1
|
Erickson SR, Basu T, Dorsch MP, Kamdar N. Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database. Ann Pharmacother 2020; 54:958-966. [PMID: 32336108 DOI: 10.1177/1060028020916842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients who have intellectual/developmental disabilities (IDDs) develop atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) at rates similar to or higher than the general population. They also face disparities accessing and using health care services. OBJECTIVE To determine if disparities exist in the use of guideline-based pharmacotherapy (GBP) for ASCVD or HF for adults with IDD. METHODS Using the 2014 Clinformatics Data Mart Database, adults with ASCVD or HF were divided into IDD or non-IDD groups. Patients with contraindications for GBP medications were excluded. Use of GBP between IDD and non-IDD groups was examined. Subgroup analysis included comparisons between IDD groups. RESULTS For HF, 1011 patients with IDD and 236,638 non-IDD patients were identified. For ASCVD, 2190 IDD and 790,343 non-IDD patients were identified. We found that 47.9%, 35.8%, and 13.1% of IDD and 58.7%, 48.4%, and 18.9% of non-IDD patients had pharmacy claims for statins (P < 0.001), β-blockers (P < 0.001), or antiplatelet therapy (P < 0.001), respectively. For HF, 46.8% and 50.3% of IDD and 59.8% and 55.4% of non-IDD patients had pharmacy claims for β-blockers (P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs; P = 0.003), respectively. In all but one multivariate regression models patients with IDD were less likely to use GBP than patients in the non-IDD group. Subgroup analysis revealed that patients who had Down syndrome had lower GBP use in 4 of the 5 measures. CONCLUSION AND RELEVANCE Disparities exist in the use of GBP for patients with IDD with ASCVD or HF. Patients who have an IDD should be examined by clinicians to ensure appropriate access to and use of GBP.
Collapse
Affiliation(s)
- Steven R Erickson
- University of Michigan, Ann Arbor, MI, USA.,Wayne State University, Detroit, MI, USA
| | | | | | | |
Collapse
|
2
|
Foley JT, Lloyd M, Turner L, Temple VA. Body mass index and waist circumference of Latin American adult athletes with intellectual disability. SALUD PUBLICA DE MEXICO 2018; 59:416-422. [PMID: 29211262 DOI: 10.21149/8204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/15/2017] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population. MATERIALS AND METHODS BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined. RESULTS The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC. CONCLUSIONS These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.
Collapse
Affiliation(s)
- John T Foley
- Physical Education Department, State University of New York College at Cortland. USA
| | - Meghann Lloyd
- Faculty of Health Sciences, University of Ontario Institute of Technology. Canada
| | - Lesley Turner
- Physical Education Department, State University of New York College at Cortland. USA
| | - Viviene A Temple
- School of Exercise Science, Physical and Health Education, University of Victoria. Canada
| |
Collapse
|
3
|
Flygare Wallén E, Ljunggren G, Carlsson AC, Pettersson D, Wändell P. High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:269-280. [PMID: 29280230 DOI: 10.1111/jir.12462] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 11/16/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Obesity and lack of physical activity are frequently reported in persons with intellectual disability (ID) or autism spectrum disorder (ASD). We hypothesised a higher prevalence of diabetes and hypertension in this population. METHOD We used administrative data for all primary and specialist outpatient and inpatient healthcare consultations for people with at least one recorded diagnosis of diabetes mellitus, hypertension or obesity from 1998 to 2015. Data were drawn from the central administrative database for Stockholm County, Sweden. It was not possible to separate data for type 1 and type 2 diabetes. We stratified 26 988 individuals with IDs or ASD into three groups, with Down syndrome treated separately, and compared these groups with 1 996 140 people from the general population. RESULTS Compared with the general population, men and women with ID/ASD had 1.6-3.4-fold higher age-adjusted odds of having a registered diagnosis of obesity or diabetes mellitus, with the exception of diabetes among men with Down syndrome. A registered diagnosis of hypertension was only more common among men with ID/ASD than in the general population. CONCLUSIONS Diabetes and blood pressure health screening, along with efforts to prevent development of obesity already in childhood, are necessary for individuals with IDs and ASD. We believe that there is a need for adapted community-based health promotion programmes to ensure more equitable health for these populations.
Collapse
Affiliation(s)
- E Flygare Wallén
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - G Ljunggren
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Public Health Care Services Committee Administration, Stockholm County Council, Stockholm, Sweden
| | - A C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - D Pettersson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - P Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
4
|
Wallace RA. National Disability Insurance Scheme, health, hospitals and adults with intellectual disability. Intern Med J 2018; 48:351-359. [PMID: 29512328 DOI: 10.1111/imj.13671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital.
Collapse
Affiliation(s)
- Robyn A Wallace
- Calvary Health Care Tasmania, Hobart, Tasmania, Australia.,St Helen's Private Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
5
|
Ranjan S, Nasser JA, Fisher K. Prevalence and potential factors associated with overweight and obesity status in adults with intellectual developmental disorders. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:29-38. [DOI: 10.1111/jar.12370] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Sobhana Ranjan
- Department of Nutrition Sciences; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
| | - Jennifer A. Nasser
- Department of Nutrition Sciences; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
| | - Kathleen Fisher
- Doctoral Nursing Programs; College of Nursing and Health Professions; Drexel University; Philadelphia PA USA
| |
Collapse
|
6
|
Dunkley AJ, Tyrer F, Spong R, Gray LJ, Gillett M, Doherty Y, Martin-Stacey L, Patel N, Yates T, Bhaumik S, Chalk T, Chudasama Y, Thomas C, Sadler S, Cooper SA, Gangadharan SK, Davies MJ, Khunti K. Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Alison J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca Spong
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mike Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabyasachi Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Thomas Chalk
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Susannah Sadler
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
7
|
Erickson SR, Spoutz P, Dorsch M, Bleske B. Cardiovascular risk and treatment for adults with intellectual or developmental disabilities. Int J Cardiol 2016; 221:371-5. [DOI: 10.1016/j.ijcard.2016.07.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
|
8
|
Erickson SR, Kornexl K. Blood Pressure Screening, Control, and Treatment for Patients With Developmental Disabilities in General Medicine Practices. J Pharm Technol 2016. [DOI: 10.1177/8755122516663219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different ( P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.
Collapse
Affiliation(s)
| | - Kayla Kornexl
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
- University of Michigan Health System Pharmacy Services, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Trollor J, Salomon C, Curtis J, Watkins A, Rosenbaum S, Samaras K, Ward PB. Positive cardiometabolic health for adults with intellectual disability: an early intervention framework. Aust J Prim Health 2016; 22:288-293. [PMID: 27444634 DOI: 10.1071/py15130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 06/05/2016] [Indexed: 12/26/2022]
Abstract
Cardiometabolic morbidity is a significant contributor to the poorer health outcomes experienced by people with intellectual disability (ID). Tailoring cardiometabolic monitoring tools developed for the general population to better fit the altered risk profiles and extra needs of people with ID may help to improve health outcomes. This paper describes a new cardiometabolic monitoring framework designed to address the extra needs of people with ID. The framework was adapted from a generalist guideline after a process of extensive consultation with the original authors and over 30 ID and cardiometabolic experts. In addition to standard cardiometabolic monitoring practice, the framework encourages clinicians to: anticipate and address barriers to care such as communication difficulties and fear of blood tests; account for socioeconomic and genetic factors altering baseline cardiometabolic risk; and carefully rationalize psychotropic prescription. Together with this framework, a toolkit of free cardiometabolic resources tailored for people with ID and formal and informal carers is included. The monitoring framework promotes a multidisciplinary and holistic approach to cardiometabolic care for people with ID.
Collapse
Affiliation(s)
- Julian Trollor
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, 34 Botany Street, Sydney, NSW 2052, Australia
| | - Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, 34 Botany Street, Sydney, NSW 2052, Australia
| | - Jackie Curtis
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Andrew Watkins
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Simon Rosenbaum
- South Eastern Sydney Local Health District, Prince of Wales Mental Health, 26 Llandaff Street, Bondi Junction, NSW 2022, Australia
| | - Katherine Samaras
- Department of Endocrinology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Wallace Wurth Building, 18 High Street, Kensington, NSW 2052, Australia
| |
Collapse
|
10
|
Temple VA, Foley JT, Lloyd M. Body Mass Index of Adult Special Olympians by Country Economic Status. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - John T. Foley
- State University of New York College at Cortland; Cortland NY USA
| | - Meghann Lloyd
- University of Ontario Institute of Technology; Oshawa ON Canada
| |
Collapse
|
11
|
Martínez-Zaragoza F, Campillo-Martínez JM, Ato-García M. Effects on Physical Health of a Multicomponent Programme for Overweight and Obesity for Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:250-65. [DOI: 10.1111/jar.12177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Manuel Ato-García
- Department of Basic Psychology and Methodology; Faculty of Psychology; University of Murcia; Murcia Spain
| |
Collapse
|
12
|
Ayaso-Maneiro J, Domínguez-Prado DM, García-Soidan JL. Influence of weight loss therapy programs in body image self-perception in adults with intellectual disabilities. Int J Clin Health Psychol 2014. [DOI: 10.1016/j.ijchp.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
13
|
Wee LE, Koh GCH, Auyong LS, Cheong A, Myo TT, Lin J, Lim E, Tan S, Sundaramurthy S, Koh CW, Ramakrishnan P, Aariyapillai-Rajagopal R, Vaidynathan-Selvamuthu H, Ma-Ma K. Screening for cardiovascular disease risk factors at baseline and post intervention among adults with intellectual disabilities in an urbanised Asian society. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:255-268. [PMID: 23279280 DOI: 10.1111/jir.12006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) face significant barriers to screening participation. We determined predictors for regular cardiovascular health screening at baseline among adults with ID in Singapore, and evaluated the effectiveness of a 3-month screening intervention. METHODS The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Over 3 months in 2011, adult clients not screened regularly at baseline for hypertension, diabetes and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose and lipid testing; data on other cardiovascular disease risk factors were also collected. Chi-square and logistic regression identified predictors of regular screening at baseline. RESULTS Participation was 95.0% (227/239). At baseline, among adults with ID, 61.8% (118/191), 24.8% (52/210) and 18.2% (34/187) had gone for regular hypertension, diabetes and dyslipidaemia screening respectively; post intervention, rates rose to 96.9%, 89.5% and 88.8% respectively. Prevalence of cardiovascular disease risk factors (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 10.7% obese and 90.6% lacking regular exercise) was high compared against the general population. While receiving residential services was associated with regular hypertension screening, receiving non-residential services and being independently mobile were associated with regular participation in fasting blood tests (all P < 0.05). CONCLUSION Cardiovascular disease risk factors are common among adults with ID and clinicians should proactively screen such populations. Provision of free and convenient screening for cardiovascular disease risk improved screening participation.
Collapse
Affiliation(s)
- L E Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Temple VA, Foley JT, Lloyd M. Body mass index of adults with intellectual disability participating in Special Olympics by world region. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:277-284. [PMID: 23331860 DOI: 10.1111/jir.12011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disability (ID) experience poorer health and have more unmet health needs compared with people without ID, and they are often absent from population health surveillance. The aim of this study was to describe the body mass index (BMI) status of adult Special Olympics participants by world region and gender. Additionally, the general influence of age and gender on overweight/obesity of all participants was explored. METHOD A total of 11 643 (7150 male and 4493 female) Special Olympics BMI records were available from the Special Olympics International Health Promotion database. BMI was compared by gender and world region. Logistic regression was used to examine whether age and gender were associated with the likelihood of being overweight/obese (BMI ≥ 25.0). RESULTS Overall, 5.5% of the sample was underweight, 36.1% in the normal range, 24.7% overweight and 32.1% obese, and levels of overweight/obesity were very high in North America. Both age and gender were significant predictors of overweight/obesity (odds ratios 1.06 and 0.59, respectively). CONCLUSIONS Our findings demonstrate that adult Special Olympics participants have high levels of overweight and obesity; particularly among women and those from North America. It is crucial that those who work with, care for, coach and live with adults with ID who participate in Special Olympics increase efforts to promote healthy weight status.
Collapse
Affiliation(s)
- V A Temple
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | | |
Collapse
|
15
|
Mikulovic J, Vanhelst J, Salleron J, Marcellini A, Compte R, Fardy PS, Bui-Xuan G. Overweight in intellectually-disabled population: physical, behavioral and psychological characteristics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:153-161. [PMID: 24176258 DOI: 10.1016/j.ridd.2013.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 06/02/2023]
Abstract
Intellectually disabled (ID) people are at high risk of overweight and obesity. Prevalence and risk factors were assessed in a French population of ID adults attending specialized institutions, using a questionnaire focusing on demographic characteristics, physical activities, food habits and self-awareness about body and health. Data analysis included descriptive statistics, univariate and multivariate regression. Overall, 570 participants were included in the analysis (59% male), aged 19-59 years. The mean body mass index (BMI) was 24.9 kg/m(2); 45.6% of participants were overweight (BMI ≥ 25), including 17.2% who were obese (BMI ≥ 30). Participants practiced sports for 5.7h/week on average and were sedentary for 21.8h/week (time spent in front of some kind of screen). Most participants had food and self-care habits usually regarded as healthy. Eighty percent of them felt unhappy with their body and their physical capacities, but otherwise expressed a rather good opinion of themselves. Bivariate and multivariate analyses showed that some behavioral habits were associated with a reduced incidence of overweight and/or obesity, such as regular sport practice outside the institution, good personal body care or alcohol avoidance. The strongest risk factor was gender. Women were much more at risk than men of being overweight (53.9% versus 39.9%) and obese (28.2% versus 9.5%). Results suggest numerous ways to improve the health of institutionalized ID adults, related to sports education, nutrition and self-care, with particular attention paid to women.
Collapse
Affiliation(s)
- Jacques Mikulovic
- ER3S, EA 4110, Université du Littoral Côte d'Opale (ULCO), 220 rue de l'Université, F-59240 Dunkerque, France
| | | | | | | | | | | | | |
Collapse
|
16
|
de Winter CF, Bastiaanse LP, Hilgenkamp TIM, Evenhuis HM, Echteld MA. Cardiovascular risk factors (diabetes, hypertension, hypercholesterolemia and metabolic syndrome) in older people with intellectual disability: results of the HA-ID study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1722-1731. [PMID: 22699246 DOI: 10.1016/j.ridd.2012.04.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 04/13/2012] [Accepted: 04/13/2012] [Indexed: 06/01/2023]
Abstract
Hypertension, diabetes, hypercholesterolemia and the metabolic syndrome are important risk factors for cardiovascular disease (CVD). In older people with intellectual disability (ID), CVD is a substantial morbidity risk. The aims of the present study, which was part of the Healthy Ageing in Intellectual Disability (HA-ID) study, were (1) to determine the prevalence of CVD risk factors in older people with ID and to compare this with the prevalence in the same-aged general population, (2) to determine how many risk factors had not been previously diagnosed, and (3) to identify correlates of CVD risk factors (gender, age, level of ID, Down syndrome, independent living, activities of daily living, mobility, instrumental activities of daily living, physical activity, use of atypical antipsychotics, central obesity), using logistic regression analyses. In this cross-sectional study, 980 people with borderline to profound ID participated. Hypertension (53%), diabetes (14%) and metabolic syndrome (45%) were present similarly as in the general Dutch population. Hypercholesterolemia was present less often (23%). Fifty percent of the people with hypertension had not been previously diagnosed with this condition. Percentages for diabetes, hypercholesterolemia, and the metabolic syndrome were 45, 46 and 94 respectively. People who were more at risk for CVD risk factors were women, older people, people with obesity, people who lived more independently and people who were able to do groceries or prepare a meal independently. Policy on prevention, detection and treatment of CVD risk factors is urgently needed.
Collapse
Affiliation(s)
- C F de Winter
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
17
|
Lim HT, Yoon JS, Hwang SS, Lee SY. Prevalence and associated sociodemographic factors of myopia in Korean children: the 2005 third Korea National Health and Nutrition Examination Survey (KNHANES III). Jpn J Ophthalmol 2012; 56:76-81. [PMID: 21975827 DOI: 10.1007/s10384-011-0090-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 08/08/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the sociodemographic factors of myopia and the care of myopia in Korean children. METHODS We acquired data from 8,633 children who had completed the Health Interview Survey portion of the third Korea National Health and Nutrition Examination Survey. We assessed the prevalence of eye problems in subjects younger than 19. Sociodemographic factors that affect myopia and myopia care were identified by multivariate logistic regression analysis. RESULTS The prevalence of child myopia in Korea was 22.6%. The results indicated a significant association between increasing age and myopia. There was a relation between the prevalence of myopia and income level. Participants living in homes owned by their parents or in urban areas as well as those with disabilities were more likely to have myopia. In terms of myopia care, age and monthly household income were significant factors. CONCLUSIONS Public education and strategies such as a national vision screening programs are needed for appropriate vision care as children get older, and more effort needs to be made in assisting disabled persons with vision care.
Collapse
Affiliation(s)
- Hyung Taek Lim
- Department of Ophthalmology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
| | | | | | | |
Collapse
|
18
|
de Winter CF, Bastiaanse LP, Hilgenkamp TIM, Evenhuis HM, Echteld MA. Overweight and obesity in older people with intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:398-405. [PMID: 22119687 DOI: 10.1016/j.ridd.2011.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 05/31/2023]
Abstract
Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight, obesity and body fat percentage in older people with intellectual disability (ID) through measurement of Body Mass Index (BMI), waist circumference, waist-to-hip ratio (WHR) and skin fold thickness, and compare this with prevalence of overweight and obesity in the general population, and (2) the association of overweight and obesity with participant and treatment characteristics (gender, age, level of ID, Down syndrome, autism, independent living, smoking, (instrumental) activities of daily living ((I)ADL), physical activity and use of atypical antipsychotic medication) using regression analyses. In this cross-sectional study 945 persons, aged 50 and over with borderline to profound ID, living in central settings, in community settings and independently were included. Overweight and obesity were highly prevalent, with more obesity (26%) than in the general Dutch older population (10%) as measured by BMI, and 46-48% obesity as measured by waist circumference and WHR respectively. Women, people with Down syndrome, higher age, less severe ID, autism, people who are able to eat independently, preparing meals and doing groceries independently, people with physical inactivity and use of atypical antipsychotics were significantly more at risk of being overweight or obese. This merits specific actions by policy makers and clinical practice to improve health outcomes.
Collapse
Affiliation(s)
- C F de Winter
- Intellectual Disability Medicine, Erasmus Medical Center Rotterdam, Department of General Practice, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
19
|
Lee L, Rianto J, Raykar V, Creasey H, Waite L, Berry A, Xu J, Chenoweth B, Kavanagh S, Naganathan V. Health and functional status of adults with intellectual disability referred to the specialist health care setting: a five-year experience. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:312492. [PMID: 22295183 PMCID: PMC3263836 DOI: 10.1155/2011/312492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/16/2011] [Accepted: 08/09/2011] [Indexed: 05/23/2023]
Abstract
Aims and Method. The Developmental Disability Database in the Department of Rehabilitation Medicine at a metropolitan hospital was audited for observations on adults with Intellectual Disability living in the local region (total population 180,000) who were seen in an identified multidisciplinary specialist clinic, during 2006-2010. Results. There were 162 people (representing half the known number of adults with Intellectual Disability living in the region): 77 females, 85 males, age range 16-86 years. The most common complex disabilities referred to the specialists in this clinic were epilepsy (52%), challenging or changing behavior (42%) and movement disorders (34%). Early onset dementia was a feature of the group (7%). The prevalence of prescription of medications for gastro-oesophageal reflux was high (36%) and similar to the numbers of people taking psychotropic medications. The rates of chronic cardiovascular disease (2%), chronic respiratory disease (10%) and generalised arthritis (11%) were low overall, but did rise with increasing age. Conclusions. Complex neurological disabilities are common, and chronic medical illnesses are uncommon in adults with Intellectual Disability referred to specialist clinicians in this region. A combined, coordinated, multidisciplinary clinic model addresses some of the barriers experienced by adults with Intellectual Disability in the secondary health system.
Collapse
Affiliation(s)
- L. Lee
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - J. Rianto
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - V. Raykar
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - H. Creasey
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - L. Waite
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - A. Berry
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - J. Xu
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| | - B. Chenoweth
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - S. Kavanagh
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
- Developmental Assessment Service, St. George Hospital, Kogarah, NSW 2217, Australia
| | - V. Naganathan
- Centre for Education and Research on Ageing, Concord Hospital and Sydney University, Concord, NSW 2139, Australia
| |
Collapse
|
20
|
Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major Health Risks in Aging Persons With Intellectual Disabilities: An Overview of Recent Studies. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00248.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
21
|
van de Louw J, Vorstenbosch R, Vinck L, Penning C, Evenhuis H. Prevalence of hypertension in adults with intellectual disability in the Netherlands. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:78-84. [PMID: 19054271 DOI: 10.1111/j.1365-2788.2008.01130.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Literature on the prevalence of hypertension in people with intellectual disability (ID) is mostly based on file studies or on measurements limited to the age group below 50 years. We measured and calculated the prevalence of hypertension in adults with ID and studied the distribution of hypertension in relation to age, gender, diagnosis of Down's syndrome and level of ID. METHODS In an observational cross-sectional study, standardized blood pressure measurements were obtained from 258 randomly selected adult clients of three Dutch care providers for people with ID. Hypertension was defined as a mean systolic blood pressure above 140 mm Hg on repeated measurements. RESULTS The overall prevalence rate of hypertension was 17.4% (95% CI 12.28-22.46). This was comparable to the prevalence in the general Dutch population. No accurate blood pressure measurement could be performed in 28.4% of people with severe and profound ID owing to repetitive physical activity or resistance. Hypertension was significantly related to older age and absence of Down's syndrome; no correlation with gender or level of ID could be shown. RECOMMENDATION The risk factor hypertension should be detected and treated in the same manner as in the general population following national guidelines.
Collapse
|