Associations of symptoms of anxiety and depression with diabetes and cardiovascular risk factors in older people with intellectual disability

Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study

The average life expectancy of individuals with intellectual and developmental disabilities (IDDs) is increasing. However, living more years does not mean living better, leading to the need for research on comorbidities associated with the aging process. Associated with this process are the physical characteristics most prevalent in an individual with IDD: low levels of all physical capacities, the accumulation of central fat, hyperglycemia, dyslipidemia, and hypertension, variables considered to be some of the main risk factors of the onset of metabolic and cardiovascular diseases, and variables that can negatively impact quality of life (QoL). Therefore, the aim of this study is to evaluate a sample of 21 institutionalized adults with IDD (42.81 ± 10.99 years old) in terms of their anthropometric characteristics, body composition, general health status, functional capacity, neuromuscular capacity, and dementia/cognitive function, and the possible associations with QoL. All assessments were performed in the laboratory of the Faculty of Sport Sciences and Physical Education-University of Coimbra. Participants, in the present study, have low levels of physical fitness and high metabolic and cardiovascular markets, which need to be improved. On the other hand, functional and neuromuscular ability seems to be associated with QoL (p ≤ 0.05). This study highlights the role of primary and secondary care providers in diagnosis, prevention, and supporting individuals with IDDs to promote QoL.

Prescription and Effects of Cardiorespiratory Training in Individuals with Intellectual Disability: A Systematic Review

This study aims to systematize effects of cardiorespiratory training (CT) programs in individuals with intellectual disability (ID) and identifying the fundamental and structuring aspects for the prescription of CT. This systematic review was carried out through four databases (Pubmed, Web of Science, Scopus, and SPORTDiscus), considering data from the period between 2013 and 2022. From 257 studies, 12 studies were included in this systematic review. Three studies used interval CT, while seven used continuous CT. Seven were carried out in the population with Down syndrome, while only three were carried out with participants with ID. The CT programs had the following characteristics: duration of 8 to 12 weeks, weekly frequency of three sessions, for 20 to 60 min, the intensity of 50% to 80% of maximal heart rate or 70% to 80% of peak oxygen consumption, using an ergometer cycle or an outdoor walking. The studies reported improvements in cardiorespiratory function, lipid, hemodynamic and metabolic profile, body composition, and neuromuscular and cognitive capacity. This review presents characteristics and recommendations that technicians can follow when structuring, prescribing, and implementing CT programs to individuals with ID.

The Effects of Virtual Zumba ® on Functional Outcomes in Adults with Developmental Disabilities

INTRODUCTION

Few studies have examined the comprehensive impact of adaptive exercise interventions across multiple functional domains (i.e., physical and cognitive health) in adults with developmental disabilities (DD).

METHODS

The present study examined the effects of a 10-wk (2 sessions per week, 1 h per session) adapted Zumba ® intervention on the Six-Minute Walk Test (6MWT), Timed Up and Go (TUG), Clinical Test of Sensory Interaction on Balance, body composition, and executive function in 44 adults with DD age 20.8-69.2 yr. In addition to examining overall differences between control and intervention conditions, the effects of different Zumba ® tempos (normal/low) were examined. A crossover design with a 3-month wash-out period was used such that participants in the intervention also served as controls. The participants were quasi-randomized into one of two Zumba ® conditions: low-tempo Zumba ® (0.75 normal speed; n = 23) and normal-tempo Zumba ® ( n = 21).

RESULTS

A significant condition-time interaction was observed for the 6MWT and TUG; participants in the low and normal-tempo Zumba ® conditions significantly increased the distance walked for the 6MWT and reduced the total time for the TUG. No improvement was observed during the control condition for these measures. There were no significant condition-time interactions for the other outcomes.

CONCLUSIONS

These findings have implications on the efficacy and implementation of virtual Zumba ® programs to increase abilities related to independent performance of activities of daily living in adults with disabilities.

Prevalence of diabetes in people with intellectual disabilities and age- and gender-matched controls: A meta-analysis

BACKGROUND

This meta-analysis aims to: (i) describe the pooled prevalence of diabetes in people with intellectual disabilities, (ii) investigate the association with demographic, clinical and treatment-related factors and (iii) compare the prevalence versus age- and gender-matched general population controls.

METHODS

Pubmed, Embase and CINAHL were searched until 01 May 2021. Random effects meta-analysis and an odds ratio analysis were conducted to compare rates with controls.

RESULTS

The trim- and fill-adjusted pooled diabetes prevalence amongst 55,548 individuals with intellectual disabilities (N studies = 33) was 8.5% (95% CI = 7.2%-10.0%). The trim- and fill-adjusted odds for diabetes was 2.46 times higher (95% CI = 1.89-3.21) (n = 42,684) versus controls (n = 4,177,550). Older age (R²  = .83, p < .001), smoking (R²  = .30, p = .009) and co-morbid depression (R²  = .18, p = .04), anxiety (R²  = .97, p < .001), and hypertension (R²  = 0.29, p < .001) were associated with higher diabetes prevalence rates.

CONCLUSIONS

Our findings demonstrate that people with intellectual disabilities are at an increased risk of diabetes, and therefore routine screening and multidisciplinary management of diabetes is needed.

Hair glucocorticoids in adults with intellectual disabilities and depressive symptoms pre- and post-bright light therapy: First explorations

BACKGROUND

Depressive symptoms and stress are common in adults with intellectual disabilities. Our aim was to explore long-term biological stress levels, assessed by hair cortisol (HairF) and cortisone (HairE) concentrations, in adults with intellectual disabilities and depressive symptoms and to investigate the effects of bright light therapy (BLT) on hair glucocorticoids.

METHOD

Scalp hair samples (n = 14) were retrospectively examined at baseline and post-BLT (10.000 and 300 lux). Liquid chromatography-tandem mass spectrometry was used to measure hair glucocorticoids.

RESULTS

A significant correlation was found between baseline HairF and depression scores (r = .605, p = .028). Post-intervention HairE levels were significantly increased ([95% CI: 11.2-17.4 pg/mg], p = .003), in particular after dim light (300 lux) ([95% CI: 10.0-18.3 pg/mg], p = .020).

CONCLUSIONS

This study showed that retrospectively examining biological levels of stress in adults with intellectual disabilities seems a potentially promising and objective method to gain insight in the stress level of adults with intellectual disabilities.

Examining Association Between Reported High Cholesterol and Risk Factors in Adults With Intellectual and Developmental Disabilities (IDD): A Five-Year Follow-Up

Adults with intellectual and developmental disabilities (IDD) are at a greater risk of developing high cholesterol and cardiovascular disease. We examined whether physical inactivity, obesity, and diabetes were predictive of reported high cholesterol and whether there were any mediating effects of diabetes on the relationship between obesity and high cholesterol in 1,618 adults with IDD across five years. Results suggest that obesity and diabetes were significantly associated with high cholesterol after adjusting for age, sex, and residence type with a partial mediator effect of diabetes in the relationship between obesity and high cholesterol across all time points. Further research is needed to explore the causal mechanisms behind the relationships between obesity, diabetes, and high cholesterol.

Patterns in the prevalence of diabetes and incidence of diabetic complications in people with and without an intellectual disability in Dutch primary care: Insights from a population-based data-linkage study

AIMS

To conduct an epidemiological analysis of patterns observed in diabetes care provided to individuals with and without intellectual disabilities (ID) in primary care settings.

METHODS

An ID-cohort (N = 21,203) was compared with a control group of similar age and sex from the general Dutch population (N = 267,628). Distinctive data for diabetes (both type 1 and type 2) and related complications were retrieved from national databases.

RESULTS

The prevalence of diabetes was higher in people with ID than in the general population (9.9% versus 6.6%). Largest differences were seen in younger age groups. Women with ID had diabetes more often than men with ID. Complications were less common in people with ID than in the general population (IR 58.6 vs. 70.4). In particular, cardiological complications were noted less, while surgical interventions and hospitalization occurred more often.

CONCLUSIONS

Although diabetes was 1.5 times more prevalent in people with ID than in other people, related complications were less common, followed different patterns and were more severe than in the general population. Future research is needed to understand of the underlying causal mechanisms and to lower the risk of severe diabetic complications among people with ID.

The prevalence, awareness, treatment, and control of hypertension in older adults with an intellectual disability in Ireland: a cross sectional study

Aims

Hypertension is a leading risk factor for cardiovascular disease, accounting for almost 50% of ischaemic heart disease mortality. This study aims to identify the prevalence, awareness, treatment, and control of hypertension and their predictors in older adults with an intellectual disability (ID).

Methods and results

This cross-sectional study utilized data from the ID Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants were drawn from the nationally representative sample and included those who completed the self/informant report measures, in addition to objective blood pressure (BP) measurement. From the 551 individuals with ID, aged ≥40 years, hypertension prevalence was 35.2% [95% confidence interval (CI) 31.2–39.2%]. Of those with hypertension, 44.3% (95% CI 37.1–51.5%) were aware of their hypertensive status, and 64.2% (95% CI 57.3–71.1) were taking antihypertensive medication. Among those on treatment, 70.8% (95% CI 61.8–78.2%) had their BP controlled to below 140/90 mmHg. Significant predictors of awareness were age (P = 0.036) and level of ID (P = 0.004), predictors of treatment were age (P = 0.002), level of ID (P = 0.019), and diabetes (P = 0.001). Both diabetes and female gender were predictors of control of hypertension (P = 0.013 and P = 0.037, respectively).

Conclusion

The prevalence of hypertension in older adults with ID was lower than reports for the general Irish population, with overall levels of treatment and control, when identified, higher in the ID population. There was under-treatment and lower levels of awareness among those with more severe ID, which requires addressing. The finding, that when diagnosed, people with ID respond well to treatment should encourage addressing the under-treatment found here.

Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing

BACKGROUND

Depression and anxiety are amongst the most prevalent mental health disorders in the older population with intellectual disability (ID). There is a paucity of research that pertains to associative biopsychosocial factors for depression and anxiety in this population. The aim of this study is to determine the biopsychosocial factors associated with depression and anxiety in a population of older adults with ID in Ireland.

METHODS

The study was part of 'The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing'. Depressive symptoms were assessed using the Glasgow Depression Scale for people with a Learning Disability. Anxiety symptoms were measured using the Glasgow Anxiety Scale for people with a Learning Disability. The cross-sectional associations of depression and anxiety with biopsychosocial parameters were measured using a variety of self-report and proxy-completed questionnaires.

RESULTS

For the study population, 9.97% met the criteria for depression, and 15.12% met the criteria for an anxiety disorder. Participants meeting criteria for depression were more likely to be taking regular mood stabiliser medications and to exhibit aggressive challenging behaviour. Participants meeting criteria for anxiety were more likely to have sleep difficulties and report loneliness. Participants meeting criteria for either/both depression and anxiety were more likely to report loneliness.

CONCLUSIONS

This study identified both treatable and modifiable, as well as unmodifiable, biopsychosocial factors associated with depression and/or anxiety in older adults with ID. A longitudinal study follow-up will further develop our knowledge on the causality and direction of associated biopsychosocial factors with depression and anxiety in older adults with ID and better inform management strategies, prevention policies and funding of services.

“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.

Diabetes and anxiety symptoms: A systematic review and meta-analysis

Although some studies have been conducted on the association between diabetes and anxiety symptoms, the data on this association remain controversial. The purpose of this meta-analysis was to examine the association between diabetes and anxiety symptoms. The authors systematically searched PubMed, Scopus, and Google Scholar databases until July 2018. After the screening process, 23 studies were included in the meta-analysis. Stata-14 was used for meta-analyzing. Forest plot was calculated for the whole 23 studies and subgroups, and publication bias was also examined. Overall, diabetes was positively associated with anxiety; pooled odds ratio was equal to1.48; 95% confidence interval was 1 .27-1.74. In cross-sectional study, the result was odds ratio = 1.50; 95% confidence interval = 1.26-1.77, and in prospective-cohort study, the result was odds ratio = 1.34; 95% confidence interval = 1.21-1.49. There was small evidence of publication bias. Overall, our findings indicate that diabetes is a risk factor for anxiety symptoms. Therefore, having a healthy medical condition can be an anxiety prevention agent.

Effects of exercise on the physical fitness level of adults with intellectual disability: a systematic review

Purpose: To systematically review the existing scientific evidence regarding the effects of physical exercise on the fitness level of people with intellectual disabilities.Methods: Following the checklist of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols, the PubMed, CINAHL, SPORTDiscus, and Scopus databases were searched using specific keywords up to January 2018. The methodological quality of the studies found was rated by the means of specific scales according to their specific design.Results: A total of 44 studies were selected. The majority of the included studies were randomized controlled trials (n = 17), followed by non-controlled studies (n = 11), non-randomized controlled trials (n = 10), and comparative studies (n = 6). Aerobic, strengthening, and combined exercise programs were the most frequently proposed interventions. Exercise showed to have significant effects on the cardiorespiratory and muscular fitness. Not all the selected studies reported improvements in parameters related to body composition.Conclusions: There is sufficient scientific evidence for the beneficial effects of exercise on the cardiovascular and muscular fitness of adults with mild/moderate ID. There is a need for more studies focused on the impact of physical exercise on the body composition of this population, and those that aim at identifying the impact of alternative interventions.IMPLICATIONS FOR REHABILITATIONThere is a need for basic guidelines that can help rehabilitation professionals to prescribe exercise for maintaining and improving physical fitness in the adults with intellectual disabilities.In adults with intellectual disabilities, aerobic exercise has beneficial effects on cardiovascular and muscular fitness, flexibility, and range of motion.No firm conclusion can be made regarding the effects of aerobic, muscular, and combined training programs on the body composition of adults with intellectual disabilities.Rehabilitation professionals should be aware that scientific evidence regarding the prescription of alternative exercise protocols in adults with intellectual disabilities (i.e. dancing, water-based exercise, animal therapy, etc) is scarce.

Type 2 diabetes and glucose intolerance in a population with intellectual disabilities: the STOP diabetes cross-sectional screening study

BACKGROUND

Adults with intellectual disabilities (ID) may be at increased risk of developing type 2 diabetes and cardiovascular disease, due to lifestyle factors, medications and other diagnosed conditions. Currently, there is lack of evidence on prevalence and prevention in this population. The aim of this study was to conduct a diabetes screening programme to determine prevalence of previously undiagnosed type 2 diabetes and impaired glucose regulation in people with ID.

METHODS

Screening was conducted in a variety of community settings in Leicestershire, UK. Adults with ID were invited via: general practices; the Leicestershire Learning Disability Register; ID psychiatric services; and some people directly contacted the research team due to publicity about the study. Screening involved collection of anthropometric, biomedical and questionnaire data. Type 2 diabetes and impaired glucose regulation were defined according to (venous) fasting plasma glucose or HbA1c, following current World Health Organisation criteria.

RESULTS

Nine hundred thirty adults (29% of those approached) participated. Mean age was 43 years, 58% were male and 16% of South Asian ethnicity. Most participants were either overweight or obese (68%). Diabetes status was successfully assessed for 675 (73%) participants: Nine (1.3%, 95% confidence interval 0.6 to 2.5) were found to have undiagnosed type 2 diabetes, and 35 (5.2%, 95% confidence interval 3.6 to 7.1) had impaired glucose regulation. Key factors associated with abnormal glucose regulation included the following: non-white ethnicity and a first degree family history of diabetes.

CONCLUSIONS

Results from this large multi-ethnic cohort suggest a low prevalence of screen-detected (previously undiagnosed) type 2 diabetes and impaired glucose regulation in adults with ID. However, the high levels of overweight and obesity we found emphasise the need for targeted lifestyle prevention strategies, which are specifically tailored for the needs of people with ID.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Background

The prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.

Objectives

The objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).

Setting

Leicestershire, UK.

Participants

Adults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.

Main outcome measures

The primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.

Data sources

Participants were recruited from general practices, specialist ID services and clinics, and through direct contact.

Results

A total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.

Limitations

We were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.

Conclusions

The results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.

Future work

Further work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.

Trial registration

ClinicalTrials.gov NCT02513277.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

Cognitive behavioural therapy on improving the depression symptoms in patients with diabetes: a meta-analysis of randomized control trials

This meta-analysis was performed to evaluate the effect of cognitive behavioural therapy (CBT) in improving the depression symptoms of patients with diabetes. Literature search was conducted in PubMed and Embase up to October 2016 without the initial date. The pooled SMD (standard mean difference) and its 95% confidence interval (CI) were calculated by Revman 5.3. Subgroup analyses were performed by type of diabetes and evaluation criteria of depression. A total of five randomized control trials involving 834 patients with diabetes mellitus (including 417 patients in CBT group and 417 patients in control group) were included in this meta-analysis. The pooled estimates indicated significant improvement of depression by CBT compared with routine approaches in overall outcomes (SMD =–0.33, 95% CI =–0.46 to –0.21, P<0.00001), post-intervention outcomes (SMD =–0.43, 95% CI =–0.73 to –0.12, P=0.006) and outcomes after 12 months intervention (SMD =–0.38, 95% CI = –0.54 to –0.23, P<0.0001). Subgroup analyses showed that the results were not influenced by the type of diabetes. However, the effect of CBT on improving the depression symptoms disappeared when only using CES-D (Centre for Epidemiological Studies scale for Depression) to evaluate depression.

People with intellectual disability who are ageing: Perceived needs assessment

Background/Objective: Ageing and progressive increase in life expectancy in people with intellectual disability present significant challenges. The present study is to examine the needs that arise in the aging process of this population. To detect these needs is fundamental to ensure personal wellbeing; almost no psychometrically sound instruments have been developed. Method: A structured interview was developed and evaluated by a panel of 20 experts to obtain evidence of content validity. The interview was then applied to 1,173 people with intellectual disability. The ages ranged from 35 to 80 (M = 52.27; SD = 7.5). Results: The interview consisted of 93 items evaluating four areas: perceived needs, personal problems, future perspectives, and solutions required. The results demonstrated the proximity and relationship of the various needs evaluated. In addition it was observed that those with intellectual disability who were older, male and users of residential services tended to indicate more needs, problems, and required more solutions. Conclusions: The instrument has adequate evidence of validity, allowing the evaluation of specific needs of people with intellectual disability. The results advocate the design of transversal intervention policies in order to effectively meet the needs and requirements of this population.

Seasonal variations in mood and behavior associate with common chronic diseases and symptoms in a population-based study

The purpose of this study was to assess how seasonality is associated with some of the most common non-communicable diseases (NCDs) in the general Finnish population. The global seasonality score (GSS) was used to measure the magnitude of seasonality in 4689 participants, in addition to which they reported the extent to which the seasonal variations in mood and behavior were experienced as a problem. Regression models and the odds ratios were adopted to analyze the associations adjusted for a range of covariates. Seventy percent of the participants had seasonal variations in sleep duration, social activity, mood, or energy level, and forty percent those in weight and appetite. Angina pectoris and depression were significantly associated with seasonality throughout the analysis. Hypertension, high cholesterol levels, diabetes, other (than rheumatoid) joint diseases and other (than depressive) psychological illnesses were significantly associated with experiencing a problem due to the seasonal variations, with an increase in the GSS, and with seasonal affective disorder and its subsyndromal form. The co-occurrence of the seasonal variations in mood and behavior with certain common NCDs warrants future research to have insights into the etiology and potentially shared pathways and mechanisms of action.