Concept of death and perceptions of bereavement in adults with intellectual disabilities

Impact of organ donation on grief symptoms in donor families

INTRODUCTION

The aim of the study was to identify the factors that influence grief among donor families regarding organ donation.

METHODS

This cross-sectional study, utilizing an analytical approach, employed a convenience sampling method to gather data from family members. Over the three years, all families who consented to organ donation were invited to participate, from all, 222 questionnaires were completed by donor family members who had given consent and successfully proceeded with the donation. We collected data using the Grief Experience Questionnaire (GEQ-34). Descriptive and analytic statistics were utilized to determine the factors influencing grief using SPSS 18 software. A significance level of P < 0.05 was considered statistically significant for all analyses.

RESULTS

The donor gender was mostly male (153, 68.9%) with a mean age of 35.96 ± 17.05 (range: 2-68) years at the time of death. The mean score of GEQ was 93.3 ± 22.4 (ranging from 39 to 141) from a theoretical range of 34 to 170 with the higher the score indicating a more intensive grief experience. 23(10.4%), 100 (45%), and 99 (44.6%) of participants suffered from low (GEQ 34-68), moderate (GEQ 69-102), and high levels of grief (GEQ higher than 103), respectively. Guilt had the highest mean score among different aspects of the GEQ component. A significant negative relationship between guilt, age of the donor (r=- 0.10, P < 0.011), and time interval from donation (r=-0.17, P < 0.001), showed that guilt may be more pronounced in cases involving younger donors or more recent losses. Families of suicide-related brain death cases, and those who lost their children rather than their spouses, experienced more grief compared to other families. Additionally, families with prior knowledge of the concept of brain death experienced lower grief compared to those without such knowledge.

CONCLUSION

The results reveal that the average grief score among the donors' families was higher than normal, with 89.1% experiencing moderate to severe levels of grief. While the results may seem challenging due to the high prevalence of grief, they offer valuable insights into how support systems and education can be tailored to better assist families in coping with their loss.

CLINICAL TRIAL NUMBER

Not applicable.

The Grief Experiences of Children with Developmental Disabilities: A Narrative Literature Review

BACKGROUND

Children with developmental disabilities have wide-ranging social, developmental, and communication challenges impacting their grieving process. This narrative review examined the literature relating to the grief experiences of children with developmental disabilities to identify implications for practice and areas for future research.

METHODS

The literature review was conducted using five databases, and a hand search of dissertations with original research, due to the sparse body of published works.

RESULTS

Nine works were included in the review, which were thematically synthesized into three categories: (1) Understanding of death concepts, (2) Social-emotional responses to loss, and (3) Disenfranchised grief.

CONCLUSIONS

Children with developmental disabilities are affected by loss, even if their comprehension of death concepts is impacted by their level of disability. They may experience challenges due to changes in routines and concrete thinking, and are at risk of disenfranchised grief. Future research is needed to inform developmentally appropriate grief interventions.

Disenfranchised Grief: The Death of a Student With Special Needs and the Coping of the School Staff - A Qualitative Study

The educational staff that meets the children at school struggles to cope with the death of a child, and often avoids talking with them about the death and their sense of loss. This way of coping is complicated in the case of grief among children with special needs, called "disenfranchised grief ". The aim of this qualitative study was to examine the experience and the perceptions of the educational staff in schools for special education and to assess their way of coping, support and care they employ following the death of a student. 15 staff members from different schools in Israel, interviewed. The findings reveal that schools are a significant source of support for students, staff and parents, alike, in the processing of the loss. The special education frameworks generally maintained a special and close connection with students and families. procedures and guidelines are required following death of a student.

Factors Influencing Palliative and End-of-Life Care for Adults with Intellectual Disabilities: A Scoping Review of Health and Care Workers' Experiences

In developed countries, there has been an increase in the longevity of adults with intellectual disabilities. In the later stages of their lives, people with intellectual disability have specific needs in terms of palliative and end-of-life care that need to be better understood in order to offer appropriate care. This scoping review aimed to identify the main factors influencing the provision of palliative and end-of-life care from the perspective of health and care workers involved with adults with an intellectual disability at the end of life. Seven databases were systematically searched for relevant articles published between 2002 and 2022. NVivo qualitative research analysis software was used to conduct a thematic analysis of the 50 included studies. Three main factors were identified: the location of care and death, the involvement of the person with intellectual disability, and collaborative practices.

Suicidal behavior among individuals with trisomy 21: an integrative review

Trisomy 21 (T21) is a genetically determined human condition that occurs in one in every 800 births worldwide. Improvements in lifelong care have generated discussion about the mental health of people with T21. However, suicidal behavior in this population has still received little attention. This integrative review aimed to understand and synthesize scientific production on the topic of 'suicide in people with T21'. We conducted the review in the Virtual Health Library, PubMed, and PsycInfo databases using the descriptors 'Down syndrome', 'Down's syndrome', and 'trisomy 21' in combination with 'suicide', 'suicide attempted', and 'suicidal ideation'. We analyzed articles published until 10th October 2023. The selected articles were evaluated for their level of evidence and categorized thematically. Eight articles from three countries met the eligibility criteria: three case reports, three narrative literature reviews, one observational cross-sectional study, and one cohort study. The articles were organized and discussed in four categories: (1) scientific literature impressions about suicide in individuals with T21; (2) T21 life course issues and forms of expression of suicidal behavior; (3) suicide frequency in individuals with T21; and (4) possible implications for caring for individuals with T21 who exhibit suicidal behavior. The results revealed a lack of literature on the subject, which indicates the need for additional research. Based on the evidence available, suicidal behavior among people with T21, while a possible phenomenon, seems uncommon. Health professionals should investigate T21 individuals' mental health, searching for depression and self-injury symptoms.

Bereavement among Adolescents with Intellectual Disability: A Qualitative Study

The current study was conducted to explore the bereavement (experienced loss of a loved one through death within time frame of 0-3 years span). Seven adolescents (10-19 years old) with intellectual disability were included in the study. Semi-structured interviews were conducted through interview guide which was prepared with the help of Piaget's theory of cognitive development concept related to death. Data was analyzed with content analysis and six major themes were derived, that is, meaning of death, death rituals, religious concepts related to death, reasons of death, grieving perception, and coping with grief. Mostly, concepts were explained under the light of religious preaching and their introjection in the lives of adolescents with intellectual disability. Current study helped in exploration of experiential phenomenon of loss in adolescents with intellectual disability.

Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying

BACKGROUND

A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying.

METHOD

A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed.

RESULTS

We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities.

CONCLUSIONS

The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.

Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models

OBJECTIVES

The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data.

METHODS

Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points.

RESULTS

The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points.

SIGNIFICANCE OF RESULTS

Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.

Shared decision making with frail people with intellectual disabilities in the palliative phase: A process evaluation of the use of the In-Dialogue conversation aid in practice

BACKGROUND

This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase.

METHODS

Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities.

RESULTS

Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging.

CONCLUSION

Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Synthesising existing research on complicated grief in intellectual disability: findings from a systematic review

BACKGROUND

Complicated grief has been identified as a phenomenon in the general population, and there is an increasing body of research investigating complicated grief in people with intellectual disability. The aim of this study is to synthesise this existing knowledge from research published between 1999 and 2022.

METHODS

A structured systematic review using PRISMA guidelines was conducted, which searched three commonly used databases (Medline, PsycINFO and CINAHL) for research on the topic of bereavement and intellectual disability. The articles identified in this search were screened to identify those that addressed the issue of 'complicated grief', with all abstracts and subsequent full texts reviewed by two researchers.

RESULTS

In total, 179 abstracts were initially identified, with 34 articles eligible for full text screening and 18 papers reaching criteria for inclusion. Data relating to the studies' objectives were extracted under the headings of definition, defining principles, signs and symptoms, risk factors and treatments for complicated grief in intellectual disability. Thematic analysis of the extracted data was performed to identify key themes.

CONCLUSIONS

This review highlights that people with intellectual disability are likely to experience complicated grief reactions and that complicated grief is both underestimated and a clinically significant condition for people with intellectual disability. Future research should work to clarify diagnostic criteria and identify appropriate interventions.

Family carers' experiences of providing care for their adult relative with intellectual disabilities and mental health problems in Singapore

BACKGROUND

Families in Singapore are primarily involved in the care of their relatives with intellectual disabilities and the study aimed to explore their experiences taking care of their relatives with intellectual disabilities and mental health problems.

METHOD

Nine unpaid family carers were interviewed. The interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Analysis revealed four themes 1) Making sense of behaviours; 2) Staff are the experts; 3) Public reaction and 4) Worries and hopes for the future.

CONCLUSIONS

Family carers found it difficult to identify and manage the mental health symptoms of their relatives and sought help from specialist mental health professionals. They were satisfied with the specialist services and found psychotropic medication helpful to reduce the symptoms. Family carers expressed worries about their relative not being accepted by the public and did not make future care plans. More resources are needed to increase accessibility of specialist mental health services for people with intellectual disabilities. It is recommended for service providers to collaborate with family carers and provide them with resources and skills to empower them to care for their relatives with intellectual disabilities.

Effect of Online Palliative Care Training on Knowledge and Self-Efficacy of Direct Care Workers

We evaluated the effectiveness of an online training on palliative care knowledge and self-efficacy among staff working with people with intellectual and developmental disabilities (IDD) using a one-group pretest-posttest design. Staff from four nonprofit residential and day services organizations in a U.S. Midwestern state participated. Among 132 staff who completed a baseline assessment, a 2-hour online training, and a posttest, 98 staff completed a 1-month follow-up survey. Palliative care knowledge was assessed before and after the training, and palliative care self-efficacy, at baseline and 1-month follow-up. We used linear regression to identify the factors that influence the effect of the training on main outcomes. Overall palliative care knowledge and self-efficacy significantly improved while higher education and longer work tenure enhanced training effectiveness.

Specialist palliative care staff's varying experiences of talking with people with intellectual disability about their dying and death: A thematic analysis of in-depth interviews

BACKGROUND

The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying.

AIM

To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations.

DESIGN

An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study.

SETTING/PARTICIPANTS

Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability.

RESULTS

Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers).

CONCLUSIONS

Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and death.

A Photovoice Study: The life experiences of middle-aged adults with intellectual disabilities in Korea

BACKGROUND

As adults with intellectual disabilities approach older adulthood, they face unique physical and psychosocial challenges. This study explored the lived experiences of middle-aged adults with intellectual disabilities living in their community.

METHOD

Six sessions of Photovoice were conducted with a purposeful sample of six middle-aged adults with intellectual disabilities in South Korea. Participants were involved with the theme selection, taking photographs related to the themes, group discussion of photo stories and sharing Photovoice outcomes.

RESULTS

Thematic analysis yielded 11 subthemes under the five major themes selected by the participants: health, free time, time in the centre, family and my future in old age.

CONCLUSIONS

The study findings showed complex issues middle-aged adults with intellectual disabilities may face in later life, including bereavement and healthy lifestyle concerns. It is important to create a space for meaningful social support and social interactions without stigma.

A New Instrument to Assess Children's Understanding of Death: Psychometrical Properties of the EsCoMu Scale in a Sample of Spanish Children

The acquisition of the death concept in children may influence how these children cope with the losses that they will confront throughout their lives. At the present time, there is a lack of psychometric instruments in Spanish-speaking countries in order to evaluate the components of the death concept in children. The aim of this study was to create and validate a scale (EsCoMu-Escala sobre el Concepto de Muerte) in order to provide insight about the concept of death in children. The sample was formed by 358 children from ages 6 to 13 years. The final EsCoMu version has 27 items which serve to evaluate universality, irreversibility, non-functionality and causality. The results of the confirmatory factor analysis show an adequate fit index for the four dimensions model, reliability (α = 83) and validity evidence, specifically based on the children’s age. In conclusion, EsCoMu is an instrument that shows adequate reliability and validity indices in order to assess the concept of death and its four components among children. Due to its simplicity, this instrument can be very useful if applied to the field of neurodevelopmental disorders.

The Relationship Between Spiritual Life and Quality of Life in People with Intellectual Disability and/or Low-Functioning Autism Spectrum Disorders

Spirituality seems to represent a relevant domain in the person-centred care planning and outcome assessment for persons with intellectual disability and low-functioning autism spectrum disorder. Despite this, the impact of spirituality on subjective well-being and quality of life (QoL) has been scarcely investigated. The aim of the present study was to map the international scientific literature in order to identify the reasons of such misconsideration and the key points for future research and practice implementation. The relationship between spirituality and QoL depends on a complexity of factors, ranging from QoL theoretical models to services' organisation. Personal attitude, family members, health and social-care personnel, training, faith and life communities, and even different religions seem to deserve an in-depth analysis.

‘I will never be old’: adults with Down syndrome and their parents talk about ageing-related challenges

The life expectancy of people with Down syndrome (DS) has increased significantly over the last few decades. Consequently, they and their families face new ageing-related challenges, the first signs of which appear in people with DS around the age of 30. The goal of this study was to explore the perceptions of adults with DS regarding their own and their parents’ ageing and end of life, and to examine the views and concerns of the parents regarding the ageing of their children with DS. The unique approach used in our study was to convene not only the ageing people with DS but also their parents, to discuss the subject together. A total of 33 people with DS participated in the study. Most of them were interviewed with one or two parents. Participants with DS found it difficult to talk about their own old age and addressed the issue mainly through the decline in the functioning of an older person they knew. The parents emphasised the changes needed in terms of the official regulations, so as to ensure that their children with DS age with dignity and quality of life. Our study identifies the increasingly pressing need to prepare adults with DS for their own and their parents’ ageing and end of life in a timely manner.

Perceptions of ageing and future aspirations by people with intellectual disability: a grounded theory study using photo-elicitation

Internationally, 1 per cent of the general population are living with an intellectual disability and life expectancy is increasing in line with global trends. The majority of people with an intellectual disability live with family. This represents a growing and largely ‘hidden’ population who have, or will have, additional needs as they and their family age. There is limited research about what is important for people with intellectual disability when thinking about getting older. This article reports on a study which explored the concept of ageing and future aspirations with 19 people living with an intellectual disability, aged 37–58 years of age (mean 48 years) and living with someone they identify as family. Using Charmaz's constructivist grounded theory approach and photo-elicitation, constant comparative analysis generated four themes: reciprocating relationships, emerging (in)dependence, configuring ageing and entertaining possibilities. As part of the interview process, photo-elicitation facilitated the expression of associations and perspectives about ageing and conceptualising the future for participants. The findings demonstrate the engagement of people with intellectual disabilities in research and provided unique insights into both their experiences and perspectives on ageing in the context of family. The need for greater flexibility in service planning and delivery are identified, alongside ensuring the meaningful inclusion of people with intellectual disability in decision-making about their own lives as they age.

Evaluating the characteristics of the grieving process in people with intellectual disability

BACKGROUND

The aim of this study was to examine the characteristics associated with the grieving process among a population with intellectual disability and the influence of particular variables.

MATERIALS AND METHODS

The sample was composed of 380 participants with intellectual disability, on whose behalf 149 professionals completed a 20-item questionnaire with four Likert-type answer options, developed to evaluate the grieving process: Inventory of Grief and Coping Strategies in Intellectual Disability (IGCS-ID).

RESULTS

The IGCS-ID shows adequate levels of reliability. It covers three dimensions: understanding of the concept of death, coping with the loss and post-bereavement reactions. The level of intellectual disability, the time elapsed since the loss and the residential setting gave rise to significant differences in the three dimensions based on the participants.

CONCLUSION

An assessment of the grieving process would help to put in place effective resources to help people with intellectual disability overcome the loss and cope with the changes that it brings.

Do men and women with intellectual disabilities understand death?

BACKGROUND

Individuals with ID are often withheld information about the death of their loved ones as it has often been thought that they do not understand death or cannot grieve. This grief exacerbates the stress of individuals with ID as they often encounter secondary losses such as transitioning to a care facility. The aim of this study is to investigate men and women with ID understanding death concepts and to what extent.

METHOD

Adopting a stratified random sampling method, 156 Chinese people with ID were invited to join the study. One hundred and ten participants were interviewed using simple death related vignettes expanding upon and replicating a published study carried out in Ireland. The understanding of the five death concepts: causality, irreversibility, nonfunctionality, universality and inevitability was examined. The correlates of demographics, bereavement experiences and comprehension were explored.

RESULTS

The majority of the participants did understand concepts such as death is irreversible and that the deceased no longer function. One third of the participants understood causality and the universality of death. One fifth understood the inevitability of death. Previous bereavement experiences were correlated with higher understanding. Communication and community skills were correlated with all concepts of death except universality.

CONCLUSION

The results indicate that individuals with ID do have a partial to full understanding of the concepts of death. The culture of Hong Kong is one that considers death to be a taboo or unlucky subject. Therefore, the results mirror the the lack of understanding of universality and inevitability concepts as it is forbidden to speak of these concepts. An open and honest environment is encouraged to educate individuals with ID about death and bereavement.

A matter of life and death: knowledge about the body and concept of death in adults with intellectual disabilities

BACKGROUND

An increased awareness of how people with intellectual disabilities (ID) understand death and dying is necessary in supporting life-long learning, post-bereavement support and planning end-of-life care. Previous research suggests that adults with ID have a limited or 'patchy' understanding of the basic biological components of death. However, the relationship between biological understanding of how the body works and conceptualisation of death remains unexplored in this population.

METHOD

Thirty adults with ID were interviewed to assess their knowledge of human body function and their understanding of the concept of death. Using pictures, participants were asked if they recognised certain organs, asked to explain the function of various body parts and what would happen if certain body parts were missing or did not work. Participants who referred to 'life' or 'not dying' as the goal of body function were categorised as 'Life Theorisers'. In addition, participants were asked about the causes of death, whether all things die and the status of the body after death.

RESULTS

The results support previous studies suggesting that understanding of death in adults with ID varies from partial to full comprehension and is associated with level of ID. Also, death comprehension was positively correlated with total body interview scores and 'Life Theorisers' who understood that body parts maintain life and who spontaneously appealed to 'vitalistic' concepts when reasoning about the human body were also more sophisticated in their understanding of death.

CONCLUSION

The study highlights the relationship between knowledge about the goal of human body functioning and death comprehension in adults with ID. The potential that learning to adopt a 'vitalistic' approach to human functioning may have on the acquisition of a greater understanding of death and dying, understanding illness and supporting end-of-life planning is discussed.

A Systematic Review of Suicidality in People with Intellectual Disabilities

BACKGROUND

Suicidality in people with intellectual disability has not been extensively researched.

AIM

To identify the nature of the research that has actually been conducted on this topic.

METHOD

A search of research databases was conducted according to predefined criteria. Key information was extracted and rated for methodological merit.

RESULTS

Twenty-four studies met the inclusion criteria for this systematic review. The aspects of suicidality investigated, which varied among studies, included suicidal attempts, behavior, ideation, and completed suicide. Thirteen studies highlighted risk factors for suicidality in this population. The most frequently noted risk factors were a concurrent mental health difficulty and the level of intellectual disability. Eight studies referred to people with intellectual disabilities' understanding of the concept of death or suicide. Various methodological issues were identified in the studies included.

CONCLUSIONS

In what we believe to be first systematic review of suicidality in people with intellectual disabilities, it was apparent that well-designed, standardized research studies on the topic are scarce. There is consequently limited evidence to guide prevention and intervention strategies for suicidality in this population.

Knowing, planning for and fearing death: Do adults with intellectual disability and disability staff differ?

BACKGROUND

Adults with intellectual disability (ID) are thought to understand less about death than the general population but there is no available research demonstrating this. Further, the detail of any possible differences in understanding is unknown.

METHODS

We compared the responses of 39 adults with mild or moderate ID and 40 disability staff (representing the general population) on (a) understanding the concept of death, (b) knowledge of and self-determination about end-of-life planning, and (c) fear-of-death.

RESULTS

We found that adults with ID had a significantly poorer understanding of the concept of death, knew much less about and were less self-determined about end-of-life planning, but reported greater fear-of-death.

CONCLUSIONS

We demonstrated, for the first time, the feasibility of assessing end-of-life planning and fear-of-death among adults with ID. The poorer understanding and lower levels of self-determination we found suggest that future research should develop and evaluate interventions to increase understanding and self-determination.

Exploring the Bereavement Experiences of Older Women with Intellectual Disabilities in Long-Term Residential Care: A Staff Perspective

This study explores the impact of bereavement on a group of older women with intellectual disabilities who have lived in a congregated residential setting for most of their lives. Using Interpretative Phenomenological Analysis, staffs' experiences of supporting individuals with varying degrees of intellectual disabilities through grief are examined. Data analysis revealed five super-ordinate themes. The findings indicate that recognizing grief in this group is complex, and secondary loss frequent. Carers and relatives may over-protect and disenfranchise their grief which is often expressed through changes in behavior and there may be a time lag before these expressions of grief are noticed. Religious practice and rituals were found to be helpful in coping and adjusting to loss. Carers are important advocates for supporting service users who are grieving, thus information on how grief is processed in elderly individuals with intellectual disabilities has implications for training and educating staff in supporting vulnerable adults.

What is talked about? Community living staff experiences of talking with older people with intellectual disability about dying and death

BACKGROUND

The aim of this study was to explore what community living staff talked about and did with people with intellectual disability (ID) to assist them to understand dying and death.

METHOD

Guided by grounded theory methodology, focus groups and one-to-one interviews were conducted with 22 staff who had talked about any topic relating to dying and death with their clients.

RESULTS

There was little evidence that staff talked with, or did things with clients to assist understanding of the end of life, both prior to and after a death. Prior to death staff assisted clients in a limited way to understand about determining wishes in preparation for death, and what dying looks like by observance of its passage. Following a death staff offered limited assistance to clients to understand the immutability of death, and how the dead can be honoured with ritual, and remembered.

CONCLUSIONS

The findings have implications for why people with ID have only partial understanding of the end of life, the staff skills required to support clients' understanding, and when conversations about the end of life should occur.

End-of-life training for paid carers working with people with learning disabilities

People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted.

'If and when?': the beliefs and experiences of community living staff in supporting older people with intellectual disability to know about dying

BACKGROUND

The aim of this study was to explore the way in which community living staff engaged with people with intellectual disability (ID) about dying and death.

METHOD

Guided by grounded theory methodology, focus groups and individual interviews were conducted with staff who had either no experience with client death, experience of a client sudden death, or a client death experience which was pre-dated by a period of end-of-life care.

RESULTS

While in principle, staff unanimously supported the belief that people with ID should know about dying, there was limited in-practice engagement with clients about the topic. Engagement varied according to staff experience, client capacity to understand and the nature of the 'opportunity' to engage. Four 'opportunities' were identified: 'when family die', 'incidental opportunities', 'when clients live with someone who is dying' and 'when a client is dying'. Despite limited engagement by staff, people with ID are regularly exposed to dying and death.

CONCLUSIONS

People with ID have a fundamental right to know about dying and death. Sophisticated staff skills are required to ensure that people with ID can meaningfully engage with end-of-life issues as opportunities arise.

The road barely taken: funerals, and people with intellectual disabilities

BACKGROUND

The topic of funerals within the life cycle approach to care in the U.K. remains largely absent. This small exploratory study sought to investigate how practitioners deal with this sensitive issue and to capture the views of older people with and without intellectual disabilities about funerals.

METHODS

A semi-structured questionnaire was administered to 40 service managers, and five focus groups for 26 people with and without intellectual disabilities were facilitated. Questionnaires were subjected to thematic content analysis; focus group data were analysed using a grounded theory approach.

RESULTS

Managers demonstrated confusion about organizing the funerals of people with intellectual disabilities. Few differences existed between the views of people with and without intellectual disabilities in relation to funerals and a number of core themes were identified including the lack of opportunities to attend funerals.

CONCLUSIONS

More thought and practical interventions are needed to support vulnerable people to participate in the funerals of people they know.

Older adults with intellectual disability

PURPOSE OF REVIEW

Improvements in health and social care for people with intellectual disability have led to a dramatic increase in the life expectancy of this population, resulting in a large and growing number of older adults with intellectual disability. They are at risk of age-related mental disorders such as dementia and continue to present with high rates of mental illness.

RECENT FINDINGS

Recent research with older adults with intellectual disability has included physical health issues that may affect mental well being, and biological and clinical features of dementia in people with Down syndrome. Two key clinical trials of memantine and antioxidants for dementia in Down syndrome showed that these treatment options were ineffective in the short term. Other research focussed on environmental and psychosocial issues (including carer issues) and end-of-life care.

SUMMARY

Improved mental well being requires effective management of mental illness and co-morbid physical health problems as well as consideration of environmental and social issues. Biological research has identified potential treatments for age-related decline, which has led to the development of medication trials. Despite disappointing results, two recent medication trials showed that randomized controlled trials are feasible in older people with intellectual disabilities - a group who are often excluded from trials.

O conceito de morte e a Síndrome de Asperger

O conceito de morte é adquirido paralelamente ao desenvolvimento cognitivo e afetivo da criança, sendo descritos três estágios, paralelos aos estágios piagetianos. O objetivo deste trabalho foi verificar se o conceito de morte em portadores da síndrome de Asperger é similar ao observado em pessoas sem psicopatologia, ou se tem relação com o observado em portadores de deficiência intelectual leve. Para tanto, foram avaliados indivíduos com síndrome de Asperger, indivíduos com deficiência intelectual leve e indivíduos sadios, sem doenças mentais e/ou neurológicas, utilizando-se o Instrumento de Sondagem do Conceito de Morte elaborado por Wilma Torres. Os resultados apontam deficits na aquisição do conceito de morte por indivíduos com síndrome de Asperger, possivelmente relacionados aos deficits na teoria da mente, função executiva e fraca coerência central.

Grief Among Demented Elderly Individuals

Grief behaviors of 17 elderly persons with dementia living at nursing homes were observed. When compared with bereaved with normal cognitive ability, both similarities and differences were found. Similarities seemed to exist for irritability, lost appetite, increased sedative medication, bodily complaints, less physical activity, and less interest in happy events. Differences were found, for example, social activity, as they did not isolate themselves. The workload of staff increased when a caretaker was bereaved. Repeated information to the patients with dementia about the loss, their seeking for the dead and crying outbursts remembering the loss, and the need of comfort was common, although several had their loss more than months ago. Proper interventions including facilitating programs for both staff and caretakers are recommended, as also a larger study group.