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Walaszek A, Albrecht T, LeCaire T, Sayavedra N, Schroeder M, Krainer J, Prichett G, Wilcenski M, Endicott S, Russmann S, Carlsson CM, Mahoney J. Training professional caregivers to screen for report of cognitive changes in persons with intellectual disability. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12345. [PMID: 36016831 PMCID: PMC9398220 DOI: 10.1002/trc2.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/13/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
Introduction By age 60, 60% of adults with Down syndrome (DS) have dementia. Detecting dementia in persons with intellectual disability (ID) can be challenging because their underlying cognitive impairment can confound presentation of dementia symptoms and because adults with ID may have difficulty reporting symptoms. The National Task Group Early Detection Screen for Dementia (NTG-EDSD) was developed to aid detection of report of cognitive impairment in adults with ID. We implemented an educational curriculum using the NTG-EDSD and evaluated the impact of the intervention on professional caregivers' self-assessed capacity to identify persons with ID and dementia. Methods We held five in-person training sessions for professional caregivers of persons with ID, partnering with various managed care organizations and social services agencies. We assessed knowledge and attitudes at baseline; immediately after training; and 1 week, 1 month, and 6 months after training. Results A total of 154 direct care workers, case managers, health-care providers, and other social services staff attended the trainings. Satisfaction with the NTG-EDSD training was high; 94% of attendees agreed or strongly agreed that they could use the NTG-EDSD with their clients. After training, attendees reported a marked increase in confidence in their ability to track various health circumstances and detect functional decline in their clients, although some gains were not sustained over time. As a result of the training, one managed care organization made the NTG-EDSD a standard part of its assessment of adults with DS starting at age 40. Discussion Social services and health-care professionals can learn to document signs of cognitive decline in adults with ID using the NTG-EDSD. Attendees were highly satisfied with the training, experienced an increase in confidence in their care of persons with ID, and found the NTG- EDSD feasible to use. Because not all gains were sustained over time, booster trainings may be necessary.
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Affiliation(s)
- Art Walaszek
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute Madison Wisconsin USA
| | | | | | - Noelia Sayavedra
- University of Wisconsin Population Health Institute Madison Wisconsin USA
| | | | - Jody Krainer
- Wisconsin Alzheimer's Institute Madison Wisconsin USA
| | | | | | - Sarah Endicott
- University of Wisconsin School of Nursing Madison Wisconsin USA
| | | | - Cynthia M Carlsson
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Wisconsin Alzheimer's Institute Madison Wisconsin USA
| | - Jane Mahoney
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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Lee EY, Neil N, Friesen DC. Support needs, coping, and stress among parents and caregivers of people with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104113. [PMID: 34678707 DOI: 10.1016/j.ridd.2021.104113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Caregiving for an individual with Down syndrome (DS) results in needs that can impact the stress and wellbeing of the entire family. These needs may also vary over the lifespan of the individual with DS. Coping strategies may affect stress levels and reduce the effects of unmet needs. AIMS (1) Do important unmet needs (IUNs), coping, and stress vary between parents and caregivers of adults compared to children with DS? (2) What is the relationship between stress, coping, and needs for parents and caregivers of people with DS? METHODS 152 parents and caregivers of people with DS of various age groups completed an online survey including: demographic information, Family Needs Survey - Revised, Questionnaire on Resources and Stress - Friedrich Version, and the Family Crisis Oriented Personal Scales. Comparisons of IUNs, coping and stress between caregivers of adults and caregivers of children with DS were conducted. Relationships between stress, coping, and needs were explored using correlations and multiple regression. RESULTS IUNs were greater for parents and caregivers of children than for parents and caregivers of adults. Stress level was positively correlated with the number of IUNs, and great use of coping strategies were associated with less stress and fewer IUNs. The coping styles that predicted stress were different for caregivers of children versus adults. CONCLUSION The results of this research highlight the importance of considering age in relation to needs and stress among families with a child with DS. Fostering effective coping strategies, including acquiring social support, is likely to support positive outcomes for caregivers of people with DS.
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Affiliation(s)
- Esther Yejin Lee
- Faculty of Education, Western University, 1137 Western Road, London, ON, N6G 1G7, Canada
| | - Nicole Neil
- Faculty of Education, Western University, 1137 Western Road, London, ON, N6G 1G7, Canada.
| | - Deanna C Friesen
- Faculty of Education, Western University, 1137 Western Road, London, ON, N6G 1G7, Canada
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Abstract
INTRODUCTION Ireland has an ageing population of persons with intellectual disability (ID), autism spectrum disorder (ASD) and both (ID/ASD). Despite this, little is known about the prevalence of ASD and its effect on functional outcomes, psychiatric comorbidity or diagnostic issues in an older population with ID. This article reviews the literature on older adults with ID/ASD and identifies opportunities for future research in this population. METHOD The authors searched the Medline, Pubmed, Embase, CINAHL and PsychInfo databases using the search terms using key words: (older adults) AND (ID OR mental retardation OR learning disability) AND (autism OR ASD). After excluding articles for relevance, a scoping review was carried out on the results retrieved. RESULTS Of the 1227 articles retrieved from the literature on ID and autism/ASD in older adults, 85 articles were relevant to an adult population with ID/ASD. The data were collated and are presented covering domains of diagnosis, prevalence, psychiatric comorbidities and functional outcomes. CONCLUSIONS Despite increased prevalence in childhood ASD in the last 20 years, there is a lack of research regarding adults, especially older adults, with ASD, up to half of whom will have some level of ID. The existing literature suggests that older adults with ID/ASD may have reduced functional independence, increased psychiatric comorbidity and psychotropic prescribing and more behavioural presentations than the older population generally or those with ID only. There is a need for longitudinal data to be collected on this ageing population so that care and management needs can be met in the future.
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Brotman S, Sussman T, Pacheco L, Dickson D, Lach L, Raymond É, Deshaies MH, Freitas Z, Milot É. The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:547-556. [PMID: 33900151 DOI: 10.1080/01634372.2021.1920537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
This commentary addresses barriers to care among older adults living with neurodiversity (ND), and their aging family carers in the context of the COVID-19 pandemic in Canada. Factors contributing to inequities are described and the significant negative consequences of current policy decisions on the social and mental health of older adults with ND and their aging family carers are highlighted. The commentary calls for a collective social work response that highlights the critical role of support and advocacy necessary to redress social exclusion.
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Affiliation(s)
- Shari Brotman
- McGill School of Social Work, Research Member of the Centre for Research and Expertise in Social Gerontology (CREGÉS), Montréal, Québec, Canada
| | - Tamara Sussman
- McGill School of Social Work, and Research Member of CREGÉS, Montréal, Québec, Canada
| | - Laura Pacheco
- McGill School of Social Work, Parenting Services, Direction DI-TSA-DP CIUSSS Du Ouest-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Daniel Dickson
- Political Science, Concordia University and Student Member of CREGÉS, Montréal, Québec, Canada
| | - Lucyna Lach
- McGill School of Social Work, Montréal, Québec, Canada
| | - Émilie Raymond
- École De Travail Social Et De Criminologie, Université Laval and Research Member of CREGÉS, Québec City, Québec, Canada
| | - Marie-Hélène Deshaies
- École De Travail Social Et De Criminologie, Université Laval, Québec City, Québec, Canada
| | - Zelda Freitas
- McGill School of Social Work, Coordinator of Caregiving, CREGÉS/CIUSSS Centre-Ouest-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Élise Milot
- École De Travail Social Et De Criminologie, Université Laval, Québec City, Québec, Canada
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McCarron M, McCallion P, Coppus A, Fortea J, Stemp S, Janicki M, Wtachman K. Supporting advanced dementia in people with Down syndrome and other intellectual disability: consensus statement of the International Summit on Intellectual Disability and Dementia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:617-624. [PMID: 29781149 DOI: 10.1111/jir.12500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 12/31/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The International Summit on Intellectual Disability and Dementia (Glasgow, Scotland; October 2016) noted that advanced dementia can be categorised as that stage of dementia progression characterised by significant losses in cognitive and physical function, including a high probability of further deterioration and leading to death. METHOD The question before the Summit was whether there were similarities and differences in expressions of advanced dementia between adults with intellectual disability (ID) and adults in the general population. RESULTS The Summit noted challenges in the staging of advanced dementia in people with ID with the criteria in measures designed to stage dementia in the general population heavily weighted on notable impairment in activities of daily living. For many people with an ID, there is already dependence in these domains generally related to the individuals pre-existing level of intellectual impairment, that is, totally unrelated to dementia. Hence, the Summit agreed that as was true in achieving diagnosis, it is also imperative in determining advanced dementia that change is measured from the person's prior functioning in combination with clinical impressions of continuing and marked decline and of increasing co-morbidity, including particular attention to late-onset epilepsy in people with Down syndrome. It was further noted that quality care planning must recognise the greater likelihood of physical symptoms, co-morbidities, immobility and neuropathological deterioration. CONCLUSIONS The Summit recommended an investment in research to more clearly identify measures of person-specific additional decline for ascertaining advanced dementia, inform practice guidelines to aid clinicians and service providers and identify specific markers that signal such additional decline and progression into advanced dementia among people with various levels of pre-existing intellectual impairment.
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Affiliation(s)
- M McCarron
- School of Nursing and Midwifery Studies, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - A Coppus
- University Medical Center, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - J Fortea
- Fundacio Catalana per a la Recerca i la Innovacio, Barcelona, Catalunya, Spain
| | | | - M Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - K Wtachman
- Faculty of Health Sciences and Sport, Stirling, Scotland
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Moro TT, Savage TA, Gehlert S. Agency, social and healthcare supports for adults with intellectual disability at the end of life in out-of-home, non-institutional community residences in Western nations: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1045-1056. [PMID: 28585240 DOI: 10.1111/jar.12374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The nature and quality of end-of-life care received by adults with intellectual disabilities in out-of-home, non-institutional community agency residences in Western nations is not well understood. METHOD A range of databases and search engines were used to locate conceptual, clinical and research articles from relevant peer-reviewed journals. RESULTS The present authors present a literature review of the agency, social and healthcare supports that impact end-of-life care for adults with intellectual disabilities. More information is needed about where people with intellectual disabilities are living at the very end of life and where they die. CONCLUSIONS The support needs for adults with intellectual disabilities will change over time, particularly at the end of life. There are some areas, such as removing barriers to providing services, staff training, partnerships between agencies and palliative care providers, and advocacy, where further research may help to improve the end-of-life care for adults with intellectual disabilities.
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Affiliation(s)
- Teresa T Moro
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Teresa A Savage
- Department of Women, Children, and Family Health Science, College of Nursing, Chicago, IL, USA
| | - Sarah Gehlert
- E. Desmond Lee Professor of Racial and Ethnic Diversity, George Warren Brown School of Social Work, St. Louis, MO, USA
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Frank AO, De Souza LH. Problematic clinical features of children and adults with cerebral palsy who use electric powered indoor/outdoor wheelchairs: A cross-sectional study. Assist Technol 2016; 29:68-75. [DOI: 10.1080/10400435.2016.1201873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Andrew O. Frank
- Stanmore Specialist Wheelchair Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK (since disbanded)
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| | - Lorraine H. De Souza
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
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Zeilinger EL, Stiehl KAM, Weber G. A systematic review on assessment instruments for dementia in persons with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3962-3977. [PMID: 24025441 DOI: 10.1016/j.ridd.2013.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
AIM This work describes an extensive systematic literature review on assessment instruments for dementia in persons with intellectual disability (ID). Existing instruments for the detection of dementia in persons with ID were collected and described systematically. This allows a direct and quick overview of available tools. Additionally, it contributes to the availability and usability of information about these instruments, thus enhancing further developments in this field. METHODS A systematic literature search in five databases (CINAHL, PsycInfo, PubMed, Scopus, and Web of Science) was conducted. In order to include gray literature an invisible college approach was used. Relevant studies were identified and selected using defined inclusion and exclusion criteria. After the selection process all instruments were coded and classified. It was determined which concepts they assess, whether they were especially developed or adapted for persons with ID, and whether they were designed to assess dementia. The selection of relevant papers, as well as the coding of instruments was done independently by two researchers. RESULTS In total, 97 records met the search criteria. Out of these, 114 different instruments were extracted. There were 79 instruments to be completed by the person with ID, and 35 informant-based instruments. Additionally, four test batteries were found. Some of these instruments were neither designed for the assessment of dementia, nor for persons with ID. CONCLUSIONS There are a variety of different tools used for the assessment of dementia in ID. Nevertheless, an agreed-upon approach or instrument is missing. Establishing this would improve the quality of assessment in clinical practice, and benefit research. Data collected would become comparable and combinable, and allow research to have more informative value.
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Affiliation(s)
- Elisabeth L Zeilinger
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria.
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Moran JA, Rafii MS, Keller SM, Singh BK, Janicki MP. The National Task Group on Intellectual Disabilities and Dementia Practices consensus recommendations for the evaluation and management of dementia in adults with intellectual disabilities. Mayo Clin Proc 2013; 88:831-40. [PMID: 23849993 DOI: 10.1016/j.mayocp.2013.04.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 11/27/2022]
Abstract
Adults with intellectual and developmental disabilities (I/DD) are increasingly presenting to their health care professionals with concerns related to growing older. One particularly challenging clinical question is related to the evaluation of suspected cognitive decline or dementia in older adults with I/DD, a question that most physicians feel ill-prepared to answer. The National Task Group on Intellectual Disabilities and Dementia Practices was convened to help formally address this topic, which remains largely underrepresented in the medical literature. The task group, comprising specialists who work extensively with adults with I/DD, has promulgated the following Consensus Recommendations for the Evaluation and Management of Dementia in Adults With Intellectual Disabilities as a framework for the practicing physician who seeks to approach this clinical question practically, thoughtfully, and comprehensively.
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Affiliation(s)
- Julie A Moran
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Chukoskie L, Townsend J, Westerfield M. Motor Skill in Autism Spectrum Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 113:207-49. [DOI: 10.1016/b978-0-12-418700-9.00007-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Shooshtari S, Naghipur S, Zhang J. Unmet Healthcare and Social Services Needs of Older Canadian Adults With Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2012. [DOI: 10.1111/j.1741-1130.2012.00346.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Janicki MP. Quality outcomes in group home dementia care for adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:763-776. [PMID: 21504494 DOI: 10.1111/j.1365-2788.2011.01424.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dementia, as a public health challenge, is a phenomenon vexing many care organisations providing specialised residential and family supports for older adults with intellectual disabilities. With increasing survivorship to ages when risk is greatest, expectations are that many more adults in service will present with cognitive decline and diagnosed dementia as they grow older. As persons with dementia present with new needs, there is often a call for a reorientation of services. With respect to residential supports, agencies may need to adapt current methods of care, with particular attention to providing care in small group homes. However, dementia-related care also must be quality care and applicable standards need to be met. METHOD Reviewed were relevant policy and practice organisational guidelines and applied research literature addressing components of care and service provision that are critical to quality care and that were consistent with professional practice. RESULTS Examined were the nuances and contributing factors of quality dementia care and it was proposed that quality of care criteria need to be universally applicable and serve as a framework for adapting extant residential environments and make them 'dementia-capable'. CONCLUSIONS It is proposed that efforts to evaluate dementia-related care provision with respect to quality need to consider quality of care provision components such as (1) clinically relevant early and periodic assessment; (2) functional modifications in the living setting; (3) constructive staff education and functionality for stage-adapted care; and (4) flexible long-term services provision that recognises and plans for progression of decline and loss of function.
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Affiliation(s)
- M P Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois 60608-6904, USA.
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Heller T, Janicki MP, Marks B, Hammel J, Factor A. Brief Report: State of the Science Symposium on Aging and Developmental Disabilities1. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2008. [DOI: 10.1111/j.1741-1130.2008.00189.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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