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Carlson SR, Munandar V, Thompson JR. Outcomes for Adults With Intellectual and Developmental Disabilities Receiving Long-Term Services and Supports: A Systematic Review of the Literature. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:137-150. [PMID: 38545817 DOI: 10.1352/1934-9556-62.2.137] [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: 11/05/2022] [Accepted: 04/10/2023] [Indexed: 04/05/2024]
Abstract
The impact of long-term services and supports on the quality of life of adults with intellectual and developmental disabilities (IDD) is not well understood given the highly complex nature of researching this topic. To support future research addressing this topic, we conducted a systematic literature review of studies addressing outcomes of adults with IDD receiving long-term services and supports. Results of this review describe current outcomes for adults with IDD who receive long-term services and supports and can be used to inform program evaluation, policy development, and future research.
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Affiliation(s)
- Sarah R Carlson
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
| | - Vidya Munandar
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
| | - James R Thompson
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
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2
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Ames JL, Morgan EH, Giwa Onaiwu M, Qian Y, Massolo ML, Croen LA. Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:290-305. [PMID: 36601333 PMCID: PMC9807255 DOI: 10.1089/aut.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Address correspondence to: Jennifer L. Ames, PhD, MS, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612-5190, USA
| | - Elizabeth H. Morgan
- College of Education California State University Sacramento, Sacramento, California, USA
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, Houston, Texas, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Maria L. Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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3
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Breaux RD, Rooks RN. The intersectional importance of race/ethnicity, disability, and age in flu vaccine uptake for U.S. adults. SSM Popul Health 2022; 19:101211. [PMID: 36052156 PMCID: PMC9425074 DOI: 10.1016/j.ssmph.2022.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 10/31/2022] Open
Abstract
Improving vaccination rates among marginalized populations is an important priority among public policy makers and healthcare providers in the United States of America (U.S.). Racial/ethnic minorities have a long history of reduced vaccination rates relative to white Americans (Khan, Hall, Tanner, & Marlow, 2018), while people with disabilities (PWD) have varied rates of vaccine use (Diab & Johnston, 2004; O'Neill, Newall, Antolovich, Lima, & Danchin, 2019). Yet, little is known about vaccine use among individuals who belong to both groups. This study examines the intersectional effects of race/ethnicity and disability on flu vaccine use. We used the 2015-2018 National Health Interview Survey to examine the odds of flu vaccine use by race/ethnicity, disability, and their interaction among adults aged 18+ in the U.S. non-institutionalized, civilian population stratified by age groups. For each unit increase in disability scores, we found a significant race-by-disability interaction for young black adults (18-39 years) who had higher odds of getting the flu vaccine compared to white adults in the same age group. A significant interaction occurred for middle-aged Hispanic vs. white adults (40-64 years) who had higher odds of getting the flu vaccine as their disability scores increased. Black vs. white adults were less likely to get the flu vaccine across all age groups irrespective of disability and other covariates, while results were more mixed among other racial/ethnic groups. Additionally, people with disabilities had higher odds of flu vaccination. Further, race/ethnicity had a moderating effect on the relationship between disability and flu vaccination and an interaction effect occurred between disability and certain racial/ethnic groups when stratified by age.
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Affiliation(s)
- Rebecca D Breaux
- University of Colorado Denver, 1224 5th Street, HUB, Denver, CO, 80204, USA
| | - Ronica N Rooks
- University of Colorado Denver, 3023C North Classroom, P.O. Box 173364, Campus Box 188, Denver, CO, 80217-3364, USA
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Landes SD, Wilmoth JM, McDonald KE, Smith AN. Racial-ethnic inequities in age at death among adults with/without intellectual and developmental disability in the United States. Prev Med 2022; 156:106985. [PMID: 35150747 PMCID: PMC8885978 DOI: 10.1016/j.ypmed.2022.106985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022]
Abstract
To identify potential differences in racial-ethnic inequities in mortality between adults with/without intellectual and developmental disability, we compared patterns in age at death by race-ethnic status among adults who did/did not have intellectual and developmental disability reported on their death certificate in the United States. Data were from the 2005-2017 U.S. Multiple Cause-of-Death Mortality files. Average age at death by racial-ethnic status was compared between adults, age 18 and older, with/without different types of intellectual and developmental disability reported on their death certificate (N = 32,760,741). A multiple descent pattern was observed among adults without intellectual or developmental disability, with age at death highest among Whites, followed by Asians, Hispanics and Blacks, then American Indians. In contrast, a bifurcated pattern was observed among adults with intellectual disability, with age at death highest among Whites, but lower and similar among all racial-ethnic minority groups. The severity of racial-ethnic inequities in age at death was most pronounced among adults with cerebral palsy. Policy makers and public health experts should be aware that racial-ethnic inequities are different for adults with intellectual and developmental disability - all minorities with intellectual and developmental disability are at greater risk of premature death than their White counterparts.
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Affiliation(s)
- Scott D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA.
| | - Janet M Wilmoth
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - Katherine E McDonald
- Department of Public Health, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Alyssa N Smith
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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Fortney S, Tassé MJ. Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:492-504. [PMID: 34700348 DOI: 10.1352/1944-7558-126.6.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
Previous research suggests that residence in non-metropolitan areas is associated with lower access to preventive care and poorer health. However, this research has been largely restricted to the general population, despite data demonstrating disparities in health status and access to healthcare services for people with intellectual and developmental disabilities (IDD). The current study examined several hypotheses involving the effects of rurality on access to preventive healthcare and services and health status: (1) individuals in non-metropolitan areas will have lower preventive healthcare utilization, (2) individuals in non-metropolitan areas will have poorer health outcomes, and (3) individuals in non-metropolitan areas will have poorer access to services. The current study uses data from the National Core Indicators (NCI) Adult Consumer Survey 2015-2016: Final Report which included Rural-Urban Commuting Area (RUCA) Codes for the first time. Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts.
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Affiliation(s)
- Stoni Fortney
- Stoni Fortney and Marc J. Tassé, The Ohio State University
| | - Marc J Tassé
- Stoni Fortney and Marc J. Tassé, The Ohio State University
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Bogenschutz M, Broda M, Lineberry S, Dinora P, Prohn S. Testing a Wellness Indicators Measure for People with Intellectual and Developmental Disabilities a. DEVELOPMENTAL DISABILITIES NETWORK JOURNAL 2021; 2:85-103. [PMID: 35721389 PMCID: PMC9201682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE People with intellectual and developmental disabilities (IDD) often have health and wellness issues that are not as good as people without disabilities. States are required to monitor health and wellness for people with IDD who use many disability services. However, there are few ways to monitor wellness between states or at different points in time. In this study, we share a new model that states may use to monitor wellness of people with IDD. METHODS We used data from a survey called the National Core Indicators (NCI) to develop this model. First, we developed the model using our state's data. Then, after we found a model that worked well, we tested that model using the National Core Indicators from the entire U.S. RESULTS Our final model worked well in both our state NCI data and the national NCI data. This is important because policies at both levels can affect the services that people with disabilities can use. Our model had three parts: heart health, mental health, and behavioral wellness. These are described more in the paper. We also used statistics to test some factors that might predict outcomes related to heart health, mental health, and behavioral wellness. Age, sex, where someone lives, and level of intellectual disability were all good predictors of all three categories of wellness that we studied. IMPLICATIONS The model of wellness that we developed worked well but should be tested using data from other individual states. It is very important to know about health and wellness right now since the services people with disabilities can use are changing in many states. We think our model can help planners and advocates understand how services affect wellness in a way that is easy to compare from state to state and at different points in time.
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Affiliation(s)
| | | | | | | | - Seb Prohn
- Virginia Commonwealth University, Richmond, VA
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Bonardi A, Lauer E, Lulinski A, Fay ML, Morris A, Nygren MA, Krahn G. Unlocking the Potential of State Level Data: Opportunities to Monitor Health and Related Outcomes in People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:390-404. [PMID: 31568734 DOI: 10.1352/1934-9556-57.5.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
No single U.S. health surveillance system adequately describes the health of people with intellectual and developmental disabilities (IDD). Researchers and policy makers have sought to understand the potential of state and local administrative and survey data to produce a local as well as a national picture of the health of the population with IDD. Analyses of these secondary data sources have significant appeal because of the potential to derive new information without the burden and expense of new data collection. The authors examined the potential for data collected by states and territories to inform health surveillance in the population with IDD, including data from the administration of eligibility-based supports, health insurance claims, and surveys administered for monitoring and quality improvement. Although there are opportunities to align and harmonize datasets to enhance the available information, there is no simple path to use state and local data to assess and report on the health of the population with IDD. Recommendations for policy, practice, and research include the development and use of consistent operational definitions in data collection, and research to fill knowledge gaps.
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Affiliation(s)
- Alexandra Bonardi
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Emily Lauer
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Amie Lulinski
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Mary Lee Fay
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Andrew Morris
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Margaret A Nygren
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
| | - Gloria Krahn
- Alexandra Bonardi, Human Services Research Institute, Cambridge, MA; Emily Lauer, Eunice Kennedy Shriver Center, University of Massachusetts Medical School; Amie Lulinski, University of Colorado; Mary Lee Fay, National Association of State Directors of Developmental Disability Services; Andrew Morris, United States Department of Health & Human Services; Margaret A. Nygren, American Association on Intellectual and Developmental Disabilities; and Gloria Krahn, Oregon State University
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8
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He P, Chen G, Liu T, Zhang L, Zheng X. Rehabilitation service utilisation among adults with intellectual disabilities: Trends and socioeconomic disparities in China. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:775-784. [PMID: 30027568 DOI: 10.1111/jir.12517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Intellectual disabilities (IDs) have become a public health concern worldwide, but few studies on rehabilitation service utilisation in this population were conducted in developing countries. We aimed to examine trends and socioeconomic disparities in the utilisation of rehabilitation services among adults with IDs in China. METHODS We obtained data from a population-based survey by using a multistage, randomised, cluster sampling process to ascertain adults with IDs in 2006 and a selected subsample for follow-up surveys during 2007-2013. Psychiatrists ascertained individuals with IDs ascertained by intelligence quotient score under 70, deficits in two or more adaptive behaviours and age of onset under 18 years. RESULTS Overall, the utilisation rate of rehabilitation services significantly increased from 10.1% in 2007 to 33.7% in 2013, with an annual average percentage growth of 34.3% when adjusting for multiple confounders. The mounting trends remained significant in all socioeconomic groups. The growth rates among lower socioeconomic participants were much higher than those among higher socioeconomic participants, and the strength in the association between socioeconomic position (education and region) and rehabilitation service utilisation declined in 2007-2013. CONCLUSIONS This study found an upward trend in rehabilitation service utilisation in Chinese adults with IDs during 2007-2013, and socioeconomic disparities in rehabilitation service use in this population showed a downward trend over time.
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Affiliation(s)
- P He
- China Center for Health Development Studies, Peking University, Beijing, China
- Institute of Population Research, Peking University, Beijing, China
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - G Chen
- Institute of Population Research, Peking University, Beijing, China
| | - T Liu
- Institute of Population Research, Peking University, Beijing, China
| | - L Zhang
- Institute of Population Research, Peking University, Beijing, China
| | - X Zheng
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
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Lee CE, Burke MM, Arnold CK, Owen A. Comparing differences in support needs as perceived by parents of adult offspring with down syndrome, autism spectrum disorder and cerebral palsy. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:194-205. [PMID: 30101573 DOI: 10.1111/jar.12521] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/02/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parents often face many barriers when taking care of their offspring with disabilities. In childhood, support needs vary with families of children with Down syndrome often reporting less caregiving challenges. However, it is unclear whether support needs vary in adulthood. This study compared parents of adults with Down syndrome (DS), autism spectrum disorder (ASD) and cerebral palsy (CP) regarding support needs of their offspring with intellectual and developmental disabilities (IDD) and their families. METHOD Data were collected via a national survey in the United States with 189 parents of adults with IDD. RESULTS Across the quantitative and qualitative analyses, parents of adults with DS (versus CP and ASD) reported significantly greater recreational, natural supports, more formal services and less future planning barriers. CONCLUSION The results indicate that the DS advantage may persist in adulthood regarding support needs. More research is needed to understand different types of support needs.
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Affiliation(s)
- Chung Eun Lee
- University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois
| | - Meghan M Burke
- University of Illinois at Urbana-Champaign, Urbana-Champaign, Illinois
| | | | - Aleksa Owen
- University of Illinois at Chicago, Chicago, Illinois
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10
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Grey JM, Totsika V, Hastings RP. Living with family: perceptions of health and subjective well-being of adults with an intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:474-485. [PMID: 29479860 DOI: 10.1111/jir.12479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 11/05/2017] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Little is known about the role of living circumstances to the perception of subjective well-being (SWB) and health of adults with intellectual disability (ID). The aim of the present study was to examine whether living circumstances impact differently on the perception of health and SWB and whether potential differences persist after accounting for other variables (e.g. level of support needs and reporting method). METHODS Secondary data analysis was undertaken of a large national survey of adults with an ID in England, aged 16 years and over. Participants were identified as living with family (N = 1528) or living out of home (N = 874). RESULTS The results of t-test and chi-square revealed that levels of health and SWB were perceived as being higher for people living with family than those living in out-of-home settings. Multiple linear regression analyses fitted to explore factors associated with these reported differences revealed that, when controlling for other variables, living with family was highly associated with reports of better SWB. Multiple logistic regression revealed that whilst the health status of people living with families were perceived as better, this was only true when their support needs were low. Poorest health outcomes were found for people with highest support needs who lived with family. CONCLUSIONS On the whole, the health and well-being of adults living with family were perceived more positively than those living out of home. However, potential health disparities exist for those with high support needs who live with family. Further longitudinal research is needed to explore causes and potential solution to these inequalities.
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Affiliation(s)
- J M Grey
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - V Totsika
- Centre for Educational Development, Appraisal and Research (CEDAR), Social Sciences, University of Warwick, Coventry, UK
| | - R P Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), Social Sciences, University of Warwick, Coventry, UK
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Hanlon P, MacDonald S, Wood K, Allan L, Cooper SA. Long-term condition management in adults with intellectual disability in primary care: a systematic review. BJGP Open 2018; 2:bjgpopen18X101445. [PMID: 30564710 PMCID: PMC6181081 DOI: 10.3399/bjgpopen18x101445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/02/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Adults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions. AIM To synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care. DESIGN & SETTING Mixed-methods systematic review. METHOD Seven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis. RESULTS Fifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care. CONCLUSION Adults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.
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Affiliation(s)
- Peter Hanlon
- SCREDS Clinical Lecturer in General Practice and Primary Care, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara MacDonald
- Senior Lecturer, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karen Wood
- Research Assistant, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Clinical Associate Professor, Health and Social Care Integration Directorate, Scottish Government, Edinburgh, UK
| | - Sally-Ann Cooper
- Professor of Learning Disabilities, Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Williamson HJ, Contreras GM, Rodriguez ES, Smith JM, Perkins EA. Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:227-236. [PMID: 28703641 DOI: 10.1177/1539449217714148] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.
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Burke MM, Heller T. Disparities in Unmet Service Needs Among Adults with Intellectual and Other Developmental Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:898-910. [DOI: 10.1111/jar.12282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Meghan M. Burke
- Department of Special Education; University of Illinois at Urbana-Champaign; Champaign IL USA
| | - Tamar Heller
- Department of Disability and Human Development; University of Illinois at Chicago; Chicago IL USA
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14
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Harrington C, Kang T. Disparities in Service Use and Expenditures for People With Intellectual and Developmental Disabilities in California in 2005 and 2013. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:1-18. [PMID: 26824130 DOI: 10.1352/1934-9556-54.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined service use and expenditures for people with intellectual and developmental disabilities (IDD) living at home and in the community in California in 2005 and 2013. The number of people assessed for IDD services increased, along with the percentage of individuals who did not receive any services between 2005 and 2013. Controlling for client needs, children age 3-21 were less likely than other age groups to receive any services using logistic regressions. All racial and ethnic minority groups were less likely to receive any services than were white populations. Females, younger people, and all racial and ethnic minority groups who received services had significantly lower expenditures, with wide geographic variations. The disparities by age, gender, race/ethnicity, and geography have persisted over time in California.
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Affiliation(s)
- Charlene Harrington
- Charlene Harrington, University of California San Francisco, Department of Social & Behavioral Sciences, San Francisco, California; and
| | - Taewoon Kang
- Taewoon Kang, University of California San Francisco, Institute for Health and Aging, San Francisco, California
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Promoting a new research agenda: health disparities research at the intersection of disability, race, and ethnicity. Med Care 2014; 52:S1-2. [PMID: 25215914 DOI: 10.1097/mlr.0000000000000220] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in access to and receipt of health care have been extensively documented across racial and ethnic groups. Similarly, a growing body of research has documented disparities between people with and without disabilities in obtaining needed health care. However, our understanding of the intersection of disability with race and ethnicity in health care is very limited. OBJECTIVES The purpose of this supplement is to begin to bridge the gap between research on racial and ethnic health disparities and research on disability-related health disparities. RESULTS The papers in this supplement examine evidence of racial and ethnic disparities within various populations of people with disabilities, and explore unique issues at the intersection of disability, race, and ethnicity. CONCLUSIONS The studies in this issue provide a starting point, and are intended to serve as an impetus for building a more robust literature on health care issues impacting the expanding segment of United States population that both experience disability and belong to racial and ethnic groups other than non-Hispanic white.
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