Aging With Developmental Disabilities: An Overview

Age-friendly communities for older persons with intellectual disabilities

Purpose

The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada.

Design/methodology/approach

Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings).

Findings

The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence.

Originality/value

The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population.

Our Ultimate Fellow Travelers: A Pilot Exploration of Sibling Support for Adults With Developmental Disabilities

People with developmental disabilities often experience needs for support that extend beyond the caregiving capacity of their aging parents and their siblings tend to be looked to as next-generation support providers. Yet, sibling support relationships are distinct for their simultaneously obligatory and voluntary nature. This pilot exploration, using in-depth focus group data from five siblings of people with developmental disabilities, is aimed at enriching understandings of the nature of, and expectations surrounding, sibling support for brothers and sisters with developmental disabilities. Findings reflect how sibling support evolves over time and can manifest in siblings assuming roles of: (1) companion and protector; (2) follower; (3) caregiver; and (4) within family protector. Siblings are a vital resource, yet not one that can be assumed as automatically forthcoming.

Effects of a group circuit progressive resistance training program compared with a treadmill training program for adolescents with cerebral palsy

OBJECTIVE

To determine whether goal-directed group circuit progressive resistance exercise training (GT) can improve motor function in adolescents with cerebral palsy (CP) and to compare outcomes with a treadmill training (TT) intervention.

METHODS

In a multi-centered matched pairs study, 95 adolescents with spastic CP (GMFCS II-III) were allocated to GT or TT interventions for 30 bi-weekly one hour training. Outcome measures of GMFM-66, GMFM-D%, GMFM-E%, TUG, 10 meter walk test (10 MWT), and 6 minute walk test (6 MWT) were made at baseline (T1), after interventions (T2) and 6 months post training (T3).

RESULTS

Both training programs induced significant improvement in all outcome measures (T2-T1) that were mostly retained at T3. At the end of the intervention, the GT group showed an advantage in all measured changes compared to the TT group and in percentage changes. Differences were significant (p < 0.02) for GMFM-66, GMFM-D%, GMFM-E% and TUG. The advantage trend for the GT group was less apparent at follow up (T3-T1).

CONCLUSION

Both programs were effective in improving motor function in adolescents with cerebral palsy. The GT program had generally greater benefits based on the functional measures.

The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities

Frailty in older people can be seen as the increased likelihood of future negative health outcomes. Lifelong disabilities in people with intellectual disabilities (ID) may not only influence their frailty status but also the consequences. Here, we report the relation between frailty and adverse health outcomes in older people with ID (50 years and over). In a prospective population based study, frailty was measured at baseline with a frailty index in 982 older adults with ID (≥50 yr). Information on negative health outcomes (falls, fractures, hospitalization, increased medication use, and comorbid conditions) was collected at baseline and after a three-year follow-up period. Odds ratios or regression coefficients for negative health outcomes were estimated with the frailty index, adjusted for gender, age, level of ID, Down syndrome and baseline adverse health condition. The frailty index was related to an increased risk of higher medication use and several comorbid conditions, but not to falls, fractures and hospitalization. Frailty at baseline was related to negative health outcomes three years later in older people with ID, but to a lesser extent than found in the general population.

Self-injurious behavior in older adults with intellectual disabilities

Self-injurious behavior (SIB) is a distressing type of problem behavior that may be exhibited in individuals with intellectual disabilities (IDs). This article provides an overview of SIB, its underlying causes and functions, as well as other key variables associated with its manifestation. Adults with IDs are routinely living longer. Given this rapidly emerging and expanding population, special attention is given to SIB in aging adults with IDs that may result from age-related risk factors. Risks include increasing and unresolved health issues, physical changes, declining physical abilities, transitions to new residential environments, and the potential for experiencing loss and bereavement. The article concludes with practice implications for social workers who may encounter older individuals with IDs and SIB.

Validating functional measures of physical ability for aging people with intellectual developmental disability

Unlike the aging population without intellectual and developmental disabilities (IDD), few standardized performance measures exist to assess physical function and risk for adverse outcomes such as nonfatal, unintentional injuries. We modified 3 selected standardized performance tools in the areas of general fitness (2-Minute Walk Test), balance and gait (Performance-Oriented Mobility Assessment I), and functional independence (Modified Barthel Index) for administration with people with IDD. The modified tools were piloted with 30 participants. Results indicated the measures are strongly associated and successfully distinguished between participants with an adverse health event in the previous year. The modified tools have potential to provide clinicians with quantitative measures that track physical performance changes associated with aging in people with IDD.

The experiences of registered intellectual disability nurses caring for the older person with intellectual disability

AIM AND OBJECTIVES

To explore the experiences of registered intellectual disability nurses caring for the older person with intellectual disability.

BACKGROUND

Increased longevity for the older person with intellectual disability is relatively a new phenomenon with social and medical factors having significantly increased the lifespan. The ageing population of people with intellectual disability is growing in Ireland, and they are outliving or expected to outlive their family carers.

DESIGN

A qualitative Heideggerigan phenomenological approach allowed the researcher become immersed in the essence of meaning and analyse how registered intellectual disability nurses working with the older person perceive, experience and express their experience of caring.

METHODS

After ethical approval was granted, data were collected through semi-structured interviews from seven participants and were transcribed and analysed thematically using Burnard's framework for data analysis.

RESULTS

Three key themes were identified: 'care delivery', 'inclusiveness' and 'client-focused care'. The study highlights the need for effective planning, an integrated approach to services and that the registered intellectual disability nurse needs to be integrated into the care delivery system within the health service to support client and family carers in the home environment.

CONCLUSIONS

Overall, the study shows the importance of teamwork, proactive planning, inclusion, attitudes, individualised care, knowing the person and best practice in providing care for older people with intellectual disability.

RELEVANCE TO CLINICAL PRACTICE

This paper reports on the findings of a study which explored the experiences of caring for the older person with intellectual disability. Teamwork, proactive planning, client-centred approach and supporting clients living at home are important as ageing is inevitable.

Drawing the line: a case study of ambivalence in sibling support for adults with complex needs

The purpose of this article is to illuminate the dynamics of sibling group support when one sibling has complex needs accompanied by difficult behaviors. A case study of sibling support for a twenty-year-old woman with a disability, a mental health issue, and addictions, drawn from the perspectives of her full brother, her half-brother, and their mother, is presented. The brothers express ambivalence between devotion to supporting their sister and limits to the support they feel able to provide. The limits the brothers place on their support allow them to adhere to their values, preserve their energy and, ultimately, sustain their ability to provide support.

Into the unknown: aging with autism spectrum disorders

Research investigation of older adults with autism spectrum disorders (ASD) noticeably lags behind studies of children and younger adults with ASD. This article reviews the current literature regarding a range of quality of life outcomes of aging adults with ASD. Studies that have addressed life expectancy, comorbid physical and mental health issues, ASD symptomatology, and social, residential, and vocational outcomes are reviewed. Research challenges in identifying older cohorts of adults with ASD are also discussed, and notable areas of concern are highlighted. Overall, aging with ASD does present challenges, but there is also evidence that positive outcomes are attainable. The article concludes with brief recommendations on how to optimize the aging process for individuals with ASD.