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Jacinto M, Rodrigues F, Monteiro D, Diz S, Morquecho Sánchez R, Morales-Sánchez V, Matos R, Amaro N, Antunes R. Effects of combined training in individual with Intellectual and Developmental Disabilities: a systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2024:1-16. [PMID: 39046088 DOI: 10.1080/09638288.2024.2381598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF THE ARTICLE This study aims to evaluate the literature, peer-reviewed clinical trials investigating the effects of combined exercise interventions on individuals with Intellectual and Developmental Disabilities. MATERIALS AND METHODS Various databases, using various descriptors and Boolean operators were utilized. RESULTS Eight studies meet the eligibility criteria. Regarding the anthropometric measures/body composition variable, the meta-analysis revealed that combined physical exercise did not have a significant effect (standard mean difference (SMD) = -0.16; 95% CI, -0.34 to 0.03; Z = 1.68; p = 0.09). For the lipid profile variable, the combined exercise interventions did not show a significant effect (SMD = -0.07; 95% CI, -0.43 to 0.29; Z = 0.38; p = 0.71). Combined exercise training had a significant effect on increasing functional capacity (SMD = 0.28; 95% CI, 0.01 to 0.54; Z = 2.03; p = 0.04), cardiorespiratory function (SMD = 0.80; 95% CI, 0.34 to 1.26; Z = 3.41; p ≤ 0.001), and strength (SMD = 0.77; 95% CI, 0.45 to 1.08; Z = 4.78; p ≤ 0.001). CONCLUSIONS Participants from the intervention group that took part in combined exercise training showed a higher probability of improving their functional, cardiorespiratory, and strength capacity compared to the control group.
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Affiliation(s)
- Miguel Jacinto
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Filipe Rodrigues
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Diogo Monteiro
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Susana Diz
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Raquel Morquecho Sánchez
- School of Sports Organization, Autonomous University of Nuevo León, San Nicolás de los Garza, Mexico
| | - Veronica Morales-Sánchez
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Rui Matos
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Nuno Amaro
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
| | - Raul Antunes
- ESECS, Polytechnique of Leiria, Leiria, Portugal
- Research Center in Sport, Health, and Human Development (CIDESD), Covilhã, Portugal
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Hidzir H, Hairi NN, Kamaruzzaman SB, Awang H. Prevalence and Factors Associated With Frailty Among Community-Dwelling Middle-Aged and Older Adults in Malaysia. Asia Pac J Public Health 2024; 36:486-492. [PMID: 38840495 DOI: 10.1177/10105395241257987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Frailty is identified in middle-aged and older adults, and frail individuals are vulnerable to dependency and poor health. In this study, we analyzed nationally representative data that includes 5592 participants aged 40 years and above to determine the prevalence and factors associated with frailty among community-dwelling middle-aged and older adults in Malaysia. Using a 40-item Frailty Index, the overall prevalence of frailty and prefrailty was 19.5% and 64.1%, respectively. A total of 38.6% of older adults (≥60 years) were frail and 56.2% were prefrail. Among middle-aged adults (<60 years), the prevalence of frailty was 10.4% and that of prefrailty was 67.9%. Factors associated with frailty include older age, ethnicity, low education and income level, moderate to poor self-rated health, abdominal obesity, absence of a spouse, and previous history of falls. These findings may serve as evidence for the implementation of a frailty policy and health care planning in Malaysia.
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Affiliation(s)
- Hiziani Hidzir
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatrics, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Halimah Awang
- Social Wellbeing Research Centre, Office of Deputy Vice-Chancellor (Research & Innovation), Universiti Malaya, Kuala Lumpur, Malaysia
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Böhmer MN, Oppewal A, Bindels PJE, van Someren EJW, Festen DAM. Long-term effects of environmental dynamic lighting on sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:620-638. [PMID: 38504557 DOI: 10.1111/jir.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Sleep-wake problems and depressive symptoms are common in people with intellectual disabilities (IDs) and are thought to be related to the unstable sleep-wake rhythm in this population. Previously, we showed that after increasing environmental light exposure, mid-sleep and sleep onset advanced, and mood improved over a period of 14 weeks after installing environmental dynamic light installations in the living room of people with IDs. We invited participants of that short-term study to take part in the current study on sleep-wake rhythm, mood and behaviour in older adults with IDs 1 year after installing environmental dynamic light installations in the common living rooms of six group homes. METHODS A pre-post study was performed from October 2017 to February 2019. We included 45 participants (63.5 ± 8.5 years, 67% female) from six group home facilities who provided data at baseline (9, 4 and 1 weeks prior to installing light installations), short term (3, 7 and 14 weeks after installing light installations) and 1 year (54 weeks after installing light installations). Wrist activity was measured with actigraphy (GENEActiv) to derive the primary outcome of interdaily stability of sleep-wake rhythms as well as sleep estimates. Mood was measured with the Anxiety, Depression and Mood Scale. Behaviour was measured with the Aberrant Behaviour Checklist. RESULTS One year after installing dynamic lighting, we did not find a change in interdaily stability. Total sleep time decreased (β = -25.40 min; confidence interval: -10.99, -39.82), and sleep onset time was delayed (β = 25.63 min; confidence interval: 11.18, 40.08). No effect on mood or behaviour was found. CONCLUSIONS We did not find a change in sleep-wake rhythm, mood or behaviour in older persons with IDs living in care facilities 1 year after installing the light. We did find evidence for a long-term effect on sleep duration and sleep timing. The results have to be interpreted with care as the current study had a limited number of participants. The need for more research on the long-term effects of enhancing environmental light in ID settings is evident.
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Affiliation(s)
- M N Böhmer
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Middin, Care Organization for People with Intellectual Disabilities, Rijswijk, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam, The Netherlands
| | - D A M Festen
- Department of General Practice, Intellectual Disability Medicine Research, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Ipse de Bruggen, Care Organization for People with Intellectual Disabilities, Zoetermeer, The Netherlands
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Grohmann D, Wellsted D, Mengoni SE. Definition, assessment and management of frailty for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13219. [PMID: 38485891 DOI: 10.1111/jar.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management. METHOD Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities. RESULTS Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management. CONCLUSION Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.
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Affiliation(s)
- Dominique Grohmann
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Silvana E Mengoni
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Cruz-Montecinos C, Valderrama-Mejías J, Martínez-Arnau FM, Carrasco JJ, Núñez-Cortés R, Cortés-Amador S. Neuromuscular control of masticatory muscles in people with intellectual disability, middle-aged adults and older adults. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:84-93. [PMID: 37698385 DOI: 10.1111/jir.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Motor control issues are common for people with intellectual disabilities (PWID), resulting in difficulties with basic activities of daily living, including eating. Mastication, which is crucial for digestion and overall health, is poorly understood in this population. PWID shows frailty similar to older people, highlighting the importance of comparing masticatory motor control with older adults. This study compared the neuromuscular control of the masticatory muscles in middle-aged, PWID and older adults. METHODS A cross-sectional analytical design was used. During the mastication task of a carrot piece (2 cm in diameter and weighing 0.5 g), surface electromyography was used to record muscle activity patterns from the right and left masseter and temporalis muscles. Principal component analysis (PCA) was used to assess neuromuscular control. A z-score normalisation of the first component's variance from PCA to identify those individuals with altered neuromuscular control. A mixed ANOVA was performed to assess the interaction between principal components, groups and body composition. RESULTS Thirty PWIDs (aged 35-55 years), middle-aged adults and 32 older adults were recruited. PWID and older adults showed decreased neuromuscular control of the masticatory muscles compared to middle-aged control adults (P < 0.05). PWID had the highest proportion of individuals with altered neuromuscular control of the masticatory muscle (53%) compared to older adults (19%) and middle-aged adults (0%) (P < 0.05). CONCLUSIONS Our results indicate that PWID and older adults have reduced neuromuscular control compared to middle-aged adults. Notably, a significant proportion of the PWID showed altered masticatory muscle control compared to older adults. Further research is needed to explore the potential benefits of masticatory muscle training for PWID.
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Affiliation(s)
- C Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - F M Martínez-Arnau
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - J J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - R Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - S Cortés-Amador
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Voermans MAC, den Boer MC, Wilthagen T, Embregts PJCM. Long-term social restrictions and lack of work activities during the COVID-19 pandemic: impact on the daily lives of people with intellectual disabilities. Disabil Rehabil 2023; 45:4122-4132. [PMID: 36398471 DOI: 10.1080/09638288.2022.2147227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Lockdowns due to the Covid-19 pandemic may have had a disproportionate impact on the daily lives of people with intellectual disabilities. Many of them had to deal with limited social contacts for an extended period. This study explores in depth how people with intellectual disabilities in the Netherlands experienced their daily lives, in particular due to lack of access to regular work activities. MATERIALS AND METHODS Eight participants with intellectual disabilities were interviewed. Interpretative Phenomenological Analysis (IPA) was employed in conducting and analysing interviews. RESULTS AND CONCLUSIONS Analysis yielded three overarching themes that are conceptually linked. Participants experienced a prolonged lack of social connections that resulted in experiences of social isolation and feelings of loneliness. This led to different kinds of struggles: either internal struggles involving negative thoughts or depressive feelings, or a perceived threat to their autonomous position in society. Meanwhile participants had to sustain their sense of self-worth in the absence of work activities. The findings emphasise the importance of social opportunities through the access to work activities for people with intellectual disabilities. Interventions are suggested to help reverse the increased social inequalities and enhance rehabilitation via work activities for people with intellectual disabilities.IMPLICATIONS FOR REHABLITATIONMore awareness may be raised among authorities, employers and the general public about the significant value people with intellectual disabilities attribute to meaningful social connections, in particular through work activities.Also, more awareness may be raised about the potential adverse effects of the loss of work activities and social connections on the quality of life of people with intellectual disabilities.Providing social support to others may help people with intellectual disabilities to construct social valued roles, either in or outside the work situation.Professionals and employers can support people with intellectual disabilities to find opportunities to provide social support to others.It is important to invest in sustainable and innovative post-pandemic community participation initiatives and particularly in accessible post-pandemic employment support, for example by organising paid in-company training placements.It is essential that professionals support people with intellectual disabilities to enhance their sources of resilience and coping strategies, that may have diminished as a result of the pandemic.
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Affiliation(s)
- Moniek A C Voermans
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
- Amarant, Healthcare Organisation for People with Intellectual Disabilities, Tilburg, the Netherlands
| | - Maria C den Boer
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Ton Wilthagen
- Public Law and Governance, Tilburg Law School, Tilburg University, Tilburg, the Netherlands
| | - Petri J C M Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Hirst H, Campbell J, Chamberlin S, Olagunju I, Bird F, Luiselli JK. Assessing inter-rater agreement of the intellectual disability-frailty index short form: A descriptive pilot study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231213436. [PMID: 37922940 DOI: 10.1177/17446295231213436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Frailty is a health concern for many adults with intellectual disability and should be measured to detect at-risk conditions, monitor disease, plan treatment, and gauge mortality. This descriptive pilot study evaluated measurement consistency (inter-rater agreement) of the Intellectual Disability-Frailty Index Short Form among multiple assessors with 20 adults (M age = 48.3 years) who had intellectual and multiple disabilities. Agreement percentages were computed for (a) non-frail, pre-frail, and frail categories derived from total index scores, and (b) each of 17 deficits listed on the form. Low average inter-rater agreement (<85%) was obtained on the index frail categories, several of the assessed deficits had acceptable inter-rater agreement (84.2-100%), while the majority of deficits were associated with moderate-to-low agreement percentages. Though research supports the Intellectual Disability-Frailty Index Short Form as a valid and practical frailty assessment instrument, our findings suggest that full-scale inter-rater agreement must be improved by adding more specificity to the form, clarifying instructions for assessors, and providing competency-based training in assessment implementation.
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Valentin B, Maes-Festen D, Schoufour J, Oppewal A. Sarcopenia predicts 5-year mortality in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1161-1173. [PMID: 37608512 DOI: 10.1111/jir.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have a lower life expectancy than their peers without ID. A contributing factor to the lower life expectancy and early mortality could be sarcopenia: low muscle mass and low muscle function. In the general population, sarcopenia strongly predicts early mortality, but this association is unknown in people with ID. Therefore, this study aims to explore the association between sarcopenia and 5-year mortality in older adults with ID. METHODS In the Healthy Ageing and Intellectual Disabilities (HA-ID) study, the prevalence of sarcopenia was measured at baseline among 884 older adults (≥50 years) with ID. All-cause mortality was measured over a 5-year follow-up period. Univariable and multivariable Cox proportional hazard models were applied to determine the association between sarcopenia (no sarcopenia, pre-sarcopenia, sarcopenia, severe sarcopenia) and early mortality, adjusted for age, sex, level of ID, presence of Down syndrome, and co-morbidity (chronic obstructive pulmonary disease, diabetes type 2 and metabolic syndrome). RESULTS The unadjusted hazard ratio (HR) for sarcopenia was 2.28 [95% confidence interval (CI) 1.48-3.42], P < 0.001), and 2.40 (95% CI 1.40-4.10, P = 0.001) for severe sarcopenia. When adjusted for age, sex, level of ID, and Down syndrome, sarcopenia (HR = 1.72, 95% CI 1.08-2.75, P = 0.022) and severe sarcopenia (HR = 1.86, 95% CI 1.07-3.23, P = 0.028) were significantly associated with early mortality. When additionally adjusted for co-morbidity, the adjusted HR decreased to 1.62 (95% CI 1.02-2.59, P = 0.043) and 1.81 (95% CI 1.04-3.15, P = 0.035) for sarcopenia and severe sarcopenia, respectively. CONCLUSION Sarcopenia is an independent risk factor for early mortality in older adults with ID over a 5-year follow-up period. Our results stress the need to delay the incidence and development of sarcopenia in older adults with ID.
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Affiliation(s)
- B Valentin
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - D Maes-Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Schoufour
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kang MG, Kim OS, Hoogendijk EO, Jung HW. Trends in Frailty Prevalence Among Older Adults in Korea: A Nationwide Study From 2008 to 2020. J Korean Med Sci 2023; 38:e157. [PMID: 37489714 PMCID: PMC10366411 DOI: 10.3346/jkms.2023.38.e157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND We aimed to evaluate the nationwide trend of the prevalence of frailty in older adults in Korea from 2008 to 2020 to inform future geriatric healthcare policies. METHODS The study used data of individuals aged 65 years and older from the Korea National Health and Nutrition Examination Survey, a nationwide repeated cross-sectional survey. Frailty was defined using frailty index, classified as non-frail (frailty index ≤ 0.15), pre-frail (0.15 < frailty index ≤ 0.25), or frail (frailty index > 0.25). RESULTS The study included 17,784 individuals, with the mean age of 72.4 and mean frailty index of 0.2. The prevalence of frailty in older adults in South Korea decreased significantly from 2008 (41.1%) to 2020 (23.1%). The decrease in the frailty index was observed in all age groups (all P < 0.05). As components of frailty index, we found that certain comorbidities, such as dyslipidemia, diabetes mellitus, and cardiovascular disease, have increased over time, while factors such as chewing difficulty, activity limitation, and smoking, have decreased. CONCLUSION The prevalence of frailty in older adults in South Korea has decreased significantly during the study period. Historical improvements in healthcare access and preventive measures may have contributed to this trend.
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Affiliation(s)
- Min-Gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Korea.
| | - Oh Seok Kim
- Department of Geography, Department of Geography Education, Institute of Future Land, Korea University, Seoul, Korea
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life Research Program, Amsterdam, The Netherlands
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Zhao J, Liu YWJ, Tyrovolas S, Mutz J. Exploring the concept of psychological frailty in older adults: a systematic scoping review. J Clin Epidemiol 2023; 159:300-308. [PMID: 37156339 DOI: 10.1016/j.jclinepi.2023.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/18/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We reviewed the existing definitions of psychological frailty and provided a comprehensive overview of the concept and associated measurements. STUDY DESIGN AND SETTING We followed the PRISMA guidelines for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. The eligibility criteria for including studies were developed based on the participants-concept-context framework. We searched the Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, Web of Science and PsycINFO databases, and other sources for relevant studies published between January 2003 and March 2022. RESULTS The final scoping review included 58 studies. Of these, 40 defined psychological frailty, seven provided a novel definition, and 11 focused on the components defining psychological frailty. We proposed four groups of components to better characterize psychological frailty: mood, cognitive, other mental health, and fatigue-related problems. We identified 28 measuring tools across studies, and the Tilburg Frailty Indicator was the most frequently used (46.6%). CONCLUSION Psychological frailty is a complex concept whose definition seems to lack consensus. It could include both psychological and physical features. Depression and anxiety are commonly used to define it. This scoping review outlined future research directions for refining the concept of psychological frailty.
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Affiliation(s)
- Jinlong Zhao
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yat Wa Justina Liu
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Stefanos Tyrovolas
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Noorlandt HW, Korfage IJ, van der Sar LJ, Felet FMAJ, Tuffrey-Wijne I, van der Heide A, Echteld MA. Degree of autonomy in making independent choices by frail older people with intellectual disabilities in a care home: A descriptive ethnographic study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023. [PMID: 37051659 DOI: 10.1111/jar.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/02/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND We aimed to gain more insight into autonomy of older people with intellectual disabilities in a residential care facility in making choices. METHODS We performed a descriptive ethnographic study in a residential facility in the Netherlands for 22 persons, aged 54-89 years, with mild to moderate intellectual disabilities (IQ <70) and low social-emotional development levels. We combined participant observations and qualitative interviews. RESULTS Based on the observations, the main themes for the interviews were established. Residents indicated to be free to make independent choices, and experienced less autonomy with regard to health issues and finances. Support staff stated that residents' level of autonomy depends on residents' characteristics, needs, preferences, the attitude of support staff and the rules of the care institution. CONCLUSION Residents had a clear view on their autonomy in making independent choices. Support staff is mindful of preserving residents' autonomy, which in practice is limited.
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Affiliation(s)
- Hanna W Noorlandt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa J van der Sar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University & St. George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael A Echteld
- Avans University of Applied Science, Expertise Centre Caring Society, Breda, The Netherlands
- Palliative care project director, Prisma Foundation, Waalwijk, The Netherlands
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Thabault M, Turpin V, Balado É, Fernandes-Gomes C, Huot AL, Cantereau A, Fernagut PO, Jaber M, Galvan L. Age-related behavioural and striatal dysfunctions in Shank3 ΔC/ΔC mouse model of autism spectrum disorder. Eur J Neurosci 2023; 57:607-618. [PMID: 36656446 DOI: 10.1111/ejn.15919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Autism spectrum disorders (ASDs) are defined as a set of neurodevelopmental disorders and a lifelong condition. In mice, most of the studies focused on the developmental aspects of these diseases. In this paper, we examined the evolution of motor stereotypies through adulthood in the Shank3ΔC/ΔC mouse model of ASD, and their underlying striatal alterations, at 10 weeks, 20 weeks, and 40 weeks. We highlighted that motor stereotypies worsened at 40 weeks possibly carried by earlier striatal medium spiny neurons (MSN) alterations in GABAergic transmission and morphology. Moreover, we report that 20 weeks could be a critical time-point in the striatal-related ASD physiopathology, and we suggest that MSN alterations may not be the direct consequence of developmental issues, but rather be a consequence of other impairments occurring earlier.
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Affiliation(s)
- Mathieu Thabault
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
| | - Valentine Turpin
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
| | - Éric Balado
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
| | - Cloé Fernandes-Gomes
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
| | | | | | - Pierre-Olivier Fernagut
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
| | - Mohamed Jaber
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France.,Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laurie Galvan
- Laboratoire de Neurosciences Expérimentales et Cliniques, Inserm, Université de Poitiers, Poitiers, France
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Ahlström G, Wallén EF, Tideman M, Holmgren M. Ageing people with intellectual disabilities and the association between frailty factors and social care: A Swedish national register study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:900-918. [PMID: 34727746 PMCID: PMC9607971 DOI: 10.1177/17446295211037170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were Residential care, Daily activities and Contact person. Home help and Security alarm increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65-79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing.
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Affiliation(s)
| | | | - Magnus Tideman
- Halmstad University, Sweden; Ersta Sköndal Bräcke University, Sweden
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Böhmer MN, Oppewal A, Valstar MJ, Bindels PJE, van Someren EJW, Maes‐Festen DAM. Light up: an intervention study of the effect of environmental dynamic lighting on sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:756-781. [PMID: 36004439 PMCID: PMC9541498 DOI: 10.1111/jir.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based interventions to improve the sleep-wake rhythm, mood and behaviour in older adults with intellectual disabilities (ID) are limited. Increasing light exposure has been shown to be effective in improving the sleep-wake rhythm, mood, and behaviour in other populations. The current study investigates the effect of installing environmental dynamic lighting in common living rooms of care facilities on sleep-wake rhythm, mood, and behaviour in older adults with ID. METHODS A non-randomised, non-concurrent, multiple baseline study was performed from October 2017 to May 2018. Fifty-four participants [mean (SD) age of 63.42 (8.6) years, 65% female] in six care facilities were included. All participants had three baseline measurements (Weeks 1, 5 and 9). Dynamic lighting was installed in Week 10, after which three intervention measurements took place (Weeks 12, 17 and 24). Sleep characteristics and the sleep-wake rhythm were assessed using actigraphy (GENEActiv). Mood was measured with the Anxiety, Depression and Mood Scale (ADAMS) and behaviour with the Aberrant Behaviour Checklist (ABC). RESULTS Mixed-effect regression analysis showed a worsening of the primary outcome interdaily stability (P = 0.001). This could be attributed to one care facility, whereas interdaily stability did not change in the other care facilities (P = 0.74). Dynamic lighting led to earlier mid-sleep (P = 0.003) and sleep onset (P < .0001) and improved mood as indicated by lower scores on the ADAMS depression (-0.64 SD, P < 0.001) and social avoidance (-0.47 SD, P = 0.004) subscales. The prevalence of screening above cut-off for depression decreased from 23 to 9.8% (OR = .16, P = 0.003). For behaviour, a decrease was seen in hyperactivity (-0.43 SD, P < 0.001), lethargy (-0.35 SD, P = 0.008) and irritability (-0.33 SD, P < .001) as measured with the ABC. No adverse effects were reported. CONCLUSION Installing dynamic lighting in common living areas for older adults with ID improved the mood and behaviour of the residents up to 14 weeks after placement. Integrated dynamic lighting is a promising, undemanding and potentially effective addition to improve mood and behaviour in care organisations for people with ID, but does not seem to do so by improving sleep or sleep-wake rhythms.
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Affiliation(s)
- M. N. Böhmer
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- MiddinRijswijkThe Netherlands
| | - A. Oppewal
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - M. J. Valstar
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Medical DepartmentASVZ, Care and Service Centre for People with Intellectual DisabilitiesSliedrechtThe Netherlands
| | - P. J. E. Bindels
- Department of General PracticeErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - E. J. W. van Someren
- Department of Sleep and CognitionNetherlands Institute for NeuroscienceAmsterdamThe Netherlands
- Department of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, Neuroscience Campus AmsterdamVrije UniversiteitAmsterdamThe Netherlands
- Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Dept. of PsychiatryAmsterdam Public Health Research IllnstituteAmsterdamThe Netherlands
| | - D. A. M. Maes‐Festen
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Ipse de BruggenZoetermeerThe Netherlands
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15
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El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Community-Based Support and Social Services and Their Association with Frailty Factors in Older People with Intellectual Disability and Affective and Anxiety Disorders: A Swedish National Population-Based Register Study. Community Ment Health J 2022; 58:1000-1013. [PMID: 34750683 PMCID: PMC9187569 DOI: 10.1007/s10597-021-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Affective and anxiety diagnoses are common in older people with intellectual disability (ID). The aim was to describe support and social services for older people with ID and affective and/or anxiety diagnoses, also to investigate in this study group the association between support and social services and frailty factors in terms of specialist healthcare utilisation, multimorbidity, polypharmacy, level of ID and behavioural impairment. Data was selected from four population-based Swedish national registries, on 871 identified persons with affective and/or anxiety diagnoses and ID. Multivariate regression analysis was used to investigate associations between frailty factors during 2002-2012 and social services in 2012. People with multimorbidity who frequently utilised specialist healthcare were less likely to utilise residential arrangements. Those with polypharmacy were more likely utilise residential arrangements, and receive personal contact. People with moderate, severe/profound levels of ID were more likely to utilise residential arrangements and to pursue daily activities.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, 25187, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden.
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Watkins LV, Henley W, Sun JJ, Perera B, Angus-Leppan H, Sawhney I, Purandare K, Eyeoyibo M, Scheepers M, Lines G, Winterhalder R, Shankar R. Tackling increased risks in older adults with intellectual disability and epilepsy: data from a national multicentre cohort study. Seizure 2022; 101:15-21. [DOI: 10.1016/j.seizure.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022] Open
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Schoufour JD, Oppewal A, van Maurik MC, Hilgenkamp TIM, Elbers RG, Maes‐Festen DAM. Development and validation of a shortened and practical frailty index for people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:240-249. [PMID: 34939710 PMCID: PMC9305773 DOI: 10.1111/jir.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is no widely used instrument to detect frailty in people with intellectual disabilities (IDs). We aimed to develop and validate a shorter and more practical version of a published frailty index for people with IDs. METHOD This study was part of the longitudinal 'Healthy Ageing and Intellectual Disability' study. We included 982 people with IDs aged 50 years and over. The previously developed and validated ID-Frailty Index consisting of 51 deficits was used as the basis for the shortened version, the ID-FI Short Form. Content of the ID-FI Short Form was based on statistics and clinical and practical feasibility. We evaluated the precision and validity of the ID-FI Short Form using the internal consistency, the correlation between the ID-FI Short Form and the original ID-Frailty Index, the agreement in dividing participants in the categories non-frail, pre-frail and frail, and the association with survival. RESULTS Seventeen deficits from the original ID-Frailty Index were selected for inclusion in the ID-FI Short Form. All deficits of the ID-FI Short Form are clinically and practically feasible to assess for caregivers and therapists supporting people with ID. We showed acceptable internal consistency with Cronbach's alpha of 0.75. The Pearson correlation between the ID-Frailty Index and the ID-FI Short Form was excellent (r = 0.94, P < 0.001). We observed a good agreement between the full and short forms in dividing the participants in the frailty categories, with a kappa statistic of 0.63. The ID-FI Short Form was associated with survival; with every 1/100 increase on the ID-FI Short Form, the mortality probability increased by 7% (hazard ratio 1.07, P < 0.001). CONCLUSION The first validation of the ID-FI Short Form shows it to be a promising, practical tool to assess the frailty status of people with ID.
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Affiliation(s)
- J. D. Schoufour
- Faculty of Sports and Nutrition, Faculty of Health, Center of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - A. Oppewal
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - M. C. van Maurik
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - T. I. M. Hilgenkamp
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of Physical TherapyUniversity of Nevada, Las VegasLas VegasNVUSA
| | - R. G. Elbers
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - D. A. M. Maes‐Festen
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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18
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de Leeuw MJ, Oppewal A, Elbers RG, Knulst MWEJ, van Maurik MC, van Bruggen MC, Hilgenkamp TIM, Bindels PJE, Maes-Festen DAM. Healthy Ageing and Intellectual Disability study: summary of findings and the protocol for the 10-year follow-up study. BMJ Open 2022; 12:e053499. [PMID: 35193910 PMCID: PMC8867312 DOI: 10.1136/bmjopen-2021-053499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The Healthy Ageing and Intellectual Disability (HA-ID) study is a prospective multicentre cohort study in the Netherlands that started in 2008, including 1050 older adults (aged ≥50) with intellectual disabilities (ID). The study is designed to learn more about the health and health risks of this group as they age. Compared with the amount of research in the general population, epidemiological research into the health of older adults with ID is still in its infancy. Longitudinal data about the health of this vulnerable and relatively unhealthy group are needed so that policy and care can be prioritised and for guiding clinical decision making about screening, prevention and treatment to improve healthy ageing. METHODS AND ANALYSIS This article presents a summary of the previous findings of the HA-ID study and describes the design of the 10-year follow-up in which a wide range of health data will be collected within five research themes: (1) cardiovascular disease; (2) physical activity, fitness and musculoskeletal disorders; (3) psychological problems and psychiatric disorders; (4) nutrition and nutritional state; and (5) frailty. ETHICS AND DISSEMINATION Ethical approval for the 10-year follow-up measurements of the HA-ID study has been obtained from the Medical Ethics Review Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2019-0562). TRIAL REGISTRATION NUMBER This cohort study is registered in the Dutch Trial Register (NTR number NL8564) and has been conducted according to the principles of the Declaration of Helsinki.
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Affiliation(s)
- Marleen J de Leeuw
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Alyt Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Roy G Elbers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Mireille W E J Knulst
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Marco C van Maurik
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Marjoleine C van Bruggen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Dederieke A M Maes-Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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19
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Jung Y, Lyu J, Kim G. Multi-group frailty trajectories among older Koreans: Results from the Korean Longitudinal Study of Aging. Arch Gerontol Geriatr 2022; 98:104533. [DOI: 10.1016/j.archger.2021.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
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Dee B, Burke E, Romero-Ortuno R, McCallion P, McCarron M. Factors associated with the progression of deficit accumulation frailty among adults with an intellectual disability: a systematic review revealing research gaps. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13257.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: People with an intellectual disability are more likely to experience frailty earlier in life and with greater severity compared to the general population. There is growing consideration of determinants of frailty and identifying factors which may influence the change in frailty status over time. The objective of this review was to investigate factors associated with the progression of frailty over time among adults with an intellectual disability. Methods: A systematic review of literature was conducted using PRISMA guidelines to identify studies reporting factors associated with transitions and trajectories in deficit accumulation frailty among adults with an intellectual disability. The following eligibility criteria was used: defined frailty as deficit accumulation; longitudinal design; reported at least one individual characteristic associated with change in frailty status; sample was people with an intellectual disability aged ≥18 years; English language. No limitation on publication date was applied. Studies which did not measure frailty according to deficit accumulation, did not report the frailty measure used, or had a cross-sectional design were excluded. Selected studies were assessed for quality using the Critical Appraisal Skills Programme (CASP) framework. Results: In total, two studies qualified for inclusion in this review. Findings revealed that frailty defined as deficit accumulation is a dynamic process and improvements are possible. Changes in the direction of frailty states over time among adults with an intellectual disability may be influenced by several factors including baseline frailty status, age, the presence of Down syndrome, functional ability, cognitive ability, living in a group home, and the use of nursing services and therapies. Conclusions: There is a relative paucity of research on frailty among adults with an intellectual disability and the evidence base must be grown. Exploration of the social domain of frailty in this group should be a priority of future research. PROSPERO registration: 179803 (05/07/2020)
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21
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Costenoble A, Knoop V, Vermeiren S, Vella RA, Debain A, Rossi G, Bautmans I, Verté D, Gorus E, De Vriendt P. A Comprehensive Overview of Activities of Daily Living in Existing Frailty Instruments: A Systematic Literature Search. THE GERONTOLOGIST 2021; 61:e12-e22. [PMID: 31872238 DOI: 10.1093/geront/gnz147] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between frailty and disability in activities of daily living (ADLs) can be seen in different ways, with disability being-to varying degrees-a characteristic, negative outcome, or predictor of frailty. This conflation of definitions is partly a result of the different frailty tools used in research. Aiming to provide a comprehensive overview, this systematic literature search analyzed (i) if, (ii) to what extent, and (iii) how ADLs are evaluated by frailty instruments. RESEARCH DESIGN AND METHODS A search was performed in PubMed, Web of Knowledge, and PsycINFO to identify all frailty instruments, followed by categorization of the ADL items into basic (b-), instrumental (i-), and advanced (a-) ADLs. RESULTS In total, 192 articles described 217 frailty instruments, from which 52.1% contained ADL items: 45.2% b-ADLs, 35.0% i-ADLs, and 10.1% a-ADLs. The most commonly included ADL items were bathing (b-ADLs); using transportation (i-ADLs); and semiprofessional work engagement in organized social life or leisure activities (a-ADLs). These instruments all had a multidomain origin (χ 2 = 122.4, p < .001). DISCUSSION AND IMPLICATIONS Because 52.1% of all instruments included ADL items, the concepts of frailty and disability appear to be highly entangled. This might lead to circular reasoning, serious concerns regarding contamination, and invalid research results.
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Affiliation(s)
- Axelle Costenoble
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
| | - Veerle Knoop
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
| | - Sofie Vermeiren
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
| | - Roberta Azzopardi Vella
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
| | - Aziz Debain
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Belgium
| | - Gina Rossi
- Personality and Psychopathology Research Group, Faculty of Psychology and Educational Sciences, Belgium
| | - Ivan Bautmans
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Belgium
| | - Dominique Verté
- Frailty in Ageing (FRIA) Research Department, Belgium
- Belgian Ageing Studies Research Group, Vrije Universiteit Brussel (VUB), Belgium
| | - Ellen Gorus
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
- Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Belgium
| | - Patricia De Vriendt
- Frailty in Ageing (FRIA) Research Department, Belgium
- Gerontology Department, Vrije Universiteit Brussel (VUB), Belgium
- Artevelde Hogeschool, Ghent, Belgium
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22
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Obrusnikova I, Firkin CJ, Cavalier AR, Suminski RR. Effects of resistance training interventions on muscular strength in adults with intellectual disability: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:4549-4562. [PMID: 33870804 DOI: 10.1080/09638288.2021.1910738] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Muscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities. This article reports the results of the first systematic review and meta-analysis of peer-reviewed clinical trials that evaluated the effects of resistance training (RT) interventions on muscular strength in adults with ID. METHODS The protocol was registered with PROSPERO (CRD42020184905). The review focuses on clinical trials that recorded quantitative measures of maximum muscular strength. Eleven electronic databases were searched from their earliest available record up to May 2020. After screening 1996 search records, 11 clinical trials were reviewed. RESULTS The RT interventions, while heterogeneous, had an overall significant (p ≤ 0.05) effect on muscular strength in adults with ID, ages 25-58 years. The findings were more significant and less heterogeneous for non-combined RT interventions than for interventions that combined RT exercises with aerobic or balance exercises. The TESTEX overall score was 8.3 ± 3.6. CONCLUSIONS RT interventions (particularly when not combined with other exercises) are effective in promoting muscular strength in adults with ID. The limited number of studies and the low study quality scores indicate a potential risk of bias, which limits the interpretation of the findings and warrants further investigation.IMPLICATIONS FOR REHABILITATIONMuscular strength is critical for adults with an intellectual disability (ID) to promote their mobility, cardiovascular capacity, and performance of daily living/recreational/vocational activities.RT interventions are an effective means of improving muscular strength in adults with ID, especially when not combined with other forms of exercise.Testing and assessment protocols used in RT programs should be individualized for adults with ID to accommodate their characteristics and should be implemented under conditions similar to those experienced during the training regimen.It is important to implement familiarization sessions before carrying out muscular strength testing or initiating an RT program to ensure safety, accuracy, and effectiveness of the program for adults with ID.
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Affiliation(s)
- Iva Obrusnikova
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, USA
| | - Cora J Firkin
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, USA
| | | | - Richard R Suminski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, USA
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23
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Patel BG, Luo S, Wildes TM, Sanfilippo KM. Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans. JCO Clin Cancer Inform 2021; 4:117-127. [PMID: 32083955 DOI: 10.1200/cci.19.00094] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.
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Affiliation(s)
| | - Suhong Luo
- Washington University School of Medicine, St Louis, MO.,St Louis VA Medical Center, St Louis, MO
| | | | - Kristen M Sanfilippo
- Washington University School of Medicine, St Louis, MO.,St Louis VA Medical Center, St Louis, MO
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Festen DAM, Schoufour JD, Hilgenkamp TIM, Oppewal A. Determining Frailty in People With Intellectual Disabilities in the COVID-19 Pandemic. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021; 18:203-206. [PMID: 33821163 PMCID: PMC8014292 DOI: 10.1111/jppi.12371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/27/2020] [Accepted: 12/02/2020] [Indexed: 01/03/2023]
Abstract
Background Across the world, frailty is part of the guidelines that are being developed in the COVID-19 pandemic for triaging in crisis situations. The Clinical Frailty Scale (CFS) evaluates the ability to perform daily tasks to identify frail individuals, potentially excluding those from intensive care (IC) treatment. Individuals with intellectual disabilities (ID) experience varying degrees of dependence, distinct from age-related physical deterioration. Using the CFS for triage in crisis situations could potentially unjustifiably exclude individuals with ID from IC treatment. Our objective was to compare the classification of individuals with ID into different frailty categories based on the CFS and the well-studied ID-frailty index and to determine suitability of CFS for evaluation of frailty in individuals with ID during the COVID-19 pandemic. Methods This retrospective analysis of the observational healthy aging and intellectual disabilities (HA-ID) study included 982 individuals with ID of ≥50 years, who were classified according to the CFS and the ID-frailty index. Results Of the cohort of 982 older adults with ID, 626 (63.7%) would be classified as moderately frail (CFS score 6), but 92% of this group is not moderately frail according to the ID-frailty index. Furthermore, 199 (20.3%) would be classified as at least severely frail (CFS score 7-9), but 74.9% of this group is not severely frail according to the ID-frailty index. Overall, 730 out of 982 (74.9%) individuals would be incorrectly classified by the CFS as too frail to have a good probability of survival. The ID-frailty index predicts mortality better than the CFS in individuals with ID. Conclusions Our results show the CFS is not suitable to evaluate frailty in individuals with ID, with potential dramatic consequences for triage and decision-making during the COVID-19 pandemic. We strongly recommend using the ID-frailty index when assessing probability of survival for individuals with ID.
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Affiliation(s)
| | | | - Thessa I M Hilgenkamp
- Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands.,University of Nevada, Las Vegas Las Vegas NV USA
| | - Alyt Oppewal
- Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
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25
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O'Connell J, Henman MC, McMahon N, Burke É, McCallion P, McCarron M, O'Dwyer M. Medication burden and frailty in older adults with intellectual disability: An observational cross-sectional study. Pharmacoepidemiol Drug Saf 2020; 29:482-492. [PMID: 32134549 DOI: 10.1002/pds.4987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Recently, efforts have been made to quantify frailty among older adults with intellectual disability (ID). Medication exposure is associated with frailty among older adults without ID. However, there is little research on this association among older adults with ID. The aim of this study was to examine specifically in people with ID the association between frailty and medication exposure, including anticholinergic and sedative medication exposure. METHODS Data were drawn from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative study of older adults with ID in Ireland. A modified version of Fried's frailty phenotype was constructed. Drug burden measures were polypharmacy, Drug Burden Index (DBI), Anticholinergic Cognitive Burden (ACB) and Sedative Load Model. Multinomial logistic regression was used to calculate odds ratios (ORs) and identify associations between frailty and drug burden. RESULTS This study included 570 participants with ID. Excessive polypharmacy (use of ≥10 medications) was significantly associated with being pre-frail (P = .017; OR = 2.56; 95% confidence interval [CI] 1.19-5.50) and frail (P < .001; OR 7.13; 95% CI 2.81-18.12), but DBI, ACB or Sedative Load score were not significantly associated with frailty status (P > .05). CONCLUSIONS This is the first study to examine frailty and its association with medication use including anticholinergic and sedative medication burden among older adults with ID. Further research is required to investigate frailty as measured by other frailty models in relation to medication burden in older adults with ID.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.,Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Niamh McMahon
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Éilish Burke
- Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.,Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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26
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Oppewal A, Hilgenkamp TIM. Physical fitness is predictive for 5-year survival in older adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:958-966. [PMID: 30950160 PMCID: PMC6850021 DOI: 10.1111/jar.12589] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/19/2018] [Accepted: 02/27/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The very low physical fitness levels of people with intellectual disabilities (ID) may influence their life expectancy. Therefore, we investigated the predictive value of physical fitness for survival in older adults with intellectual disabilities. METHOD In the Healthy Ageing and Intellectual Disabilities (HA-ID) study,the physical fitness levels of 900 older adults (≥50 years; 61.5 ± 8.1 years) were measured at baseline. All-cause mortality was collected over a 5-year follow-up period. Cox proportional hazard models were used to determine the association between each physical fitness test and survival, adjusted for age, sex, level of ID, and Down syndrome. RESULTS The physical fitness components that were independently predictive for survival were manual dexterity (HR = 0.96 [0.94-0.98]), visual reaction time (HR = 1.57 [1.28-1.94]), balance (HR = 0.97 [0.95-0.99]), comfortable gait speed (HR = 0.65 [0.54-0.78]), fast gait speed (HR = 0.81 [0.72-0.91]), grip strength (HR = 0.97 [0.94-0.99]) and cardiorespiratory fitness (HR = 0.997 [0.995-0.999]), with a better physical fitness showing a lower mortality risk. CONCLUSION We showed for the first time that physical fitness was independently associated with survival in older adults with intellectual disabilities. Improving and maintaining physical fitness must become an essential part of care and support for this population.
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Affiliation(s)
- Alyt Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois
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27
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Oppewal A, Hilgenkamp TIM. Adding meaning to physical fitness test results in individuals with intellectual disabilities. Disabil Rehabil 2019; 42:1406-1413. [PMID: 30712416 DOI: 10.1080/09638288.2018.1527399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Evaluating physical fitness in individuals with intellectual disabilities (ID) is challenging, and a multitude of different versions of tests exist. However, psychometric properties of these tests are mostly unknown, and both researchers as clinical practitioners struggle with selecting appropriate tests for individuals with ID. We aim to present a selection of field tests with satisfactory feasibility, reliability, and validity, and of which reference data are available.Methods: Tests were selected based on (1) literature review on psychometric properties, (2) expert meetings with physiotherapists and movement experts, (3) studies on population specific psychometric properties, and (3) availability of reference data. Tests were selected if they had demonstrated sufficient feasibility, reliability, validity, and possibilities for interpretation of results.Results: We present a basic set of physical fitness tests, the ID-fitscan, to be used in (older) adults with mild to moderate ID and some walking ability. The ID-fitscan includes tests for body composition (BMI, waist circumference), muscular strength (grip strength), muscular endurance (30 second and five times chair stand), and balance (static balance stances, comfortable gait speed).Conclusions: The ID-fitscan can be used by researchers, physiotherapists, and other clinical practitioners to evaluate physical fitness in adults with ID. Recommendations for future research include expansion of research into psychometric properties of more fitness tests and combining physical fitness data on this population in larger datasets. Implications for rehabilitationIndividuals with intellectual disabilities have low physical fitness levels, and a high risk for unnecessary functional decline and unhealthy aging.Physical fitness testing could help improve, adapt and evaluate exercise interventions, but is challenging in this population.This paper proposes a selection of tests (ID-fitscan) with sufficient feasibility, reliability, and validity in this population, and provides reference values to aid interpretation of physical fitness test outcomes in individuals with intellectual disabilities.The ID-fitscan can be used by researchers, physiotherapists, and other clinical practitioners to evaluate physical fitness, and thereby allowing for a better interpretation of results by using the same tests, and an increasing knowledge of the physical fitness levels of this population.
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Affiliation(s)
- Alyt Oppewal
- Department of General Practice, Intellectual Disability Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Thessa I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands.,Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL, USA
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28
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Miot S, Akbaraly T, Michelon C, Couderc S, Crepiat S, Loubersac J, Picot MC, Pernon É, Gonnier V, Jeandel C, Blain H, Baghdadli A. Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study. Front Psychiatry 2019; 10:617. [PMID: 31607957 PMCID: PMC6761800 DOI: 10.3389/fpsyt.2019.00617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is an early-onset and lifelong neurodevelopmental condition frequently associated with intellectual disability (ID). Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. Objectives: To determine the comorbidity burden and its association with distinct clinical presentation in terms of ASD severity, adaptive skills, level of autonomy, and drug exposure in a well-phenotyped sample of individuals with ASD-ID-the EFAAR (Frailty Assessment in Ageing Adults with Autism Spectrum and Intellectual Disabilities) cohort. Methods: A total of 63 adults with ASD-ID, with a mean age of 42.9 ± 15.1 years, were recruited from 2015 to 2017 from nine specialized institutions. They underwent detailed clinical examinations, including screening for comorbidities, ASD severity [Childhood Autism Rating Scale (CARS)], adaptive functioning [Vineland Adaptive Behavior Scale II (VABS-II)], autonomy [activities of daily living (ADLs)], and drug use [polypharmacy and the Drug Burden Index (DBI)]. The comorbidity burden was evaluated using the Cumulative Illness Rating Scale (CIRS-G) and its sub-scores [the severity index (CIRS-SI) and severe comorbidity (CIRS-SC)]. Results: We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy. Conclusion: The severity of the comorbidity burden associated with premature ageing in adults with ASD and ID highlight their crucial need of personalized medical care.
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Affiliation(s)
- Stéphanie Miot
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.,Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Tasnime Akbaraly
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France.,MMDN, Univ. Montpellier, EPHE, INSERM, U1198, Montpellier, France.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cecile Michelon
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Sylvie Couderc
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Sophie Crepiat
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Julie Loubersac
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Biostatistic Department, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Éric Pernon
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Véronique Gonnier
- Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Claude Jeandel
- Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Hubert Blain
- Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
| | - Amaria Baghdadli
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.,Autism Resources Centre of Languedoc-Roussillon, University Hospital of Montpellier, CHRU de Montpellier, Univ. Montpellier, Montpellier, France
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29
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Frailty indexes in perioperative and critical care: A systematic review. Arch Gerontol Geriatr 2018; 79:88-96. [DOI: 10.1016/j.archger.2018.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
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30
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O’Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf 2018; 9:535-557. [PMID: 30181861 PMCID: PMC6116771 DOI: 10.1177/2042098618782785] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023] Open
Abstract
It is known that for all adults, prevalence of potentially inappropriate prescribing (PIP) and polypharmacy increases with advancing age and morbidity. This has been associated with adverse drug reactions and poor outcomes. As a result, screening tools have been developed to identify PIP and to improve prescribing and health outcomes. A growing body of evidence supports the fact that there are even greater concerns among older adults with intellectual disability (ID) who are living longer than before but still have premature mortality and poorer health outcomes compared with the general population. They have different patterns of multimorbidity, with higher rates of epilepsy and mental health conditions. Polypharmacy is prevalent and some prescribing practices may be inappropriate. High exposure to anticholinergic and sedative medicines has additional adverse effects on quality of life. There may also be underutilization of clinically needed therapies. There has been substantial controversy internationally relating to extensive use of psychotropic medicines, particularly off-label use for challenging behaviours. Despite the mounting evidence and concerns about the impact of PIP on quality of life, health and safety for people with ID, appropriate methods to measure PIP are lacking, which represents an important gap in the research literature. Differences in morbidity and medicines use patterns in this population mean instruments used to identify inappropriate medicines in the older population are not suitable. In this perspective article we outline the specific health and medicinal needs for people with ID, the prevalence of polypharmacy and presentation of chronic health conditions in older adults with ID. We provide an overview of the psychotropic medicine classes most frequently used in people with ID which carry substantial risk. We highlight studies to date that have attempted to assess PIP and present research priorities to improve prescribing, health outcomes and quality of life for people with ID.
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Affiliation(s)
- Maire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Trinity College Dublin, Dublin,
Ireland
| | - Philip McCallion
- School of Social Work, College of Public Health,
Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Faculty of Health Sciences, University of Dublin
Trinity College, Dublin, Ireland
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Dublin, Ireland
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31
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Mian HS, Wildes TM, Fiala MA. Development of a Medicare Health Outcomes Survey Deficit-Accumulation Frailty Index and Its Application to Older Patients With Newly Diagnosed Multiple Myeloma. JCO Clin Cancer Inform 2018; 2. [PMID: 30547157 DOI: 10.1200/cci.18.00043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose To develop a frailty index using the Rockwood Accumulation of Deficits approach for the Medicare Health Outcomes Survey (MHOS) and apply it in a subset of older patients with newly diagnosed multiple myeloma. Methods Data from 2,692,361 patients without cancer, > 66 years of age, in SEER-MHOS linked databases between 1998 and 2009 were analyzed. A frailty index was constructed, resulting in a 25-item scale; cutoff values were created for individuals classified as frail. This frailty index was then applied to 305 patients with newly diagnosed myeloma in the database to predict overall survival. Results In the derivation cohort of patients without cancer, the median age was 74 years and the mean frailty index was 0.23 (standard deviation, 0.17). Among patients without cancer, each 10% increase in frailty index (approximately three to four more deficits) was associated with a 40% increased risk for death (adjusted hazard ratio, 1.397; 95% CI, 1.396 to 1.399; P < .001). In the cohort of patients with newly diagnosed myeloma, the median age was 76 years an d the mean frailty index was 0.28 (standard deviation, 0.17). Each 10% increase in frailty index was associated with a 16% increased risk for death (adjusted hazard ratio, 1.159; 95% CI, 1.080 to 1.244; P < .001). Fifty-three percent of patients with multiple myeloma were considered frail. The estimated median overall survival of patients considered frail was 26.8 months, compared with 43.7 months (P = .015) for those who were not. Conclusion The MHOS-based frailty index was prognostic for patients with multiple myeloma in predicting overall survival.
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Affiliation(s)
- Hira S Mian
- Hira S. Mian, McMaster University, Hamilton, Ontario, Canada; and Tanya M. Wildes and Mark A. Fiala, Washington University School of Medicine, St. Louis, MO
| | - Tanya M Wildes
- Hira S. Mian, McMaster University, Hamilton, Ontario, Canada; and Tanya M. Wildes and Mark A. Fiala, Washington University School of Medicine, St. Louis, MO
| | - Mark A Fiala
- Hira S. Mian, McMaster University, Hamilton, Ontario, Canada; and Tanya M. Wildes and Mark A. Fiala, Washington University School of Medicine, St. Louis, MO
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Vrijmoeth C, Echteld MA, Assendelft P, Christians M, Festen D, van Schrojenstein Lantman-de Valk H, Vissers K, Groot M. Development and applicability of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1122-1132. [DOI: 10.1111/jar.12472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Cis Vrijmoeth
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
- Advisium Apeldoorn; ‘s Heeren Loo the Netherlands
| | - Michael A. Echteld
- Prisma Foundation Biezenmortel; Biezenmortel The Netherlands
- Avans University of Applied Sciences; Breda The Netherlands
| | - Pim Assendelft
- Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Milou Christians
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Dederieke Festen
- Intellectual Disability Medicine; Department of General Practice; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | | | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
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Ouellette-Kuntz H, Martin L, Burke E, McCallion P, McCarron M, McGlinchey E, Sandberg M, Schoufour J, Shooshtari S, Temple B. How best to support individuals with IDD as they become frail: Development of a consensus statement. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:35-42. [PMID: 29947461 DOI: 10.1111/jar.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND While higher rates and earlier onset of frailty have been reported among adults with intellectual and developmental disabilities (IDD), research on how best to support these individuals is lacking. METHOD An international consultation relied on three consensus building methods: the Nominal Group Technique, an NIH consensus conference approach, and a Delphi survey. RESULTS There is agreement that person-centered planning and aging in place should be guiding principles. Frailty must be considered earlier than in the general population with the recognition that improvement and maintenance are viable goals. Intersectoral collaboration is needed to coordinate assessments and actions. Safety and planning for the future are important planning considerations, as are the needs of caregivers. Ongoing research is needed. CONCLUSION The statement offers guidance to respond to frailty among adults with IDD and fosters ongoing exchange internationally on best practice. As new evidence emerges, the statement should be revisited and revised.
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Affiliation(s)
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Eilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,School of Social Work, Temple University, Philadelphia, Pennsylvania
| | - Mary McCarron
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Eimear McGlinchey
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Josje Schoufour
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Bev Temple
- Department of Nursing, University of Manitoba, Winnipeg, MB, Canada
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34
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Rate of deficit accumulation in home care users with intellectual and developmental disabilities. Ann Epidemiol 2018; 28:220-224. [DOI: 10.1016/j.annepidem.2018.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/28/2017] [Accepted: 01/21/2018] [Indexed: 11/21/2022]
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35
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Vrijmoeth C, Groot CM, Christians MGM, Assendelft WJJ, Festen DAM, van der Rijt CCD, van Schrojenstein Lantman-de Valk HMJ, Vissers KCP, Echteld MA. Feasibility and validity of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:67-78. [PMID: 29107852 DOI: 10.1016/j.ridd.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/18/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for a specific tool that supports healthcare professionals in timely identifying people with intellectual disabilities (ID) in need of palliative care. Therefore, we developed PALLI: a tool for screening deteriorating health, indicative of a limited life expectancy. AIMS We evaluated feasibility, construct validity and predictive validity of PALLI. METHODS 190 people with ID likely to be in need of palliative care were included. Physicians and daily care professionals (DCPs) completed PALLI and provided information on health outcomes at baseline, after 5-6 months and after 10-12 months. Linear Mixed Models and Generalized Linear Mixed Models were used to test validity. RESULTS Feasibility was adequate: physicians and DCPs were able to answer most items with 'yes' or 'no' and within a short amount of time. Construct validity was promising: a higher PALLI score at baseline was related to a higher level of decline in health, a higher symptom burden, a lower quality of life and more ADL-dependency at baseline. Predictive validity: only a higher physician-reported PALLI score at baseline significantly increased risk of death within 12 months. CONCLUSIONS PALLI shows promising feasibility and validity and has potential as a tool for timely identifying people with ID who may benefit from palliative care.
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Affiliation(s)
- C Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C M Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - W J J Assendelft
- Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, PO Box 5201, 3008 AE Rotterdam, The Netherlands.
| | | | - K C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M A Echteld
- Prisma Foundation Biezenmortel, Hooghoutseweg 3, 5074 NA Biezenmortel, The Netherlands.
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Martin L, McKenzie K, Ouellette-Kuntz H. Once frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities. Geriatr Gerontol Int 2017; 18:547-553. [PMID: 29215206 DOI: 10.1111/ggi.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/07/2017] [Accepted: 10/09/2017] [Indexed: 01/10/2023]
Abstract
AIM Frailty is understood as a dynamic non-linear process, and used to indicate age-related decline. Recent work has shown that adults with intellectual and developmental disabilities experience higher rates of frailty at much earlier ages than the general population. The present study describes transitions in frailty status (i.e. non-frail, pre-frail, frail) over 1 year, and explores the association between baseline frailty status and worsening/death over time. METHODS Results are based on secondary analysis of 2893 individuals with intellectual and developmental disabilities receiving community-based home care services in Ontario (Canada). Frailty status is based on a validated 42-item frailty index (FI); where FI ≤0.21 indicates non-frail, 0.21 < FI ≤ 0.3 indicates pre-frail and FI >0.30 indicates frail. Baseline characteristics of frailty groups at baseline were compared using the χ2 -test/analysis of variance. Relative risk of worsening/dying was calculated using a modified Poisson regression model. RESULTS Initially, 67.0% of participants were non-frail, 16.2% were pre-frail and 16.8% were frail. Of those non-frail at baseline, 84.3% remained non-frail, 11.8% worsened and 3.9% died. Among those initially pre-frail, 37.0% remained stable, 35.3% improved, 18.2% worsened and 9.6% died. Although similar proportions of frail individuals improved (37.4%) or remained stable (36.8%), 25.9% had died. After controlling for other factors, being pre-frail at baseline was associated with an increase in the risk of worsening or death (RR 1.24, 95% CI 1.04-1.49). CONCLUSIONS While many experience worsening of frailty status, stability and improvement are viable goals of care. Future research should examine the rate at which non-frail, pre-frail and frail individuals accumulate deficits, as well as the impact of home care services on frailty. Geriatr Gerontol Int 2018; 18: 547-553.
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Affiliation(s)
- Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Katherine McKenzie
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University & Ongwanada, Kingston, Ontario, Canada
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Martin L, Ouellette-Kuntz H, McKenzie K. The Power of Population Health Data on Aging and Intellectual and Developmental Disabilities: Reactions of Knowledge Users. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Lynn Martin
- Department of Health Sciences; Lakehead University; Thunder Bay ON Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences; Queen's University; Kingston ON Canada & Ongwanada
| | - Katherine McKenzie
- Departmentof Public Health Sciences; Queen's University; Kingston ON Canada
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Carey IM, Hosking FJ, Harris T, DeWilde S, Beighton C, Cook DG. An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation.
Objectives
To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID.
Design
A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets.
Setting
A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD).
Participants
A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13.
Interventions
None.
Main outcome measures
Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality.
Data sources
CPRD, Hospital Episodes Statistics and Office for National Statistics.
Results
Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records.
Limitations
Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks.
Conclusions
Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.
Future work
No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Iain M Carey
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Fay J Hosking
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Tess Harris
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George’s, University of London, London, UK
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McKenzie K, Ouellette-Kuntz H, Martin L. Applying a General Measure of Frailty to Assess the Aging Related Needs of Adults with Intellectual and Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine McKenzie
- Department of Public Health Sciences; Queen's University; Kingston, ON Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences; Queen's University; Kingston, ON Canada
- Department of Public Health Sciences; Queen's University; Kingston, ON Canada & Ongwanada
| | - Lynn Martin
- Department of Health Sciences; Lakehead University; Thunder Bay, Ontario Canada
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Northway R, Holland-Hart D, Jenkins R. Meeting the health needs of older people with intellectual disabilities: exploring the experiences of residential social care staff. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:923-931. [PMID: 27580975 DOI: 10.1111/hsc.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Older people with intellectual disabilities often experience high levels of health needs and multiple morbidities but they may be supported by residential care staff with little or no previous experience of identifying and meeting health needs. Little is known regarding how they undertake this health-related role and this exploratory study seeks to address this gap. A purposive sample of 14 managers of supported living accommodation in Wales were interviewed in 2014 to determine their experiences of supporting tenants in relation to age-related health needs. The semi-structured interviews were transcribed and thematically analysed. Three of the emerging themes are reported in this paper: meeting health needs, the consequences of ageing and relationships. Findings indicate that residential care staff support older people with intellectual disabilities with complex and multiple health needs: they monitor health status, support access to healthcare, provide additional support arising from changing health needs and advocate for tenants in the context of healthcare. However, their role is often not understood by healthcare professionals. The importance of staff having a long-term relationship with those they support was identified as being important to identifying any health-related changes. The need to develop effective relationships with healthcare staff was also noted. It is concluded that there is a need for better understanding among health staff of the role of residential social care workers and for further research regarding health-related communication.
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Affiliation(s)
- Ruth Northway
- School of Care Sciences, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Daniella Holland-Hart
- School of Care Sciences, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Robert Jenkins
- School of Care Sciences, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Orkaby AR, Hshieh TT, Gaziano JM, Djousse L, Driver JA. Comparison of two frailty indices in the physicians' health study. Arch Gerontol Geriatr 2017; 71:21-27. [PMID: 28242579 DOI: 10.1016/j.archger.2017.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND As the population ages it is important to identify frailty, a powerful predictor of morbidity and mortality, and often an important unmeasured confounder. We sought to develop a frailty index in the Physician's Health Study (PHS) and estimate the association with mortality. METHODS Prospective cohort study. Annual questionnaire assessed mood, function and health status. Two frailty scores were compared - cumulative deficit frailty index (PHS FI) and modified Study of Osteoporotic Fracture (mSOF) frailty score. Endpoints committee confirmed mortality. RESULTS 12,180 male physicians ≥60 years were analyzed. Mean(SD) follow-up was 10(3) years, 2168 deaths occurred. PHS FI identified 4412 (36%) physicians robust, 5305 (44%) pre-frail, and 2463 (20%) frail, while mSOF identified 7323 (61%) robust, 3505 (29%) pre-frail and 1215 (10%) frail. Age-standardized rate of death was lower among subjects identified as robust using the PHS FI, 11/1000 person-years (PY) (95% Confidence Interval (CI): 9.5-11.9) compared to 14/1000PY (95% CI: 13.5-15.4) using mSOF [P-difference <0.001]. In the prefrail group, death rates were 16/1000PY in PHS FI and 21/1000PY in mSOF, [P-difference <0.001]. There was no difference in age-adjusted mortality rates in the frail group according to each definition (35 vs 33/1000PY). Survival analysis showed an increased risk of mortality in each frailty category using either definition, (log-rank p<0.001). CONCLUSION The PHS FI outperformed mSOF in identifying risk of death particularly in robust and pre-frail categories. Similar indices can be created in existing datasets to identify frail individuals and where appropriate account for frailty, an often unmeasured confounder.
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Affiliation(s)
- Ariela R Orkaby
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston, MA, USA.
| | - Tammy T Hshieh
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John M Gaziano
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston, MA, USA
| | - Luc Djousse
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston, MA, USA
| | - Jane A Driver
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston, MA, USA
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Schoufour JD, Erler NS, Jaspers L, Kiefte-de Jong JC, Voortman T, Ziere G, Lindemans J, Klaver CC, Tiemeier H, Stricker B, Ikram AM, Laven JSE, Brusselle GGO, Rivadeneira F, Franco OH. Design of a frailty index among community living middle-aged and older people: The Rotterdam study. Maturitas 2016; 97:14-20. [PMID: 28159055 DOI: 10.1016/j.maturitas.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/28/2016] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To design a frailty index (FI) and evaluate three methods to handle missing data. Furthermore, we evaluated its construct (i.e., skewed distribution, correlation with age and sub-maximum score) and criterion validity (based on mortality risk). STUDY DESIGN We included 11,539 participants (45± years) from a population-based cohort in the Netherlands. Frailty was measured with a FI, which we constructed based on the accumulation of 45 health-related variables, related to mood, cognition, functional status, diseases and conditions, biomarkers, and nutritional status. A total FI-score was calculated by averaging the scores of the deficits, resulting in a score between 0 and 1, with higher scores indicating increasing frailty. Mean imputation, single- and multiple imputation were applied. MAIN OUTCOME MEASURE Mortality data were obtained by notification from the municipal administration. Median follow-up time was 9.5 years, during which 3902 (34%) participants died. RESULTS The median FI for the full population was 0.16 (IQR=0.11-0.23). The distribution of the FI was slightly right-skewed, the absolute maximum score was 0.78 and there was a strong correlation with age (Pearson correlation=0.52;95%CI=0.51-0.54). The adjusted HR per unit increase in FI-score on mortality was 1.05 (95%CI=1.05-1.06). Multiple imputation seemed to provide more robust results than mean imputation. CONCLUSION Based on our results we advise to the use of at least 30 deficits from different health domains to construct a FI if data are not imputed. Future research should use the continuous nature of the FI to monitor trajectories in frailty and find preventive strategies.
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Affiliation(s)
| | - Nicole S Erler
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - Loes Jaspers
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Leiden University College, The Hague,the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Gijsbertus Ziere
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Jan Lindemans
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Caroline C Klaver
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus MC, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Bruno Stricker
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Arfan M Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Respiratory Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, 3000 CA Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
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Oppewal A, Schoufour JD, Evenhuis HM, Festen DAM, Hilgenkamp TIM. [Older adults with intellectual disabilities markedly decline in daily functioning over a 3‑year period: Results of the HA-ID study]. Tijdschr Gerontol Geriatr 2016; 47:258-271. [PMID: 27848168 DOI: 10.1007/s12439-016-0198-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The responsibilities for the care of a significant portion of the population with an intellectual disability (ID) were recently transferred from the government to the municipalities. It is therefore important that policymakers and care professionals know how much support this population needs in their daily life. Therefore, this study focuses on the decline in daily functioning of older adults with ID (≥50 years, n = 703) over 3 years, and if daily functioning is a predictor for all-cause mortality. Daily functioning was operationalized as basic and instrumental activities of daily living (ADL and IADL) and mobility. Fifty-five percent of the total group declined in ADL, 42 % in IADL, and 38 % in mobility. Thirty-nine percent of the participants with mild ID declined in ADL, 55 % in IADL, and 27 % in mobility. Poor daily functioning and mobility was a risk factor for all-cause mortality. This epidemiological study shows a clear decline in the daily functioning of older adults with intellectual disabilities over a 3-year follow-up period. Care providers should be aware of this decline and focus on maintaining as much independence as possible.
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Affiliation(s)
- Alyt Oppewal
- Geneeskunde voor verstandelijk gehandicapten, Huisartsgeneeskunde, Erasmus MC, Universitair Medisch Centrum Rotterdam, Postbus 2040, 3000 CA, Rotterdam, Nederland.
| | - Josje D Schoufour
- Geneeskunde voor verstandelijk gehandicapten, Huisartsgeneeskunde, Erasmus MC, Universitair Medisch Centrum Rotterdam, Postbus 2040, 3000 CA, Rotterdam, Nederland
| | - Heleen M Evenhuis
- Geneeskunde voor verstandelijk gehandicapten, Huisartsgeneeskunde, Erasmus MC, Universitair Medisch Centrum Rotterdam, Postbus 2040, 3000 CA, Rotterdam, Nederland
| | - Dederieke A M Festen
- Geneeskunde voor verstandelijk gehandicapten, Huisartsgeneeskunde, Erasmus MC, Universitair Medisch Centrum Rotterdam, Postbus 2040, 3000 CA, Rotterdam, Nederland
- Ipse de Bruggen, Postbus 7027, 2701 AA, Zoetermeer, Nederland
| | - Thessa I M Hilgenkamp
- Geneeskunde voor verstandelijk gehandicapten, Huisartsgeneeskunde, Erasmus MC, Universitair Medisch Centrum Rotterdam, Postbus 2040, 3000 CA, Rotterdam, Nederland
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Vrijmoeth C, Barten P, Assendelft WJJ, Christians MGM, Festen DAM, Tonino M, Vissers KCP, Groot M. Physicians' identification of the need for palliative care in people with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:55-64. [PMID: 27501524 DOI: 10.1016/j.ridd.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A growing number of people with intellectual disabilities (ID) is suffering from life-threatening chronic illnesses and is therefore in need for palliative care. AIMS We aimed to explore how the need for palliative care is recognized in people with ID. METHODS AND PROCEDURES We conducted a semi-structured interview study among 10 ID-physicians in the Netherlands. OUTCOMES AND RESULTS Identification of people with ID in need for palliative care mostly results from a process in which multiple signals from different information sources converge and lead to a growing awareness. As a result, ID-physicians do not expect people to return to their prior level of health or functioning, but rather expect an irreversible decline leading to death. The presence, stage and prognosis of the disease, physician-patient interaction, and communication with proxies who provide contextual information are factors influencing the process. CONCLUSIONS AND IMPLICATIONS Distinctive for a population of people with ID are the frequent diagnostic uncertainty in people with ID, the patients' communicational abilities and the reliance of ID-physicians on close proxies. We argue for a proactive attitude of physicians regarding care and support of people with ID with palliative care needs.
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Affiliation(s)
- Cis Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands; Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040 (NA 1909), 3000 CA Rotterdam, The Netherlands.
| | - Pleun Barten
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands.
| | - Willem J J Assendelft
- Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 117), 6500 HB Nijmegen, The Netherlands.
| | - Milou G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO box 9101 (route 68), 6500 HB Nijmegen, The Netherlands.
| | - Dederieke A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040 (NA 1909), 3000 CA Rotterdam, The Netherlands.
| | - Marijke Tonino
- Prisma Foundation Biezenmortel, Hooghoutseweg 3, 5074 NA Biezenmortel, The Netherlands.
| | - Kris C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO box 9101 (route 549), 6500 HB Nijmegen, The Netherlands.
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO box 9101 (route 549), 6500 HB Nijmegen, The Netherlands.
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McKenzie K, Martin L, Ouellette-Kuntz H. Frailty and Intellectual and Developmental Disabilities: a Scoping Review. Can Geriatr J 2016; 19:103-112. [PMID: 27729949 PMCID: PMC5038926 DOI: 10.5770/cgj.19.225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Individuals with intellectual and developmental disabilities (IDD) are both living longer than in previous generations and experiencing premature aging. Improved understanding of frailty in this aging population may inform community supports and avoid negative outcomes. Methods The objective of this study was to review the literature on frailty and IDD and determine areas for future research and application. The methodological framework for a scoping review as developed by H. Arksey and L. O’Malley was applied to identify and select original studies published since 2000. Results Seventeen studies were identified; these were based on the work of researchers from four research programs. The studies utilized six measures of frailty, including two frailty indices, the VFQ-ID(-R), the frailty phenotype, and the frailty marker. Frailty was equally studied as an outcome and as predictor for other outcomes (e.g., mobility, falls, care intensity, institutionalization, and survival). Conclusions There is evidence of a growing interest in the measurement of frailty in aging adults with IDD. As in the general population, frailty in this group is associated with many negative outcomes. While a few measures have emerged, more work is required to replicate results, validate tools, and test the feasibility of applying frailty measures in practice and to inform policy.
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Affiliation(s)
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
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46
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Northway R, Jenkins R, Holland-Hart D. Training of Residential Social Care Staff to Meet the Needs of Older People with Intellectual Disabilities who Develop Age-Related Health Problems: An Exploratory Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:911-921. [DOI: 10.1111/jar.12283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Ruth Northway
- School of Care Sciences; Faculty of Life Sciences and Education; University of South Wales; Pontypridd RCT UK
| | - Robert Jenkins
- School of Care Sciences; Faculty of Life Sciences and Education; University of South Wales; Pontypridd RCT UK
| | - Daniella Holland-Hart
- School of Care Sciences; Faculty of Life Sciences and Education; University of South Wales; Pontypridd RCT UK
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47
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Schoufour JD, Echteld MA, Evenhuis HM. Comparing two frailty concepts among older people with intellectual disabilities. Eur J Ageing 2016; 14:63-79. [PMID: 28286466 PMCID: PMC5323495 DOI: 10.1007/s10433-016-0388-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In general, disabilities are considered a consequence of frailty rather than a cause of frailty, whereas in people with intellectual disabilities (ID), disabilities are often lifelong, which could have consequences for the feasibility and validity of frailty instruments. To better understand frailty in people with ID, we compared two broadly used concepts: the frailty phenotype (FP) and the frailty index (FI) taking into account their feasibility (e.g., percentage of participants able to complete the frailty assessments), agreement, validity (based on 5-year mortality risk), influence of motor disability, and the relation between single frailty variables and mortality. The FI and an adapted version of the FP were applied to a representative dataset of 1050 people with ID, aged 50 years and over. The FI was feasible in a larger part of the dataset (94 %) than the adapted FP: 29 % for all five items, and 81 % for at least three items. There was a slight agreement between the approaches (κ = 0.3). However defined, frailty was related with mortality, but the FI showed higher discriminative ability and a stronger relation with mortality, especially when adjusted for motor disabilities. Concluding, these results imply that the used FI is a stronger predictor for mortality and has higher feasibility than our adaptation of the FP, in older people with ID. Possible explanations of our findings are that we did not use the exact FP variables or that the FI includes multiple health domains, and the variables of the FI have lower sensitivity to lifelong disabilities and are less determined by mobility.
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Affiliation(s)
- Josje D Schoufour
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael A Echteld
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands
| | - Heleen M Evenhuis
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands
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48
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McKenzie K, Ouellette-Kuntz H, Martin L. Frailty as a Predictor of Institutionalization Among Adults With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:123-135. [PMID: 27028254 DOI: 10.1352/1934-9556-54.2.123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adults with intellectual and developmental disabilities (IDD) frequently become frail earlier than the general population, resulting in higher care needs. This population is at risk for institutionalization, or re-institutionalization, into long-term care (LTC). Using a retrospective cohort design to follow 3,034 individuals (18-99 years) living in Ontario, Canada, and assessed with the Resident Assessment Instrument-Home Care, individuals were characterized with a frailty index (FI) for persons with IDD. Survival analyses determined differences in rates of admission to LTC and survival in the community. Frail individuals had greater rates of admission than non-frail individuals, adjusted HR = 2.19, 95% CI [1.81, 2.64]. The FI predicts institutionalization.
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Affiliation(s)
- Katherine McKenzie
- Katherine McKenzie, Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hélène Ouellette-Kuntz
- Hélène Ouellette-Kuntz, Department of Public Health Sciences, Queen's University & Ongwanada, Kingston, Ontario, Canada; and
| | - Lynn Martin
- Lynn Martin, Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
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49
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Skorpen S, Nicolaisen M, Langballe EM. Hospitalisation in adults with intellectual disabilities compared with the general population in Norway. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:365-377. [PMID: 26915087 DOI: 10.1111/jir.12255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 10/16/2015] [Accepted: 12/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Previous studies have found that adults with intellectual disabilities (ID) are hospitalised more often than the general population (GP). This study investigates hospital discharge rates and main diagnostic causes for hospitalisation among administratively defined people with ID compared with the GP in Norway. METHOD Data from the Norwegian Labour and Welfare Service was combined with data from the Norwegian Patient Register (Ntotal = 1 764 072 and NID = 7573) for the period 2008-2011. Data from a Norwegian patient report generator and Statistics Norway are also analysed. RESULTS During the study period, 11% of people with ID and 11.5% of the GP were admitted to hospitals. The length of the average hospital stay was just over 4 days for both groups. Among those who were hospitalised, the majority were only admitted to hospital once during the study period: ID 66% and GP 70%. People with ID were admitted somewhat more often than people in the GP. Contrary to the GP, adults with ID were more frequently hospitalised at a younger age and less frequently at old age. The most common International Classification of Diseases diagnostic group for hospitalisation among people with ID is injury, poisoning and certain other consequences of external causes, whereas for the GP, it is diseases of the circulatory system. CONCLUSION This study finds that the proportion of people being hospitalised per year is statistically, but only slightly, different among adult people with ID and the GP. The results must be interpreted in light of the organisation of the health care system in Norway.
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Affiliation(s)
- S Skorpen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
| | - M Nicolaisen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - E M Langballe
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
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50
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Schoufour JD, Echteld MA, Boonstra A, Groothuismink ZMA, Evenhuis HM. Biochemical measures and frailty in people with intellectual disabilities. Age Ageing 2016; 45:142-8. [PMID: 26563885 DOI: 10.1093/ageing/afv152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 09/23/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION People with intellectual disabilities (ID) are earlier frail than people in the general population. Although this may be explained by lifelong unfavourable social, psychological and clinical causes, underlying physiological pathways might be considered too. Biological measures can help identify pathophysiological pathways. Therefore, we examined the association between frailty and a range of serum markers on inflammation, anaemia, the metabolic system, micronutrients and renal functioning. METHODS Participants (n = 757) with borderline to severe ID (50+) were recruited from three Dutch ID care and support services. RESULTS Frailty was measured with a frailty index, a measure based on the accumulation of deficits. Linear regression analyses were performed to identify associations between frailty and biochemical measures independent of age, gender, level of ID and the presence of Down syndrome. Frailty appears associated with inflammation (IL-6 and CRP), anaemia, metabolic markers (glucose, cholesterol and albumin) and renal functioning (cystatin-C and creatinine). DISCUSSION These results are in line with results observed in the general population. Future research needs to investigate the causal relation between biochemical measures and frailty, with a special focus on inflammation and nutrition. Furthermore, the possibility to screen for frailty using biochemical measures needs to be used.
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Affiliation(s)
- Josje D Schoufour
- Department of General Practice, Intellectual Disabilities Medicine, Erasmus University Medical Center, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Michael A Echteld
- Department of General Practice, Intellectual Disabilities Medicine, Erasmus University Medical Center, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Zwier M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heleen M Evenhuis
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
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