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Couvrette R, Milot É, Fortin G. Factors Influencing Palliative and End-of-Life Care for Adults with Intellectual Disabilities: A Scoping Review of Health and Care Workers' Experiences. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024:1-19. [PMID: 38704821 DOI: 10.1080/15524256.2024.2346113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
In developed countries, there has been an increase in the longevity of adults with intellectual disabilities. In the later stages of their lives, people with intellectual disability have specific needs in terms of palliative and end-of-life care that need to be better understood in order to offer appropriate care. This scoping review aimed to identify the main factors influencing the provision of palliative and end-of-life care from the perspective of health and care workers involved with adults with an intellectual disability at the end of life. Seven databases were systematically searched for relevant articles published between 2002 and 2022. NVivo qualitative research analysis software was used to conduct a thematic analysis of the 50 included studies. Three main factors were identified: the location of care and death, the involvement of the person with intellectual disability, and collaborative practices.
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Affiliation(s)
- Romane Couvrette
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Canada
- Centre for Research and Expertise in Social Gerontology (CREGES), Montréal, Canada
| | - É Milot
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Canada
- Centre for Research and Expertise in Social Gerontology (CREGES), Montréal, Canada
| | - G Fortin
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, Canada
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O'Riordan D, Boland G, Guerin S, Dodd P. Synthesising existing research on complicated grief in intellectual disability: findings from a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:833-852. [PMID: 36042575 PMCID: PMC9805198 DOI: 10.1111/jir.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/12/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Complicated grief has been identified as a phenomenon in the general population, and there is an increasing body of research investigating complicated grief in people with intellectual disability. The aim of this study is to synthesise this existing knowledge from research published between 1999 and 2022. METHODS A structured systematic review using PRISMA guidelines was conducted, which searched three commonly used databases (Medline, PsycINFO and CINAHL) for research on the topic of bereavement and intellectual disability. The articles identified in this search were screened to identify those that addressed the issue of 'complicated grief', with all abstracts and subsequent full texts reviewed by two researchers. RESULTS In total, 179 abstracts were initially identified, with 34 articles eligible for full text screening and 18 papers reaching criteria for inclusion. Data relating to the studies' objectives were extracted under the headings of definition, defining principles, signs and symptoms, risk factors and treatments for complicated grief in intellectual disability. Thematic analysis of the extracted data was performed to identify key themes. CONCLUSIONS This review highlights that people with intellectual disability are likely to experience complicated grief reactions and that complicated grief is both underestimated and a clinically significant condition for people with intellectual disability. Future research should work to clarify diagnostic criteria and identify appropriate interventions.
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Affiliation(s)
- D. O'Riordan
- Royal College of Surgeons ‐ School of Postgraduate StudiesDublinIreland
| | - G. Boland
- University College Dublin, School of PsychologyDublinIreland
| | - S. Guerin
- University College Dublin, School of PsychologyDublinIreland
| | - P. Dodd
- Health Service Executive: National Office for Suicide PreventionDublinIreland
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‘I will never be old’: adults with Down syndrome and their parents talk about ageing-related challenges. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe life expectancy of people with Down syndrome (DS) has increased significantly over the last few decades. Consequently, they and their families face new ageing-related challenges, the first signs of which appear in people with DS around the age of 30. The goal of this study was to explore the perceptions of adults with DS regarding their own and their parents’ ageing and end of life, and to examine the views and concerns of the parents regarding the ageing of their children with DS. The unique approach used in our study was to convene not only the ageing people with DS but also their parents, to discuss the subject together. A total of 33 people with DS participated in the study. Most of them were interviewed with one or two parents. Participants with DS found it difficult to talk about their own old age and addressed the issue mainly through the decline in the functioning of an older person they knew. The parents emphasised the changes needed in terms of the official regulations, so as to ensure that their children with DS age with dignity and quality of life. Our study identifies the increasingly pressing need to prepare adults with DS for their own and their parents’ ageing and end of life in a timely manner.
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Chow AYM, McEvoy J, Chan IKN, Borschel M, Yuen JHL, Lo JYM. Do men and women with intellectual disabilities understand death? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1130-1139. [PMID: 29044766 DOI: 10.1111/jir.12431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/23/2016] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Individuals with ID are often withheld information about the death of their loved ones as it has often been thought that they do not understand death or cannot grieve. This grief exacerbates the stress of individuals with ID as they often encounter secondary losses such as transitioning to a care facility. The aim of this study is to investigate men and women with ID understanding death concepts and to what extent. METHOD Adopting a stratified random sampling method, 156 Chinese people with ID were invited to join the study. One hundred and ten participants were interviewed using simple death related vignettes expanding upon and replicating a published study carried out in Ireland. The understanding of the five death concepts: causality, irreversibility, nonfunctionality, universality and inevitability was examined. The correlates of demographics, bereavement experiences and comprehension were explored. RESULTS The majority of the participants did understand concepts such as death is irreversible and that the deceased no longer function. One third of the participants understood causality and the universality of death. One fifth understood the inevitability of death. Previous bereavement experiences were correlated with higher understanding. Communication and community skills were correlated with all concepts of death except universality. CONCLUSION The results indicate that individuals with ID do have a partial to full understanding of the concepts of death. The culture of Hong Kong is one that considers death to be a taboo or unlucky subject. Therefore, the results mirror the the lack of understanding of universality and inevitability concepts as it is forbidden to speak of these concepts. An open and honest environment is encouraged to educate individuals with ID about death and bereavement.
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Affiliation(s)
- A Y M Chow
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong
- Sau Po Centre on Ageing, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - J McEvoy
- Centre for Disability Studies, School of Psychology, University College Dublin, Ireland
| | - I K N Chan
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - M Borschel
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - J H L Yuen
- Jockey Club Rehabilitation Complex, Tung Wah Group of Hospitals, Hong Kong
| | - J Y M Lo
- Jockey Club Rehabilitation Complex, Tung Wah Group of Hospitals, Hong Kong
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Lord AJ, Field S, Smith IC. The experiences of staff who support people with intellectual disability on issues about death, dying and bereavement: A metasynthesis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1007-1021. [DOI: 10.1111/jar.12376] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ailsa J. Lord
- Later Life Community Mental Health TeamGreater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Stephen Field
- Adult Community Learning Disability ServiceFylde & Wyre, Lancashire Care NHS Foundation Trust Wesham UK
| | - Ian C. Smith
- Clinical PsychologyFaculty of Health and MedicineFurness CollegeLancaster University Lancaster UK
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McEvoy J, Treacy B, Quigley J. A matter of life and death: knowledge about the body and concept of death in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:89-98. [PMID: 27862508 DOI: 10.1111/jir.12347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND An increased awareness of how people with intellectual disabilities (ID) understand death and dying is necessary in supporting life-long learning, post-bereavement support and planning end-of-life care. Previous research suggests that adults with ID have a limited or 'patchy' understanding of the basic biological components of death. However, the relationship between biological understanding of how the body works and conceptualisation of death remains unexplored in this population. METHOD Thirty adults with ID were interviewed to assess their knowledge of human body function and their understanding of the concept of death. Using pictures, participants were asked if they recognised certain organs, asked to explain the function of various body parts and what would happen if certain body parts were missing or did not work. Participants who referred to 'life' or 'not dying' as the goal of body function were categorised as 'Life Theorisers'. In addition, participants were asked about the causes of death, whether all things die and the status of the body after death. RESULTS The results support previous studies suggesting that understanding of death in adults with ID varies from partial to full comprehension and is associated with level of ID. Also, death comprehension was positively correlated with total body interview scores and 'Life Theorisers' who understood that body parts maintain life and who spontaneously appealed to 'vitalistic' concepts when reasoning about the human body were also more sophisticated in their understanding of death. CONCLUSION The study highlights the relationship between knowledge about the goal of human body functioning and death comprehension in adults with ID. The potential that learning to adopt a 'vitalistic' approach to human functioning may have on the acquisition of a greater understanding of death and dying, understanding illness and supporting end-of-life planning is discussed.
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Affiliation(s)
- J McEvoy
- School of Psychology, University College Dublin, Dublin, Ireland
| | - B Treacy
- School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | - J Quigley
- School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
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Stott J, Charlesworth G, Scior K. Measures of readiness for cognitive behavioural therapy in people with intellectual disability: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:37-51. [PMID: 27886587 DOI: 10.1016/j.ridd.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities. METHODS AND PROCEDURES Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review. OUTCOMES AND RESULTS Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions. CONCLUSIONS AND IMPLICATIONS Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties. WHAT THIS PAPER ADDS This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom.
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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Stancliffe RJ, Wiese MY, Read S, Jeltes G, Clayton JM. Knowing, planning for and fearing death: Do adults with intellectual disability and disability staff differ? RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:47-59. [PMID: 26658384 DOI: 10.1016/j.ridd.2015.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adults with intellectual disability (ID) are thought to understand less about death than the general population but there is no available research demonstrating this. Further, the detail of any possible differences in understanding is unknown. METHODS We compared the responses of 39 adults with mild or moderate ID and 40 disability staff (representing the general population) on (a) understanding the concept of death, (b) knowledge of and self-determination about end-of-life planning, and (c) fear-of-death. RESULTS We found that adults with ID had a significantly poorer understanding of the concept of death, knew much less about and were less self-determined about end-of-life planning, but reported greater fear-of-death. CONCLUSIONS We demonstrated, for the first time, the feasibility of assessing end-of-life planning and fear-of-death among adults with ID. The poorer understanding and lower levels of self-determination we found suggest that future research should develop and evaluate interventions to increase understanding and self-determination.
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Affiliation(s)
- Roger J Stancliffe
- The University of Sydney, Centre for Disability Research and Policy, Australia.
| | - Michele Y Wiese
- The University of Sydney, Centre for Disability Research and Policy, Australia.
| | - Sue Read
- School of Nursing and Midwifery, Keele University, UK.
| | | | - Josephine M Clayton
- HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, Australia; The University of Sydney, Northern Clinical School, Sydney, Australia.
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Davies BE, Frude N, Jenkins R, Hill C, Harding C. A study examining the relationship between alexithymia and challenging behaviour in adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:1022-1032. [PMID: 25683670 DOI: 10.1111/jir.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 12/14/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Research suggesting that people with intellectual disabilities (ID) have difficulties in recognising emotions provides a rationale for studying alexithymia in this population. A number of studies have found a relationship between alexithymia and challenging behaviours in various populations and this study aims to discover if this is the case for people with ID. METHOD Cross-sectional data were collected from 96 participants with ID and 95 of their carers. The service user participants completed an alexithymia questionnaire for children while carers completed the checklist for challenging behaviour and the observer alexithymia scale. Correlational analyses were employed to explore relationships between the variables. RESULTS The relationship between service user and carer-rated alexithymia was very weak. The analysis did show significant associations between observer-rated alexithymia and challenging behaviour frequency, management difficulty and severity, but there was no significant relationship between challenging behaviour and alexithymia as rated by service users themselves. CONCLUSIONS This study suggests that observer-rated alexithymia is important in understanding challenging behaviour presented by people with ID. Service user-rated alexithymia had no association with challenging behaviour, in contrast to the results from similar research with other challenging populations.
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Affiliation(s)
- B E Davies
- Abertawe Bro Morgannwg University Health Board, Psychology, Caswell Clinic, Glanrhyd Hospital, Bridgend, Wales, UK
| | - N Frude
- Doctoral Course in Clinical Psychology, Cardiff University, Cardiff, Wales, UK
| | - R Jenkins
- Doctoral Course in Clinical Psychology, Cardiff University, Cardiff, Wales, UK
| | - C Hill
- Aneurin Bevan Health Board, Learning Disability Services, Gwent, Wales, UK
| | - C Harding
- Aneurin Bevan Health Board, Learning Disability Services, Gwent, Wales, UK
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McEvoy J, Smith E. Families Perceptions of the Grieving Process and Concept of Death in Individuals with Intellectual Disabilities. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979505799103803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Handley E, Hutchinson N. The experience of carers in supporting people with intellectual disabilities through the process of bereavement: an interpretative phenomenological analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:186-94. [PMID: 23580205 DOI: 10.1111/jar.12025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study explored the personal experiences of family carers and residential care staff in supporting adults with intellectual disabilities through the process of bereavement. METHOD A semi-structured interview was used to interview 11 carers on their experience of supporting adults with intellectual disabilities through the process of bereavement. The transcripts were analysed using interpretative phenomenological analysis (IPA). RESULTS A total of five superordinate themes were identified: (i) Factors making the experience difficult for carers, (ii) Factors that helped carers, (iii) Carers' perspectives on the responses of people with intellectual disabilities, (iv) Approaches to supporting people with intellectual disabilities and (v) Carers' perspectives on support. CONCLUSIONS Supporting people with intellectual disabilities through bereavement is an emotionally demanding task for carers. The support needs of carers need to be acknowledged and addressed in order to ensure that adequate support is available to people with intellectual disabilities following bereavement.
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Affiliation(s)
- Emily Handley
- Southwark Psychology Service for Adults with Learning Disabilities, South London and Maudsley NHS Trust, London, UK.
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McEvoy J, Machale R, Tierney E. Concept of death and perceptions of bereavement in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:191-203. [PMID: 21801263 DOI: 10.1111/j.1365-2788.2011.01456.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Bereavement is potentially a time of disruption and emotional distress. For individuals with an intellectual disability (ID), a limited understanding of the concept of death may exacerbate this distress. The aim of the present study was to investigate how individuals with ID understand and explain death and make sense of life without the deceased. METHOD Thirty-four people with ID were interviewed using simple vignettes describing death-related incidents. Participants were asked about the causes of death, the status of the body after death and whether all living things die. In addition, participants were asked about reactions to death and for their views on post-bereavement support. RESULTS Nearly one quarter of participants had a full understanding and over two-thirds a partial understanding of the concept of death. Death comprehension was positively correlated with cognitive ability and adaptive functioning. While cause of death was predominantly associated with illness and old age, participants viewed death as final and understood that all living things die. The role of religious beliefs was also found to be important for many participants. CONCLUSIONS The results support earlier findings that suggest people with ID have only a partial understanding of the concept of death leaving them vulnerable to factually incorrect thoughts. The study highlights the considerable scope for making sense of death using religious and spiritual themes and emphasises the need for teaching individuals biological explanations of the life cycle. The results also provide some insight into the views of individuals with ID for carers involved in providing post-bereavement support.
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Affiliation(s)
- J McEvoy
- School of Health & Science, Dundalk Institute of Technology, Dundalk, County Louth, Ireland.
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Dysch C, Chung MC, Fox J. How Do People with Intellectual Disabilities and Diabetes Experience and Perceive their Illness? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011; 25:39-49. [DOI: 10.1111/j.1468-3148.2011.00641.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MacHale R, McEvoy J, Tierney E. Caregiver Perceptions of the Understanding of Death and Need for Bereavement Support in Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1468-3148.2009.00513.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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