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Timmins F. A national cohort study of spiritual and religious practices of older people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:533-548. [PMID: 36958936 PMCID: PMC11059840 DOI: 10.1177/17446295231163977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background: Spirituality and spiritual support for older people with intellectual disability are deemed important, however little is known about their specific needs. This paper reports for the first time on the religious and spiritual practices of older adults with intellectual disability. Methods: A national longitudinal study examined the prevalence of spiritual practices among older people with intellectual disability in the Republic of Ireland. Results: Older people with intellectual disability seek and receive solace from religious and spiritual practices, especially if they are lonely, in poor health, distressed or bereaved. There is likely a social benefit to spiritual and religious aspects of life that would be beneficial to explore further. Conclusions: Globally more research is required and efforts should be made to ensure greater opportunities for inclusion in societal spiritual and religious activities and to more clearly determine the spiritual needs of this population.
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Affiliation(s)
- Fiona Timmins
- Midwifery and Health Systems, School of Nursing, UCD, Dublin, Ireland
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2
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Dennehy H, Allen AP, McGlinchey E, Buttery N, García-Domínguez L, Chansler R, Corr C, Dunne P, Kennelly S, Daly L, McCallion P, McCarron M. A scoping review of post-diagnostic dementia supports for people with intellectual disability. Aging Ment Health 2022:1-10. [PMID: 36218056 DOI: 10.1080/13607863.2022.2130171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: People with intellectual disability, particularly people with Down syndrome, are at an increased risk for early-onset dementia, in comparison to people without an intellectual disability. The aim of this review was to scope the current landscape of post-diagnostic dementia supports for people with intellectual disability.Method: A systematic search of five electronic databases (CINAHL, Medline, PsycArticles, PsycInfo and Web of Science) was conducted for this scoping review. Results were screened independently by two reviewers, with a third reviewer for arbitration where necessary.Results: Forty-two studies met the inclusion criteria, and relevant information was extracted. The articles included focussed on the experiences of people with intellectual disability and dementia, as well as the role of carers, family members and staff. Key themes included ageing in place, environmental supports for people with intellectual disability and dementia, dementia-specific interventions and therapies, as well as the feasibility of these interventions. Besides the studies that focussed on these themes, other studies focussed on staff training and family supports.Conclusion: This review highlights the importance of implementing timely and appropriate post-diagnostic supports for people living with intellectual disability and dementia. More controlled trials are required on post-diagnostic dementia supports for people with intellectual disability.
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Affiliation(s)
- Holly Dennehy
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland
| | - Andrew P Allen
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland.,School of Nursing & Midwifery, Trinity College Dublin, Ireland
| | - Eimear McGlinchey
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland.,School of Nursing & Midwifery, Trinity College Dublin, Ireland.,National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
| | - Nadine Buttery
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland
| | | | - Rachael Chansler
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Christina Corr
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland
| | - Pamela Dunne
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
| | - Seán Kennelly
- National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Louise Daly
- School of Nursing & Midwifery, Trinity College Dublin, Ireland
| | - Philip McCallion
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland.,School of Social Work, Temple University, Philadelphia, USA
| | - Mary McCarron
- Trinity Centre for Ageing & Intellectual Disability, Trinity College Dublin, Ireland.,School of Nursing & Midwifery, Trinity College Dublin, Ireland.,National Intellectual Disability Memory Service, Tallaght University Hospital, Dublin, Ireland
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3
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Doody O, Bailey ME, Hennessy T. Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research. BMJ Open 2021; 11:e051858. [PMID: 34615681 PMCID: PMC8496393 DOI: 10.1136/bmjopen-2021-051858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To capture the extent and nature of intellectual disability nursing publications in Ireland. DESIGN Scoping review using Arksey and O'Malley approach. DATA SOURCES Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. ELIGIBILITY CRITERIA Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. DATA EXTRACTION AND SYNTHESIS Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. RESULTS The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. CONCLUSIONS This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.
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Affiliation(s)
- Owen Doody
- Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria E Bailey
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Shirai Y, Bishop K, Kushner M. National Dementia Capable Care Training: A Model Implementation and Evaluation. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:422-435. [PMID: 34551102 DOI: 10.1352/1934-9556-59.5.422] [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: 01/29/2020] [Accepted: 10/05/2020] [Indexed: 06/13/2023]
Abstract
With a growing need for specialized training for direct caregivers and support staff of persons with intellectual and developmental disabilities (IDD) affected by dementia, the National Task Group on Developmental Disabilities and Dementia Practices (NTG) developed a comprehensive evidence-informed Dementia Capable Care Training (DCCT). To overcome the challenge of the training length and cost, and to extend its dissemination, the Sonoran Center developed a shorter version of the NTG-DCCT while retaining its core components, and implemented it in seven cities in the U. S. Southwest (N = 368). The pre- and post-training evaluation (n =260) demonstrated that the short version of the NTG-DCCT is effective in significantly improving participants' knowledge and/or confidence in dementia capable care. The follow-up semi-structured interviews of participants (n = 7) provide some insights.
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Affiliation(s)
- Yumi Shirai
- Yumi Shirai, Sonoran Center for Excellence in Disabilities
| | - Kathleen Bishop
- Kathleen Bishop, National Task Group on ID and Dementia Practices
| | - Melissa Kushner
- Melissa Kushner, Sonoran Center for Excellence in Disabilities
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5
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Todd S, Brandford S, Worth R, Shearn J, Bernal J. Place of death of people with intellectual disabilities: An exploratory study of death and dying within community disability service settings. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:296-311. [PMID: 31714176 DOI: 10.1177/1744629519886758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article describes an exploratory study of deaths of people with intellectual disabilities (IDs) that had occurred in group homes managed by an ID service provider in Australasia. Such settings are increasingly recognised as places for both living and dying. Little is known about the extent to which they encounter the death of a person with ID and with what outcomes. Data were obtained from service records and telephone interviews on 66 deaths occurring within a 2-year period. The findings suggest that death is an important but relatively rare event within ID services. This rate of death was influenced by the age structure of the population. Most of the deaths occurred within a hospital setting. Cause of death did not have much impact upon place of death. However, setting characteristics seemed to have some influence. As an exploratory study, lessons for future population-based research in this area are addressed.
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Gracner T, Stone PW, Agarwal M, Sorbero M, Mitchell SL, Dick AW. Advanced cognitive impairment among older nursing home residents. BMC Geriatr 2021; 21:382. [PMID: 34162335 PMCID: PMC8220753 DOI: 10.1186/s12877-021-02336-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Though work has been done studying nursing home (NH) residents with either advanced Alzheimer's disease (AD) or Alzheimer's disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. METHODS This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011-2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. RESULTS Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). CONCLUSIONS There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, 560 W. 168th St, New York, NY, 10032, USA
| | - Mansi Agarwal
- Washington University School of Medicine, 660 S Euclid Ave, St.Louis, MO, 63110, USA
| | - Mark Sorbero
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Susan L Mitchell
- Hebrew Senior Life Marcus Institute for Aging Research, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrew W Dick
- RAND Corporation, 20 Park Plaza #920, Boston, MA, 02116, USA
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What Constitutes Good Quality End‐of‐Life Care? Perspectives of People With Intellectual Disabilities and Their Families. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Todd S, Bernal J, Shearn J, Worth R, Jones E, Lowe K, Madden P, Barr O, Forrester Jones R, Jarvis P, Kroll T, McCarron M, Read S, Hunt K. Last months of life of people with intellectual disabilities: A UK population‐based study of death and dying in intellectual disability community services. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1245-1258. [DOI: 10.1111/jar.12744] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Stuart Todd
- Care Sciences University of South Wales Pontypridd UK
| | - Jane Bernal
- Care Sciences University of South Wales Pontypridd UK
| | - Julia Shearn
- Care Sciences University of South Wales Pontypridd UK
| | - Rhian Worth
- Care Sciences University of South Wales Pontypridd UK
| | - Edwin Jones
- Care Sciences University of South Wales Pontypridd UK
| | - Kathy Lowe
- Care Sciences University of South Wales Pontypridd UK
| | | | - Owen Barr
- School of Nursing Ulster University Derry UK
| | | | - Paul Jarvis
- Care Sciences University of South Wales Pontypridd UK
| | - Thilo Kroll
- School of Nursing Midwifery and Health Systems University College Dublin Dublin UK
| | - Mary McCarron
- School of Nursing & Midwifery Trinity College Dublin Dublin UK
| | - Sue Read
- School of Nursing & Midwifery University of Keele Newcastle under Lyme UK
| | - Katherine Hunt
- Faculty of Health Sciences Southampton University Southampton UK
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Fisher K, Robichaux C, Sauerland J, Stokes F. A nurses' ethical commitment to people with intellectual and developmental disabilities. Nurs Ethics 2020; 27:1066-1076. [PMID: 32228209 DOI: 10.1177/0969733019900310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: This article explores the issues of knowledge deficits of healthcare professionals in meeting the needs of people with IDD throughout the life span, and to identify factors that contribute to these deficits. Although statistics vary due to census results and the presence of a "hidden population," approximately 1%-3% of the global population identify as living with an intellectual or developmental disability. People with intellectual or developmental disability experience health inequities and confront multiple barriers in society, often related to the stigma of intellectual or developmental disability. Disparities in care and service are attributed to a lack of knowledge and understanding among healthcare providers about people with intellectual or developmental disability, despite their increased risk for chronic health problems. The near absence of educational programs in nursing both nationally and internationally contributes to this significant knowledge deficit. In addition, ethical considerations between paternalistic beneficence and idealized autonomy have resulted in a lack of clear direction in working with a population that is often ignored or exploited. Nurses who view people with intellectual or developmental disability as vulnerable without assessing or acknowledging their capabilities may err toward paternalism in an effort to "first do no harm." Likewise, nurses who fail to recognize the challenges and limitations faced by people with intellectual or developmental disability may not provide sufficient protections for a vulnerable person. People with intellectual or developmental disability are not binary, but rather complex individuals with a myriad of presentations. This article seeks to encourage a well-informed model of nursing care. Through an ethical lens, this article explores the nurse's ethical commitments in cases of victimization, access to care, decision making, and the provision of optimal end-of-life care for people with intellectual or developmental disability.
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Watchman K, Janicki MP. The Intersection of Intellectual Disability and Dementia: Report of The International Summit on Intellectual Disability and Dementia. THE GERONTOLOGIST 2019; 59:411-419. [PMID: 29106536 DOI: 10.1093/geront/gnx160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/16/2017] [Indexed: 11/13/2022] Open
Abstract
An International Summit on Intellectual Disability and Dementia, held in Glasgow, Scotland (October 13-14, 2016), drew individuals and representatives of numerous international and national organizations and universities with a stake in issues affecting adults with intellectual disability (ID) affected by dementia. A discussion-based consensus process was used to examine and produce a series of topical reports examining three main conceptual areas: (a) human rights and personal resources (applications of the Convention for Rights of People with Disabilities and human rights to societal inclusion, and perspectives of persons with ID), (b) individualized services and clinical supports (advancing and advanced dementia, post-diagnostic supports, community supports and services, dementia-capable care practice, and end-of-life care practices), and (c) advocacy, public impact, family caregiver issues (nomenclature/terminology, inclusion of persons with ID in national plans, and family caregiver issues). Outcomes included recommendations incorporated into a series of publications and topical summary bulletins designed to be international resources, practice guidelines, and the impetus for planning and advocacy with, and on behalf of, people with ID affected by dementia, as well as their families. The general themes of the conceptual areas are discussed and the main recommendations are associated with three primary concerns.
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Affiliation(s)
- Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | - Matthew P Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
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Dillane I, Doody O. Nursing people with intellectual disability and dementia experiencing pain: An integrative review. J Clin Nurs 2019; 28:2472-2485. [PMID: 30786087 DOI: 10.1111/jocn.14834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/09/2019] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To explore the current evidence of nurses caring for people with intellectual disability and dementia who experience pain. BACKGROUND People with intellectual disability are ageing and are experiencing age-related health conditions including dementia and conditions associated with pain, but at an earlier age. Addressing the needs of people with intellectual disability who develop dementia is a new challenge for nurses. DESIGN An integrative literature review. METHODS A systematic search of databases: CINAHL, MEDLINE, PsycINFO, Cochrane, EMBASE, Academic Search Complete, Scopus and Web of Science between 27 October 2017-7 November 2017. Hand searching and review of secondary references were also undertaken. Quality appraisal (Crowe Critical Appraisal Tool), thematic data analysis (Braun and Clarke, Qualitative Research in Psychology, 3, 2006, 77) and reporting using the PRISMA guidelines. RESULTS Seven papers met the inclusion criteria, and three themes emerged from this review: nurses knowledge of ageing, dementia and pain; recognising pain in people with intellectual disability and dementia; and the role of nurse education. People with intellectual disability and dementia have difficulty communicating their pain experience compounded by pre-existing communication difficulties. CONCLUSIONS A pain experience can present similar to behavioural and psychological symptoms of dementia, and diagnostic overshadowing often occurs whereby a pain need is misinterpreted as behavioural and psychological symptoms resulting in inappropriate treatment. Nurses need greater knowledge about the presence of pain and potential causes in people with intellectual disability and dementia, and education can be effective in addressing this knowledge deficit. RELEVANCE TO CLINICAL PRACTICE Pain assessment tools for people with intellectual disability and dementia need to include behavioural elements, and baseline assessments are required to identify changes in presentation. Nurses need to recognise and respond to pain based on the evidence in order to deliver quality care.
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Affiliation(s)
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Abstract
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.
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Affiliation(s)
- Brian Draper
- a School of Psychiatry , University of NSW , Sydney , NSW , Australia
| | - Lee-Fay Low
- b Faculty of Health Sciences , University of Sydney , Sydney , NSW , Australia
| | - Henry Brodaty
- c Centre for Healthy Brain Ageing , University of NSW Sydney , Sydney , NSW , Australia
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Tromans S, Andrews H, Wani A, Ganghadaran S. The ELCIDD Project: An Audit of End-of-Life Care in Persons with Intellectual Disabilities and Dementia. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Hayley Andrews
- General Adult Psychiatry Service; Leicestershire Partnership NHS Trust; Leicester UK
| | - Anu Wani
- Learning Disabilities Service; Leicestershire Partnership NHS Trust; Leicester UK
| | - Satheesh Ganghadaran
- Learning Disabilities Service; Leicestershire Partnership NHS Trust; Leicester UK
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Dodd K, Watchman K, Janicki MP, Coppus A, Gaertner C, Fortea J, Santos FH, Keller SM, Strydom A. Consensus statement of the international summit on intellectual disability and Dementia related to post-diagnostic support . Aging Ment Health 2018; 22:1406-1415. [PMID: 28880125 DOI: 10.1080/13607863.2017.1373065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Post diagnostic support (PDS) has varied definitions within mainstream dementia services and different health and social care organizations, encompassing a range of supports that are offered to adults once diagnosed with dementia until death. METHOD An international summit on intellectual disability and dementia held in Glasgow, Scotland in 2016 identified how PDS applies to adults with an intellectual disability and dementia. The Summit proposed a model that encompassed seven focal areas: post-diagnostic counseling; psychological and medical surveillance; periodic reviews and adjustments to the dementia care plan; early identification of behaviour and psychological symptoms; reviews of care practices and supports for advanced dementia and end of life; supports to carers/ support staff; and evaluation of quality of life. It also explored current practices in providing PDS in intellectual disability services. RESULTS The Summit concluded that although there is limited research evidence for pharmacological or non-pharmacological interventions for people with intellectual disability and dementia, viable resources and guidelines describe practical approaches drawn from clinical practice. Post diagnostic support is essential, and the model components in place for the general population, and proposed here for use within the intellectual disability field, need to be individualized and adapted to the person's needs as dementia progresses. CONCLUSIONS Recommendations for future research include examining the prevalence and nature of behavioral and psychological symptoms (BPSD) in adults with an intellectual disability who develop dementia, the effectiveness of different non-pharmacological interventions, the interaction between pharmacological and non-pharmacological interventions, and the utility of different models of support.
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Affiliation(s)
- Karen Dodd
- a Department of Psychology , Surrey and Borders Partnership NHS Foundation Trust , Leatherhead , UK
| | | | | | - Antonia Coppus
- d Radboudumc , Nijmegen , The Netherlands.,e Dichterbij Centre of the Intellectual Disabled , Gennep , The Netherlands
| | | | - Juan Fortea
- g Hospital De La Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau , Barcelona , Spain.,h Down Medical Center, Fundació Catalana Síndrome de Down , Barcelona , Spain
| | - Flavia H Santos
- i University of Minho , Braga , Portugal.,j UNESP - São Paulo State University , Bauru , Brazil
| | - Seth M Keller
- k Advocare Neurology South Jersey , Lumberton , NJ USA
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Santos FH, Watchman K, Janicki MP. Highlights from the International Summit on Intellectual Disability and Dementia Implications for Brazil. Dement Neuropsychol 2018; 12:329-336. [PMID: 30546842 PMCID: PMC6289481 DOI: 10.1590/1980-57642018dn12-040001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022] Open
Abstract
In October of 2016, an interdisciplinary group representing North and South American and European countries met in Glasgow, Scotland, to scrutinize universal issues regarding adults with intellectual disability (ID) affected by dementia and to produce recommendations and guidelines for public policy, practice, and further research. The aim of this paper is to apprise relevant outcomes of the Summit targeting Brazilian researchers, clinicians, and nongovernmental organizations in the field of ageing and dementia that are committed to developing the Brazilian national dementia plan. Three core themes were covered by the Summit: i) human rights and personal resources, ii) personalized services and caregiver support, and iii) advocacy and public impact. The exploration of the themes highlighted variations across countries, and revealed consensual views on matters such as international networks, guidance for practices, and advocacy on behalf of both people with ID affected by dementia, and their families. The authors outline the challenges Brazil must confront regarding ageing and dementia and proffer recommendations to address the needs of adults with ID affected by dementia within this scenario; both of which would help in developing the Brazilian national dementia plan.
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Affiliation(s)
- Flavia H Santos
- São Paulo State University, Bauru, SP, Brazil
- University College Dublin, Ireland
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McCarron M, McCallion P, Watchman K, Janicki MP, Coppus A, Service K, Fortea J, Hogan M, Reilly E, Stemp S. Quality Care for People with Intellectual Disability and Advanced Dementia: Guidance on Service Provision. J Palliat Med 2018; 21:1344-1352. [DOI: 10.1089/jpm.2017.0442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mary McCarron
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- School of Social Work, Temple University, Philadelphia, Pennsylvania
| | - Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | | | - Antonia Coppus
- School of Medicine, Radboud University, Nijmegen, The Netherlands
| | | | - Juan Fortea
- Catalan Foundation for Down Syndrome, Barcelona, Spain
| | | | - Evelyn Reilly
- Daughters of Charity Disability Support Service, Dublin, Ireland
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McCarron M, McCallion P, Coppus A, Fortea J, Stemp S, Janicki M, Wtachman K. Supporting advanced dementia in people with Down syndrome and other intellectual disability: consensus statement of the International Summit on Intellectual Disability and Dementia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:617-624. [PMID: 29781149 DOI: 10.1111/jir.12500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 12/31/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The International Summit on Intellectual Disability and Dementia (Glasgow, Scotland; October 2016) noted that advanced dementia can be categorised as that stage of dementia progression characterised by significant losses in cognitive and physical function, including a high probability of further deterioration and leading to death. METHOD The question before the Summit was whether there were similarities and differences in expressions of advanced dementia between adults with intellectual disability (ID) and adults in the general population. RESULTS The Summit noted challenges in the staging of advanced dementia in people with ID with the criteria in measures designed to stage dementia in the general population heavily weighted on notable impairment in activities of daily living. For many people with an ID, there is already dependence in these domains generally related to the individuals pre-existing level of intellectual impairment, that is, totally unrelated to dementia. Hence, the Summit agreed that as was true in achieving diagnosis, it is also imperative in determining advanced dementia that change is measured from the person's prior functioning in combination with clinical impressions of continuing and marked decline and of increasing co-morbidity, including particular attention to late-onset epilepsy in people with Down syndrome. It was further noted that quality care planning must recognise the greater likelihood of physical symptoms, co-morbidities, immobility and neuropathological deterioration. CONCLUSIONS The Summit recommended an investment in research to more clearly identify measures of person-specific additional decline for ascertaining advanced dementia, inform practice guidelines to aid clinicians and service providers and identify specific markers that signal such additional decline and progression into advanced dementia among people with various levels of pre-existing intellectual impairment.
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Affiliation(s)
- M McCarron
- School of Nursing and Midwifery Studies, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - A Coppus
- University Medical Center, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - J Fortea
- Fundacio Catalana per a la Recerca i la Innovacio, Barcelona, Catalunya, Spain
| | | | - M Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - K Wtachman
- Faculty of Health Sciences and Sport, Stirling, Scotland
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Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A 2017; 176:116-133. [PMID: 29130597 DOI: 10.1002/ajmg.a.38512] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.
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Affiliation(s)
- George T Capone
- Kennedy Krieger Institute, Down Syndrome Clinic & Research Center, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Adult Down Syndrome Center, Park Ridge, Illinois
| | - Peter Bulova
- Montefiore Hospital, Adult Down Syndrome Clinic, Pittsburgh, Pennsylvania
| | - Mary Stephens
- Christiana Care Health System, Adult Down Syndrome Clinic, Wilmington, Delaware
| | - Sarah Hart
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrea Videlefsky
- The Adult Disability Medical Home, Urban Family Practice, Marietta, Georgia
| | | | - Nancy Roizen
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Moya Peterson
- University of Kansas Medical Center, Adults with Down Syndrome Specialty Clinic, Kansas City, Kansas
| | | | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Barry Martin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Smith
- Children's Hospital of Wisconsin, Down Syndrome Clinic of Wisconsin, Milwaukee, Wisconsin
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Stancliffe RJ, Wiese MY, Read S. End of life and people with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:977-981. [PMID: 28758356 DOI: 10.1111/jar.12383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Roger J Stancliffe
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW, Australia
| | - Michele Y Wiese
- School of Social Sciences and Psychology, Western Sydney University, Penrith NSW, Australia
| | - Sue Read
- School of Nursing and Midwifery, Keele University, Keele, UK
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Watchman K, Janicki MP, Splaine M, Larsen FK, Gomiero T, Lucchino R. International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans. Am J Alzheimers Dis Other Demen 2017; 32:230-237. [PMID: 28417674 PMCID: PMC10852755 DOI: 10.1177/1533317517704082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.
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Affiliation(s)
- Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - Matthew P. Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Frode K. Larsen
- Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway
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