopauza lehetősége, az epilepsziakészség, a hypothyreosis, a diabetes, az obesitas, az alvási apnoe és a gerincterhelhetőségi problémák.…”

The Health-Related Quality of Life of Adults with Down Syndrome

“…Anwar, Walker, and Frier (1998) found that Type I diabetes occurs at a rate of 1.4-10.6% of individuals with DS in an area of Scotland, while the estimated incidence of Type 1 diabetes was 0.18-.3% in the general population of the United Kingdom. Individuals with DS do not appear to be at an increased risk of Type 2 diabetes (Esbensen, 2010). In a study of 440 children with DS, 0.9% of their parents reported diabetes (Roizen et al, 2013); however the occurrence of diabetes was not specified as Type 1 or Type 2.…”