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Molin J, Jonsson LI, Antonsson H. From traditional counselling to health-promoting conversations? Registered nurses' experiences of providing health counselling to people living with severe mental ill-health in supported housing. Int J Ment Health Nurs 2023; 32:875-883. [PMID: 36861747 DOI: 10.1111/inm.13133] [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] [Received: 11/09/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
People with severe mental ill-health have lower life expectancies than the rest of the population, partly due to unhealthy lifestyles. Counselling to help these people improve their health can also be complex, and registered nurses are key to its success. The aim of this study was to elucidate registered nurses' experiences of providing health counselling to people living with severe mental ill-health in supported housing. We conducted eight individual semi-structured interviews with registered nurses working in this context and subjected the responses to qualitative content analysis. The results show that registered nurses who counsel people with severe mental ill-health feel dispirited, but they defend their often fruitless endeavours and strive, through health counselling, to help these people meet healthier lifestyle goals. Shifting the focus from traditional health counselling to person-centred care using health-promoting conversations could strengthen registered nurses in their efforts towards improving lifestyles among people living with severe mental ill-health in supported housing. Therefore, to facilitate healthier lifestyles among this population, we recommend that community healthcare support registered nurses working in supported housing by educating them in the use of health-promoting conversations, including teach-back techniques.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Science, Division of Psychiatry, Umeå, Sweden
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Melvin CL, Barnoux M, Alexander R, Roy A, Devapriam J, Blair R, Tromans S, Shepstone L, Langdon PE. A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience. BJPsych Open 2022; 8:e187. [PMID: 36268640 PMCID: PMC9634562 DOI: 10.1192/bjo.2022.571] [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: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. AIMS The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. METHOD A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). RESULTS A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. CONCLUSIONS There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
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Affiliation(s)
| | | | - Regi Alexander
- Broadland Clinic and Community Forensic Learning Disability Team, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Ashok Roy
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; and Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK
| | - John Devapriam
- Trust Headquarters, Herefordshire and Worcestershire Health and Care NHS Trust, UK
| | - Robert Blair
- School of Computing Sciences, University of East Anglia, UK
| | - Samuel Tromans
- Adult Learning Disabilities Service, Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK; and Research and Development, Herefordshire and Worcestershire Health and Care NHS Trust, UK
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Song M, Ware RS, Doan TN, Harley D. Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1403-1417. [DOI: 10.1111/jar.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
- Menzies Health Institute Queensland Griffith University Nathan Queensland Australia
| | - Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
| | - David Harley
- Centre for Clinical Research University of Queensland South Brisbane Queensland Australia
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Wise E, Holingue C, Klein A, Caoili A, Charlot L, Barnhill J, Beasley JB. Psychiatric Presentations and Medication Use in Older Adults With Intellectual and Developmental Disabilities. Am J Geriatr Psychiatry 2022; 30:65-77. [PMID: 34210596 DOI: 10.1016/j.jagp.2021.05.022] [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] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adults with intellectual and developmental disabilities (IDD) are living longer, yet research about the medical and psychiatric needs of older adults still lags behind that of younger individuals with IDD. The aim of this study was to assess age-related differences in the mental health presentations of adults with IDD. METHODS Fully deidentified data for adults 30 years and older were extracted from the START (Systemic, Therapeutic, Assessment, Resources, and Treatment) Information Reporting System, a deidentified database housed at the Center for START Services. Caregivers and START team documents reported psychiatric diagnoses, service use, recent stressors, and challenging behaviors. t Tests, Mann Whitney U tests, χ2 tests, and multinominal logistic regression models were used to compare the two age groups, 30-49 years (n = 1,188) versus 50 years and older (n = 464). RESULTS Older adults had more medical conditions, fewer reported psychiatric conditions, and were more likely to be taking more psychiatric medications compared to younger adults, after adjusting for demographic variables, disability level, and number of recent stressors. CONCLUSION Although older individuals reported fewer psychiatric diagnoses, they were more likely to take higher numbers of psychiatric medications and have more medical conditions. Clinicians and researchers ought to devote more attention to the healthcare needs of older adults with IDD, a vulnerable group exposed to polypharmacy and at risk of adverse events.
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Affiliation(s)
- Elizabeth Wise
- Department of Psychiatry and Behavioral Sciences (EW), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Calliope Holingue
- Department Neuropsychology (CH), Kennedy Krieger Institute, Baltimore, MD; Department of Mental Health (CH), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann Klein
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Andrea Caoili
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Lauren Charlot
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Jarrett Barnhill
- Department of Psychiatry (JB), University of North Carolina School of Medicine, Chapel Hill
| | - Joan B Beasley
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
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El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Healthcare utilisation patterns among older people with intellectual disability and with affective and anxiety diagnoses in comparison with the general population. Aging Ment Health 2021; 25:1525-1534. [PMID: 32208744 DOI: 10.1080/13607863.2020.1742657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigates specialist healthcare visits of older people with intellectual disability ID having affective and anxiety diagnoses in comparison with the general population, as well as across different levels of ID, behavioural impairment, and living in special housing in Sweden. METHOD The study is a retrospective national-register-based study from 2002-2012 of people with ID 55 years and older (n = 7936) and a control group the same size matched by birth year and sex from the general population at the end of study. The study groups comprised those with affective (n = 918) and anxiety (n = 825) diagnoses who visited specialist healthcare, including data about living in special housing at the end of study in 2012. RESULTS Older people with ID and with affective and anxiety diagnoses have a higher risk of inpatient and unplanned visits to psychiatric and somatic healthcare than the general population. The average length of stay in inpatient psychiatric healthcare was higher in older people with ID and anxiety diagnoses than in the general population. Within the ID group, more inpatient and unplanned visits were made by those with moderate and severe levels of ID, behavioural impairment, and living in special housing. CONCLUSION Older people with ID and affective and anxiety diagnoses are more likely to have inpatient and unplanned visits for specialist healthcare than the general population. Future research should explore the quality of healthcare services delivered by healthcare providers to older people with ID and with affective and anxiety diagnoses.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Lin JD, Lin LP. Mental Disorders and the Impacts in Older Adults with Intellectual Disabilities. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ahlström G, Axmon A, Sandberg M, Hultqvist J. Specialist psychiatric health care utilization among older people with intellectual disability - predictors and comparisons with the general population: a national register study. BMC Psychiatry 2020; 20:70. [PMID: 32066421 PMCID: PMC7027029 DOI: 10.1186/s12888-020-02491-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. MATERIAL AND METHODS We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002-2012. RESULTS After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. CONCLUSIONS Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers' plans of resources to meet the needs of these people.
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Affiliation(s)
- G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Lund University, Lund, Sweden
| | - M Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - J Hultqvist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Segerlantz M, Axmon A, Gagnemo Persson R, Brun E, Ahlström G. Prescription of pain medication among older cancer patients with and without an intellectual disability: a national register study. BMC Cancer 2019; 19:1040. [PMID: 31684896 PMCID: PMC6829972 DOI: 10.1186/s12885-019-6290-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background The longevity for people with intellectual disability (ID) has significantly increased in developed countries during the past decades. Consequently, the incidence of cancer is expected to increase in this group. The aim of the present study was to investigate the prescription of pain medication in older cancer patients with intellectual disability (ID) compared to older patients in the general population, surviving or living with a cancer diagnosis. Methods This Swedish national registry-based study, included people with ID aged 55 years or older in 2012, and alive at the end of that year (ID cohort, n = 7936). For comparisons, we used a referent cohort, one-to-one matched with the general population by year of birth and sex (gPop cohort, n = 7936). People with at least one diagnosis of cancer during 2002–2012 were identified using the Swedish National Patient Register, resulting in 555 cancer patients with ID and 877 cancer patients from the general population. These two cohorts of cancer patients were compared with respect to prescription of pain medication for the period 2006–2012. Outcome data were aggregated so that each patient was categorized as either having or not having at least one prescription of each investigated drug group during the study period, and relative risks (RRs) for prescription were estimated for prescription in the ID cohort vs the gPop cohort. Results Cancer patients with ID were less likely than cancer patients in the gPop cohort to have at least one prescription of COX inhibitors (RR 0.61) and weak opioids (RR 0.63). They were, however, more likely to be prescribed paracetamol (RR 1.16), antidepressants (RR 2.09), anxiolytics (RR 2.84), and “other hypnotics, sedatives, and neuroleptics” (RR 1.39). No statistically significant differences between the two cohorts were found for strong opioids, antiepileptics, tricyclic antidepressants, or hypnotics and sedatives. Conclusion In the studied cohort of older people surviving or living with cancer, prescriptions for pain-treatment was less common in patients with ID compared to the general population. These results may suggest that pain is not sufficiently treated among cancer patients with ID, a situation that most likely would compromise the quality of life in this group.
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Affiliation(s)
- Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane, Lund, Sweden
| | - Anna Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Rebecca Gagnemo Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiotherapy and Radiophysics, Skane University Hospital, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Lund, Sweden.
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Nylander L, Axmon A, Björne P, Ahlström G, Gillberg C. Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals. J Autism Dev Disord 2019; 48:3076-3085. [PMID: 29663191 PMCID: PMC6096790 DOI: 10.1007/s10803-018-3567-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. Register data concerning diagnoses of other psychiatric disorders, psychiatric care, and psychiatric medication were reviewed. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group. Professionals need awareness of this vulnerable group; studies concerning their life circumstances and service requirements should be conducted.
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Affiliation(s)
- Lena Nylander
- Department of Clinical Sciences/Psychiatry, Lund University, 221 00, Lund, Sweden. .,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, 411 19, Sweden. .,VUB-teamet Psykiatriska Kliniken, Baravägen 1, 221 85, Lund, Sweden.
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Lund University, 221 00, Lund, Sweden.,Department of Health Sciences, Lund University, 221 00, Lund, Sweden
| | - Petra Björne
- Research and Development Unit, City Office, City of Malmö, 205 80, Malmö, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, 221 00, Lund, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, 411 19, Sweden
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Axmon A, Björkman M, Ahlström G. Hospital readmissions among older people with intellectual disability in comparison with the general population. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:593-602. [PMID: 30734976 PMCID: PMC6850197 DOI: 10.1111/jir.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Older people with intellectual disability have high multimorbidity and poor physical and mental health compared with the general population. Consequently, they have a greater need for health care. Hospital readmissions may be an indicator of the quality of health care. However, so far, only a few studies have investigated this outcome in populations of people with intellectual disability. None has focused on older people. METHOD We identified a cohort of people with intellectual disability aged 55+ years and alive at the end of 2012 (n = 7936). Moreover, we established a reference cohort from the general population, one-to-one matched by sex and year of birth. Data on hospital visits during the period 2002-2012 were collected from the Swedish National Patient Register. Readmissions were defined as unplanned visits with the same diagnosis occurring within 30 days of discharge and with no planned visit for the same diagnosis during this time. RESULTS Compared with the general population, people with intellectual disability had increased risk of readmissions for diseases of the nervous system [relative risk (RR) 2.62], respiratory system (RR 1.48), digestive system (RR 1.40) and musculoskeletal system and connective tissue (RR 2.10). Within these diagnostic groups, increased risks were found for arthropathies (RR 3.73), disorders of gallbladder, biliary tract and pancreas (RR 1.78), other diseases of intestines (RR 1.30), and other forms of heart disease (RR 1.23). Decreased risk of readmissions was found for mental and behavioural disorders (RR 0.78) and diseases of the circulatory system (RR 0.64). CONCLUSIONS The increased risk for readmissions related to diseases of the nervous and musculoskeletal systems has a clear relation to the prevalence of comorbidities in these areas. People with intellectual disability often also have inborn limitations and damages in these systems which with time lead to complications and risk for diseases, which can be difficult to discover. The increased risk for readmissions for disease of the respiratory system, together with the already known increased prevalence of such diagnoses and their occurrence as a cause for death, warrants further investigations and considerations of potential preventive measures. The pattern of readmissions among older people with intellectual disability cannot be explained solely by a higher prevalence of disorders in this group. Our finding of increased risks for readmissions for diseases in the digestive system could be interpreted as communication problems, which sometimes result in too rapid discharges and their consequential early readmissions.
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Affiliation(s)
- A. Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of MedicineLund UniversityLundSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - M. Björkman
- The Swedish Medical Institute for Adult Persons with Intellectual DisabilityIggesundSweden
| | - G. Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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Axmon A, Ahlström G, Höglund P. Prevalence and treatment of diabetes mellitus and hypertension among older adults with intellectual disability in comparison with the general population. BMC Geriatr 2017; 17:272. [PMID: 29169334 PMCID: PMC5701367 DOI: 10.1186/s12877-017-0658-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 11/09/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Diabetes mellitus and hypertension are risk factors for cardiovascular disease, which is the most common cause of death in the world. People with intellectual disability (ID) have been reported to have high rates of both these disorders. The aim of this study was to describe and compare prevalence ratios of diabetes mellitus and hypertension between older adults with ID and their age peers in the general population, and to describe and compare treatment patterns in these two groups. METHODS This is a Swedish register-based study, in which we established a cohort of people aged 55+ years and who had received support for those with ID in 2012 (n = 7936). We also established a same-sized referent cohort from the general population matched by sex and year of birth. Information on diagnoses of diabetes mellitus and hypertension, and prescription of drugs for these disorders, were collected from national registers for the period 2006-2012. The two cohorts were compared using generalized linear models (GLM). RESULTS People with ID were 20% more likely than the general population to have a diagnosis of diabetes mellitus, and 26% more likely to have prescription of drugs for diabetes mellitus. People in the general population were 81% more likely to have a diagnosis of hypertension, and 9% more likely to have a prescription of drugs for hypertension. Among those with diabetes, ID was associated with higher occurrence of prescription of insulin combination drugs and sulfonylureas, but lower occurrence of prescription of dipeptidyl peptidase (DPP) 4-inhibitors and exenatide/liraglutide. Among those with hypertension, ID was associated with higher occurrence of prescription of diuretics, but lower occurrence of prescription of calcium channel blockers and angiotensin II antagonists. CONCLUSIONS Treatment regimens among people with ID tended to include older types of medication compared with what was prescribed in the general population. To ensure that this is medically appropriate and not due to failure to update the treatment regimen, it is important to investigate if the people with ID and diabetes mellitus or hypertension are subjected to the same regular drug reviews that are recommended for older adults in general.
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Affiliation(s)
- Anna Axmon
- Division of Occupational and Environmental Medicine, Faculty of Medicine, Lund University, SE-221 00, Lund, Sweden. .,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Peter Höglund
- Division of Clinical Chemistry and Pharmacology, Faculty of Medicine, Lund University, Lund, Sweden
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Ng N, Flygare Wallén E, Ahlström G. Mortality patterns and risk among older men and women with intellectual disability: a Swedish national retrospective cohort study. BMC Geriatr 2017; 17:269. [PMID: 29166873 PMCID: PMC5700486 DOI: 10.1186/s12877-017-0665-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 11/14/2017] [Indexed: 01/18/2023] Open
Abstract
Background Sweden has closed all institutions and imposed legislation to ensure service and support for individuals with intellectual disability (ID). Understanding mortality among older individuals with ID is essential to inform development of health promotion and disease control strategies. We investigated patterns and risk of mortality among older adults with ID in Sweden. Methods This retrospective cohort study compared older adults aged 55 years and older with ID with a control population. Participants were followed during 2002–2015 or death, and censored if they moved out of Sweden. Individuals with ID were identified from two national registers: one covering all specialist health-care visits (out-patient visits and hospitalisation) and the other covering people accessing social/support services. Individuals with ID (n = 15,289) were matched with a control population by sex, birth year, and year of first hospitalisation/out-patient visit/access to LSS services. Cause-of-death data were recorded using International Classification of Diseases, Tenth Revision. Cox proportional hazards regression were conducted to assess if overall and cause-specific mortality rate among individuals with ID was higher than in the Swedish population. Results The overall mortality rate among individuals with ID was 2483 per 100,000 people compared with 810 in the control population. Among those who died, more individuals with ID were younger than 75 years and unmarried. Leading causes of death among individuals with ID were circulatory diseases (34%), respiratory diseases (17%) and neoplasms (15%). Leading causes of death in a sub-sample with Down syndrome (DS) were respiratory diseases (37%), circulatory diseases (26%) and mental/behavioural disorders (11%). Epilepsy and pneumonitis were more common among individuals with ID than controls. Alzheimer’s disease was common in the control population and individuals with DS, but not among those with ID when DS was excluded. Individuals with ID had a higher overall mortality risk (hazard ratio [HR] 4.1, 95% confidence interval [CI] 4.0–4.3) and respiratory disease death risk (HR 12.5, 95% CI 10.9–14.2) than controls. Conclusion Older adults with ID in Sweden carry a higher mortality risk compared with the general population, mainly attributable to respiratory, nervous and circulatory diseases. Care for this group, particularly during the terminal stage of illness, needs to be tailored based on understanding of their main health problem. Electronic supplementary material The online version of this article (10.1186/s12877-017-0665-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-901 87, Umeå, Sweden.,Centre for Demographic and Ageing Research, Umeå University, SE-901 87, Umeå, Sweden
| | - Eva Flygare Wallén
- Karolinska Institutet (KI), Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Alfred Nobels allé 23, D2, SE-141 83, Huddinge, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Prescription of potentially inappropriate medications among older people with intellectual disability: a register study. BMC Pharmacol Toxicol 2017; 18:68. [PMID: 29070067 PMCID: PMC5657112 DOI: 10.1186/s40360-017-0174-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population. METHODS We established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006-2012. RESULTS People with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort. CONCLUSIONS Although prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, SE, Sweden. .,Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden.
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, 221 00, Lund, SE, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, 221 00, Lund, SE, Sweden
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Chronic Respiratory Disorders and Their Treatment among Older People with Intellectual Disability and/or Autism Spectrum Disorder in Comparison with the General Population. Healthcare (Basel) 2017; 5:healthcare5030040. [PMID: 28763010 PMCID: PMC5618168 DOI: 10.3390/healthcare5030040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
Respiratory disorders are common among people with intellectual disabilities (ID). However, few studies have investigated these disorders among older people with ID. We identified 7936 people, aged 55+ years, with ID and a reference cohort from the general population. Data on diagnoses of chronic respiratory disorders, with a focus on asthma and chronic obstructive pulmonary disease (COPD), were collected, as was information on health care visits due to such disorders. We also added data on the prescription of drugs for obstructive airway diseases. Whereas the risk of having at least one diagnosis of asthma during the study period was similar in the two cohorts, people with ID were less likely than the general population to have been diagnosed with COPD. The same was found for health care visits due to asthma and COPD, respectively. The patterns of drug prescription were similar among people with ID and the general population, with the exception of adrenergics for systemic use, which were more commonly prescribed to people with ID. Thus, older people with ID do not seem to have an increased risk of asthma or COPD. Moreover, the indications are that when diagnosed with any of these disorders, they receive treatment adapted to their particular needs.
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