Guidelines for dementia-related health advocacy for adults with intellectual disability and dementia: National Task Group on Intellectual Disabilities and Dementia Practices

A Comparative Case Study of Hospice and Hospital End-of-Life Care for Aging Adults With Developmental Disabilities

Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life's end.

National Dementia Capable Care Training: A Model Implementation and Evaluation

With a growing need for specialized training for direct caregivers and support staff of persons with intellectual and developmental disabilities (IDD) affected by dementia, the National Task Group on Developmental Disabilities and Dementia Practices (NTG) developed a comprehensive evidence-informed Dementia Capable Care Training (DCCT). To overcome the challenge of the training length and cost, and to extend its dissemination, the Sonoran Center developed a shorter version of the NTG-DCCT while retaining its core components, and implemented it in seven cities in the U. S. Southwest (N = 368). The pre- and post-training evaluation (n =260) demonstrated that the short version of the NTG-DCCT is effective in significantly improving participants' knowledge and/or confidence in dementia capable care. The follow-up semi-structured interviews of participants (n = 7) provide some insights.

Healthcare access for autistic adults: A systematic review

BACKGROUND

People with autism spectrum disorder (ASD) have an increased susceptibility for many chronic health conditions compared with their peers. An increasing number of adolescents are transitioning from pediatric to adult healthcare services. Thus, being able to access appropriate healthcare services that can not only address specific needs of the person but enable them to better manage healthcare conditions and decrease the development of preventable disease is necessary. A systematic review was conducted to identify barriers and enablers of healthcare access for autistic adults.

METHODS

The studies included in the review were quantitative and qualitative and were published between 2003 and 2019. The participants for the review are considered to be adults (over 18 years of age) with a primary diagnosis of ASD.

RESULTS

In total, 1290 studies were initially identified and 13 studies were included based on the inclusion and exclusion criteria outlined in a previous protocol paper. The analysis of these studies identified areas of concern to access appropriate healthcare, such as clinician knowledge, the environment, and life events.

CONCLUSION

Identifying the barriers to healthcare, highlights ways healthcare services can regulate scope of practice, the physical environment, and the process of managing health conditions, thus, autistic adults can strive for optimal health. This review contributes to peer-reviewed evidence for future research and up-to-date information when developing and piloting health interventions for autistic adults.

ETHICS AND DISSEMINATION

There are no human participants, data, or tissue being directly studied for the purposes of the review; therefore, ethics approval and consent to participate is not applicable.

REGISTRATION AND STATUS

PROSPERO 2018 CRD42018116093.

Aging and Autism: Understanding, Intervention and Proposals to Improve Quality of Life

BACKGROUND

The population with autism spectrum disorder (ASD) has been increasing and is currently estimated to be 1 in 58 births. The increased prevalence of ASD together with the lack of knowledge on the processes of aging in this population, the support needed at this stage of life, and the associated risk factors, have led to an urgent need for further research.

METHODS

This study provides a review of the literature on social- and health-related conditions that may appear when persons with ASD grow old.

RESULTS

In addition to the autism-related conditions, different neurological, genetic, and environmental factors may be involved in the process of aging. In this complex setting, this study provides proposals that may guide the development of support services that may improve the quality of life for aging people with ASD.

CONCLUSION

Aging in ASD is emerging as a growing problem, which requires immediate planning and targetted treatment development.

Intellectual disability and dementia: perspectives on environmental influences

Purpose

The purpose of this paper is to improve understandings of environmental influences on participation in routine and familiar activities for people with intellectual disabilities and dementia from first-person and caregiver perspectives.

Design/methodology/approach

Four adults with intellectual disabilities and dementia participated in 2 nominal group technique sessions and 12 family and staff caregivers participated in 5 standard focus groups. Transcripts were analyzed utilizing thematic analysis centering the findings from nominal group technique sessions and an ecological systems lens.

Findings

Participants with intellectual disabilities and dementia identified six important themes: activity access, caregiver assistance, social interactions, responsibilities, privacy, and health and wellness. Their perspectives focused primarily at an immediate environment level, while caregiver input added additional understandings from broader ecological systems levels.

Originality/value

This study provides a beginning point to establishing a framework for creating supports and addressing barriers to participation for adults with intellectual disability and dementia based on direct input from potential service consumers and their caregivers. People with intellectual disabilities and dementia provide valuable insights into their experiences through engagement in accessible research.

The disparities of healthcare access for adults with autism spectrum disorder: Protocol for a systematic review

INTRODUCTION

Adults living with autism spectrum disorder (ASD) can experience many factors that may impact their everyday lives. Striving for optimal health and enduring a healthy lifestyle comes with the ability to access appropriate healthcare services, yet adults with ASD have unmet healthcare needs. The barriers and enablers of healthcare access for adults with ASD remain unclear. We will conduct a systematic review to explore what is currently known about healthcare access for adults with ASD, this will determine the level and appropriateness of access to healthcare services to better support the lives of adults with ASD.

METHOD AND ANALYSIS

The systematic review will report on all studies that include quantitative, qualitative, and mixed-methods designs that consider healthcare access for adults with ASD. We will search 5 databases: EBSCOhost, Scopus, PubMed, the Cochrane Library, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) will be used to assess quality of articles and the Cochrane RoB 2.0 Tool will be used to assess for bias. Clarifying the evidence in this area will be important for future research directions when developing and piloting health interventions for researchers and healthcare clinicians in the field.

ETHICS AND DISSEMINATION

There are no human participants, data, or tissue being directly studied for the purposes of the review; therefore, ethics approval and consent to participate is not applicable.

REGISTRATION AND STATUS

PROSPERO 2018 CRD42018116093.

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale

The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

Caregiving, intellectual disability, and dementia: Report of the Summit Workgroup on Caregiving and Intellectual and Developmental Disabilities

INTRODUCTION

A specially commissioned working group produced a report on caregiving, intellectual and developmental disabilities (IDDs), and dementia for the National Institutes of Health-located National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers.

METHODS

Experts in caregiving, dementia, and IDDs examined the current state of research, policy, and practice related to caregiving and supports; identified the similarities and dissimilarities between IDD-related care and services and the general population affected by dementia; and considered how these findings might contribute to the conversation on developing a dementia care research and services development agenda.

RESULTS

Five major areas related to programs and caregiving were assessed: (1) challenges of dementia; (2) family caregiving interventions; (3) supportive care settings; (4) effects of diversity; and (5) bridging service networks of aging and disability.

DISCUSSION

Recommendations included increasing supports for caregivers of adults with IDDs and dementia; increasing research on community living settings and including caregivers of persons with IDDs in dementia research; acknowledging cultural values and practice diversity in caregiving; increasing screening for dementia and raising awareness; and leveraging integration of aging and disability networks.

Prevalence of dementia and organization of dementia care in Swiss disability care homes

BACKGROUND

With higher life expectancy an increasing number of people with intellectual disability (PWID) are at risk for developing dementia.

OBJECTIVE

Since PWID are an often neglected patient population, the objective of this study was to investigate the prevalence of dementia in residential disability homes in Switzerland and to describe how residential homes organize dementia care.

METHODS

All residential homes for adults with disabilities in Switzerland (N = 437) were invited to participate in a cross-sectional survey. A subset of questions covered the number of residents with diagnosed and suspected dementia and the organization of dementia care. The response rate to the dementia-related questions was 32% (n = 140 care homes with 10403 residents).

RESULTS

In residential homes specialised in PWID, 5.8% of the residents were reported to have a diagnosed or suspected dementia. In 140 deaths of PWID, 26% (n = 37) died with a diagnosed or suspected dementia. Residential homes for PWID mostly rely on internal resources (67.7%), general practitioners (61.3%) or psychiatrists (45.2%) for the care of residents with dementia, while specialized dementia nurses are rarely involved (16.1%).

CONCLUSION

This is the first study in Switzerland to assess the prevalence of dementia in PWID. The study indicates a diagnostic gap. Dementia care is provided in a heterogeneous way across Swiss residential homes for people with disability. Since the number of PWID requiring such care will likely increase in the future, best-practice examples and guidelines are needed.

Successful ageing for people with an intellectual disability

PURPOSE OF REVIEW

Successful ageing has not yet been defined in people with an intellectual disability. The purpose of this review is to discuss and define successful ageing in the context of intellectual disability and to propose strategies to improve health and wellbeing for this population.

RECENT FINDINGS

People with an intellectual disability experience higher rates of diabetes, hypertension, obesity and cardiovascular disease, and higher rates of mental disorders than people without an intellectual disability. People with an intellectual disability engage in more passive leisure activities because many active leisure activities require the participation of or assistance by others. Health promotion programmes tailored to people with an intellectual disability consisting of exercise and health education can result in more positive attitudes toward exercise and improvements in psychosocial outcomes.

SUMMARY

With modifications for people with an intellectual disability, the concept of successful ageing can be used as a template for development of strategies to improve health and wellbeing for people with an intellectual disability as they age. Targeted programmes focused on health promotion and prevention of age-related morbidities is required. There is a need for policies addressing positive ageing, including social participation and maximizing community participation. Appropriate and ongoing education for people with an intellectual disability and their carers on healthy living in areas of physical, social, and cognitive activity, nutrition and avoidance of risk factors is essential.