How to improve the quality of life of elderly people with intellectual disability: A systematic literature review of support strategies

Challenges and responsibilities in the medication management process in 24/7 group housing services for adults with intellectual disability: Interviews with nurses

Staff in 24/7 group housing services for adults with intellectual disability are responsible for ensuring safe medication management processes and supporting the residents in their health-related issues. Ten interviewed nurses reported several challenges in the medication management process emerging at the staff level, the level of the group home, and the level of the social and healthcare system, and were often related to issues in communication and responsibility. They reported a variety of complex tasks in the medication management process, for which they need a multiple skill set. They also act as healthcare advocates for residents, but healthcare services do not always match residents' needs. Training for social and healthcare professionals, access to healthcare services and the collaboration of social and healthcare services should be improved to provide the people with intellectual disability the best possible pharmacotherapy and healthcare.

Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study

BACKGROUND

The global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training.

AIMS

This study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model.

METHODS AND PROCEDURES

247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution.

OUTCOMES AND RESULTS

Both populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.

Good life in old age: Qualitative interviews about ageing with older adults with mild intellectual disability, prior to an educational intervention

Background: Knowledge about ageing from the perspective of people with intellectual disability is extremely scarce, which means a lack of evidence-based interventions for healthy ageing adjusted to their needs. Aim: To investigate how people with intellectual disability experience ageing, prior to an educational intervention. Methods: Twenty-six persons with mild intellectual disability, age 42-74 (mean 61.3) were interviewed and the text was analyzed qualitatively. Results: The main findings are reflected in the themes Live for today - tomorrow you are old and Need of support to enable a meaningful ageing. The participants avoided thinking about ageing, which they associated with retirement, loneliness and social isolation, increased need for help in everyday life, worsening health and death. Meaningful ageing meant continuance of leisure activities and working as long as possible. Conclusions: Interventions to prepare people with mild intellectual disability for healthy ageing must take into account these people's loneliness.

Empowerment of the older adults in the context of Chinese culture: an evolutionary concept analysis

Background

With the increasing focus on addressing the challenges of aging, researchers have begun to recognize the potential impact of empowering older individuals in addressing retirement issues. However, within different cultural contexts, there still needs to be a more precise analysis regarding the definition of empowering older individuals.

Objective

To define and analyze the concept of empowering older individuals within the cultural context of China.

Method

Using Rodgers' concept analysis approach, a search was conducted in five databases (PubMed, Web of Science, China National Knowledge Infrastructure, Wan fang Data, and VIP Chinese Journal Platform) for studies on empowering older individuals from the time the databases were established until February 2023. The main disciplines involved in the search included nursing, medicine, and public health.

Results

Out of the 7,028 studies, 50 articles met the inclusion criteria. The identified attributes are as follows: support system, belief change, and behavioral autonomy. The antecedents were grouped into four categories: physical obstacles, psychological concerns, personal needs and external challenges. The consequences were determined to be improved quality of life, reduced burden of old-age care, gain respect, and self-actualization.

Conclusion

Empowering older individuals is a dynamic and evolving concept that involves aligning personal aspirations with appropriate external resources and expressing a certain degree of belief and behavioral change. This study deepens our understanding of empowering older individuals through comprehensive concept analysis, and the identified attributes, antecedents, and consequences of empowering older individuals can be utilized in practice, education, and research.

Support needs of older people with intellectual disabilities: An exploratory study among psychologists in the Netherlands

BACKGROUND

Information regarding the common-daily support needs of older people with intellectual disabilities remains scarce, despite the necessity of such knowledge to the provision of adequate support. This exploratory study aims to identify the most important support needs.

METHOD

A mixed-method design was conducted, in which 11 semi-structured interviews were held with psychologists to gain insight into the support needs of older people with intellectual disabilities.

RESULTS

The data provide an overview of the support needs of older people with intellectual disabilities in all quality-of-life (QoL) domains. Physical well-being, emotional well-being, interpersonal relationships and self-determination were identified as the most important domains for older people with intellectual disabilities.

CONCLUSIONS

The findings of this study may guide the development of a specific training for support staff and constitute a valuable contribution to raising awareness among support staff concerning the broad range of support needs existing among older people with intellectual disabilities.

Ableism, racism, and the quality of life of Black, Indigenous, people of colour with intellectual and developmental disabilities

BACKGROUND

Research indicates Black, Indigenous, people of colour (BIPOC) with intellectual and developmental disabilities face disparities in quality of life outcomes. This study's aim was to examine how ableism and racism impacted the quality of life of BIPOC with intellectual and developmental disabilities.

METHODS

Using a multilevel linear regression, we analysed secondary quality of life outcome data from Personal Outcome Measures® interviews with 1393 BIPOC with intellectual and developmental disabilities and implicit ableism and racism data from the 128 regions of the United States in which they lived (discrimination data came from 7.4 million people).

RESULTS

When BIPOC with intellectual and developmental disabilities lived in regions of the United States which were more ableist and racist, they had a lower quality of life, regardless of their demographics.

CONCLUSION

Ableism and racism are a direct threat to BIPOC with intellectual and developmental disabilities' health, wellbeing, and overall quality of life.

A microswitch-aided program to enable people with extensive multiple disabilities to control environmental stimulation through different responses

Objectives

This study assessed whether a simple technology-aided program (i.e., a program involving the use of microswitches linked to a smartphone) could be set up to enable people with motor, sensory and intellectual disabilities to control preferred environmental stimulation through two different response movements.

Methods

Ten participants were involved in the study. Each of them was exposed to an ABAB design, in which A represented baseline phases without the program and B intervention phases with the use of the program. The study assessed whether the participants (a) had significant increases of each of the two response movements available and/or showed response variability across sessions and over time and (b) had signs of satisfaction/happiness during the study sessions, in connection with their stimulation access and control.

Results

The program was effective in increasing the participants' responding and consequently their self-regulated stimulation input. Half of the participants showed a significant increase of both responses available from the first intervention phase. Other participants seemed to focus more on one of the two responses. Even so, they tended to have occasionally high performance frequencies also with regard to their non-dominant (not significantly increased) response. Finally, all participants showed clear signs of satisfaction/happiness during the intervention sessions.

Conclusions

The program represents a potentially useful approach for enabling people with extensive multiple disabilities to self-regulate their access to preferred environmental stimulation and improve their mood.

Supporting direct support professionals in enabling people with intellectual disabilities to engage in meaningful activities: protocol for the Meaningful Activities 4 All (MA4A) study based on the human-centred design process

INTRODUCTION

Meaningful activities (MA) have a positive impact on identity, well-being, participation and inclusion. Although people with intellectual disabilities (PID) depend on their direct support professionals (DSPs) to engage in MA, the DSPs need support which could enable them to offer more qualitative care and support.

METHODS AND ANALYSIS

To identify DSPs' needs, and to develop a tool/service, an innovative and iterative approach is developed, based on the human-centred design (HCD) process, combined with traditional qualitative and quantitative research methods. In the inspiration phase (needs analysis), in-depth interviews will be conducted in two day care centres in Flanders using an interpretative phenomenological analyses, one with a supply-driven approach and the other with a demand-driven approach, followed by a survey sent to all Flemish day care centres. In the ideation phase, the insights of phase 1 will guide a cocreation process (comprising a World Cafe, brainstorm and prototype sessions) with the DSPs, PID and other stakeholders. In the implementation phase, the solution will be tested in the two day care centres from phase 1 by means of living labs and a realist evaluation. By adopting this protocol, the functionality, quality, usability and acceptance are expected to increase. This protocol adopts all phases of the HCD process and shows the complementarity of HCD with traditional research methods. PID and the DSPs will benefit as the end result is truly grounded in their specific needs and wishes.

ETHICS AND DISSEMINATION

Ethical approval by the Ethics Committee of the University Hospital Ghent, Belgium (reference numbers: B670202042983 and PA2021-091). All participants will sign informed consent forms. Results of this study will be submitted for publication in relevant peer-reviewed journals and will be presented at relevant conferences.

Conceptualization of quality of life in autistic individuals

The present study examines to what extent two core characteristics of the quality of life (QoL) construct were incorporated in the field of autism: (1) its subjective nature; and (2) its multidimensionality. Therefore, we reviewed 174 articles examining QoL in individuals with autism. The review showed parents reporting a lower QoL compared with autistic individuals themselves, especially on internal domains. This may suggest different expectations about what a good QoL may entail. Such an underestimation of QoL by others is commonly observed in individuals with disabilities (the so-called 'disability paradox'). For the multidimensionality of the QoL construct, our findings suggest that the narrower (and more unidimensional) construct of health-related QoL is often measured instead of QoL. Additionally, a substantial proportion of items did not measure QoL, but they evaluated characteristics that may or may not have an impact on QoL. Researchers and clinicians should be aware that QoL domains are selected and operationalized differently by different instruments. QoL may benefit from an exclusive focus on subjective aspects, which can be measured alongside more normative, objective characteristics of individuals or their environment.

Predictors of Productivity and Leisure for People Aging with Intellectual Disability

Background. Adults aging with intellectual disability (ID) face barriers to engagement in occupation. Greater understanding of factors that affect engagement in work and leisure occupations is required to support occupational engagement in this population. Purpose. Identify predictors of engagement in work and leisure occupations for adults aging with an ID, and consider implications for occupational therapy practice. Method. Data from wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (IDS-TILDA) was analyzed using regression analysis to identify predictors of engagement in work and leisure occupations for adults aging with an ID. Findings. Adults who had difficulty getting around their home environment, poor physical health, or older age were less likely to engage in work and leisure activities. Implications. Occupational therapists can support adults aging with ID to age in place. Occupation-focused health promotion could enhance well-being through engagement in occupation.

Psychosocial interventions for older people with intellectual disabilities and the role of support staff: A systematic review

Background

The life expectancy of people with intellectual disabilities has increased. The implications of ageing have resulted in changes in their support needs and challenges to support staff. Access to evidence based strategies for support staff providing care to elderly with intellectual disabilities remains scarce. A systematic review was conducted to provide an overview of available psychosocial interventions.

Methods

Four databases were searched and assessed according to the PRISMA guidelines. A narrative, integrative method of analysis was conducted to synthesise quantitative and qualitative data.

Results

The 36 studies included in the review reported on interventions aimed at either identifying and meeting the needs or perceptions of older individuals or at improving their behaviour and skills. Furthermore, the role of support staff in the implementation of interventions was either active, assisting or undefined.

Conclusions

This overview of studies could contribute to the existing body of knowledge and help to optimise psychosocial support for a growing population.

Environmental Modifications and Supports for Participation Among Adults Aging With Intellectual and Developmental Disabilities: A Scoping Review

IMPORTANCE

Adults aging with intellectual and developmental disabilities (IDD) continue to face barriers to participation in meaningful occupation; moreover, the increased life expectancy of adults with IDD intensifies the need for age- and environment-specific support.

OBJECTIVE

To map and categorize transdisciplinary literature on environmental modifications and supports for adults aging with IDD.

DATA SOURCES

Studies published between January 1, 2000, and January 1, 2019, identified through PubMed and Scopus. Study Selection and Data Collection: Eleven articles met the inclusion criteria and contained information specific to occupational participation based on environmental modification (e.g., physical space, technology, universal design, type of living setting), social supports (e.g., family members, caretakers, peer groups, health care professionals, policies, organizational infrastructure), or both and adults age ≥35 yr with IDD.

FINDINGS

Eleven studies met the criteria for this scoping review. Thematic coding was used to examine the articles within one or more themes: definition of need, environmental risk and assessment, environmental setting, intervention and program planning, use of technology, and bureaucracy.

CONCLUSIONS AND RELEVANCE

This review highlights collective and individual outcomes in the areas of assessment, intervention, and advocacy. Further research is needed within the scope of occupational therapy and disability studies that examines environmental factors and participation outcomes in this population. What This Article Adds: The authors define the interconnectedness of adults aging with IDD and environmental factors, identify barriers to participation, and guide occupational therapy practitioners' logic on how to positively affect environmental change and supports through intervention.

Mental health of older people with mild and moderate intellectual disability in Australia

BACKGROUND

The progressive increase in life expectancy of people with intellectual disability (ID) has resulted in enhanced survival into old age and has also seen a growth in research on both lifelong and emerging ageing-related health issues. Health issues amongst provider-supported adults have been previously studied, but these studies have not always included older community-dwelling adults with ID.

METHODS

A study examining the extent of mental health of 391 community-dwelling adults with ID age 60 and older in both metropolitan and rural areas of two East Coast Australian states was undertaken using a cross-sectional survey. Examined were a range of demographic (age, sex, living arrangements, employment and socio-economic status) and life (co-morbidities, adverse life events and social support) factors. Data were parsed by two age groupings (60-65: n = 234 and >65: n = 157).

RESULTS

Findings revealed that older community-dwelling adults with ID have many of the same mental health disorders as do other ageing people, with the exception of significant psychiatric disorders often associated with older age. Over a third (35%: n = 137) reported some one or more mental health disorders. Age, sex, location (rural or urban), financial hardship, social support or type of living arrangement were not statistically significant as risk factors for poor mental health. However, employment status was a clear predictor. Stepwise regression models showed a strong association between mental ill-health and adverse life events and between mental ill-health and multiple physical co-morbidities.

CONCLUSIONS

The cross-sectional nature of the study limits causal inference. The cumulative effect of chronic health conditions and adverse life events cannot be prevented retrospectively. However, greater awareness amongst both health professionals and care staff that older adults with ID have a high likelihood of significant and/or repeated traumas and need better health care to limit physical co-morbidity may assist in providing support that is better tailored to individual needs in older age to reduce the burden of mental ill-health.

Mitigating the impact of the 'silos' between the disability and aged-care sectors in Australia: Development of a Best Practice Framework

BACKGROUND

Although a 'person-centred focus' is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos.

METHODS

Mixed-methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in-depth interviews; and survey of health professionals.

RESULTS

There is an urgent need to develop inter-sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well-being indicators; development and adoption of nationally consistent policies/standards across integrated aged- and disability-care sectors; improved strategies for workforce planning; and upskilling of existing staff including place-based collaboration.

CONCLUSIONS

An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person-centred support systems.

Intellectual Disability, Employment and Aging: Intervention Measures

Workers living with intellectual disability suffer in a special way from the onset of premature aging. Hence the need to generate alternatives and policies for the development of a new model for active aging and the care of workers with intellectual disability. Our objective in this study is, therefore, to devise intervention measures that can minimize the effects of aging on the lives and the activities of these workers. Employing the Delphi technique, we assembled and consulted a panel of 8 experts with relevant expertise in the fields of intellectual disability; aging; employment and dependency. The panel included employers, families and workers with disability. Each expert reached a prior consensus over every response and contribution after having consulted four other experts with similar backgrounds, a consultative process in which a total of 40 experts participated. A total of 68 measures were proposed which correspond to three lines of action or key contexts: Firms and Organizations that employ People with Intellectual Disability; People with Intellectual Disability, and Family setting. In all, 10 recommendations with a focus on both firms and organizations were advanced to implement the proposed measures. The conclusion was that interventions are needed from the time at which the first symptoms of deterioration are detected, which should not necessarily lead to immediate loss of employment, as well as individualized and coordinated interventions among all relevant stakeholders, including the families.

Factors facilitating or hindering meaningful staff-client interactions in people with intellectual disabilities and challenging behaviour: A systematic mixed studies review using thematic synthesis

BACKGROUND

Interactions with professional caregivers affect the quality of support and life of people with intellectual disabilities and contribute to the occurrence of challenging behaviour. The present literature review provides an overview of factors facilitating or hindering meaningful staff-client interactions in people with borderline to profound intellectual disabilities and challenging behaviour.

METHOD

Database searches, reference list and citation screening, and expert consultations were undertaken. A thematic synthesis of 28 studies was performed.

RESULTS

Factors were identified at the client (i.e. behaviour, emotions and (dis)abilities), staff (i.e. interactive principles, knowledge, psychological resources, attributions, attitudes and (coping with) emotions) and context levels (i.e. group size, team and organization).

CONCLUSIONS

The present overview provides insights into factors that facilitate or hinder meaningful staff-client interactions with people with intellectual disabilities and challenging behaviour. The results support the need to combine client, staff and contextual factors when considering staff-client interactions in research and practice.

Active Time in Cooperative Activities, Quality of Life and Body Mass Index in Individuals with Intellectual Disabilities. A Model of Structural Equations

Current research shows that individuals with intellectual disabilities do not engage in enough physical activity to acquire health benefits. However, cooperative learning has been shown to be an effective tool for inclusion and for improving healthy physical habits. The aim of this study is to contrast an explanatory model which incorporates quality of life, active time in cooperative activities, body mass index and age, as well as to analyze, using multi-group structural equations, the existing associations according to the sex of subjects with intellectual disabilities. The convenience sampling used allowed the collection of data from a total of 156 subjects in Granada (Spain), aged between 18–55 years. In terms of gender, the sample was homogeneous, representing 52.6% (n = 82) for women and 47.4% (n = 74) for men. The active time during the cooperative learning was recorded with the Xiaomi Mi Band 2 activity band, for the quality of life scale (GENCAT) was used, and the body mass index was calculated through its standardized equation. Age was directly associated with body mass index in both sexes. Likewise, age was positively related to the active time of women. Quality of life was directly associated with active time and body mass index was inversely related to active time. This study shows the importance of active time during work and cooperative learning in individuals with intellectual disabilities, as it is associated with an improvement in the quality of life and a reduction in the problems of sedentarism, overweight, and obesity.

Important aspects of home care service: An interview study of persons with dementia

Background and Aim

Because of the policy of ‘ageing in place’ and a decreasing number of beds in residential settings, more persons with dementia live at home with support from home care services. However, previous studies have revealed more unmet needs and a lower quality of life in this group than in other groups. Because few qualitative studies are performed in which persons with dementia have the opportunity to tell their own stories and describe what they find important, this study aimed to interview persons with dementia and describe their views on the important aspects of receiving home care service.

Methods

The study used a qualitative approach, and 14 persons with dementia participated in the interviews. The interviews were analysed using qualitative content analysis.

Findings

The findings revealed one overarching theme. The importance of being supported as a unique and capable human, that is the persons with dementia stated that despite their dementia diagnoses, it was important to be seen as a person with capabilities, although in need of support. This theme was built on three subthemes: being seen as a person, being informed and involved, and being part of a relationship.

Conclusions

Our study showed that persons with dementia are able to express, formulate and reflect on their needs and preferences about their daily care as well as what is important to them when receiving home care service. Therefore, their point of view should be taken into consideration when planning, providing and evaluating care.

Chronic Health Conditions in Aging Individuals with Intellectual Disabilities

Life expectancy of people with intellectual disability (ID) has increased in recent decades. However, there is little evidence of whether these extra years of life are spent in good health. The aim of this study, conducted in Spain, is to obtain information about the prevalence of chronic health conditions in people with ID over the age of 44 and compare it with that of their peers without disability. Twenty health conditions were analyzed in 1040 people with ID and 12,172 people without ID through a study of their prevalence. The findings show that chronic constipation, urinary incontinence, thyroid disorders and obesity are the most prevalent chronic diseases among individuals with ID. In addition, this population group suffers these health conditions more frequently than older adults without ID. Detection and early intervention in these health conditions will improve adequate access to social health services and subsequent treatment of aging adults with ID.

“One does not forget, it all comes back”: elderly people with intellectual disability review adversities and stress-protection in their lives

Purpose

People with intellectual disability are reported to encounter many negative life events during their increasingly long lives. In the absence of protective elements, these may cause toxic stress and trauma. Given the reported negative effects of such adverse events on their quality of life (QoL), the perspective of older people with intellectual disability themselves may be of relevance. The paper aims to discuss these issues.

Design/methodology/approach

The authors questioned nine participants with mild intellectual disability, aged 61–88 years old, in four 90-min focus group sessions and thematically analysed the data.

Findings

Many recent and bygone negative life events still weighed heavily on the participants. Negative interactions, experiences of loss, lack of control and awareness of one’s disability caused stress. Their emotional response contrasted with their contentment, compliance and resilience. Having (had) good relationships, having learnt coping skills, remaining active, talking about past experiences and feeling free of pain, safe, well supported, capable, respected and involved seemed to heighten resilience and protect participants from toxic stress.

Research limitations/implications

Monitoring and preventing adverse (childhood) experiences, supporting active/emotional coping strategies, psychotherapy and life story work may facilitate coping with negative events and enhance QoL of elderly people with intellectual disability.

Originality/value

Elderly people with mild intellectual disability run a higher risk of experiencing (early) adverse events in life. They are very capable of talking about their experiences, QoL, and the support they need. Focus groups were a reliable method to capture their insights.

Improving healthcare access for older adults with intellectual disability: What are the needs?

This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty-nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open-ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter-rater agreement, was developed to analyse participants' written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.