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Bensken WP, Alberti PM, Khan OI, Williams SM, Stange KC, Vaca GFB, Jobst BC, Sajatovic M, Koroukian SM. A framework for health equity in people living with epilepsy. Epilepsy Res 2022; 188:107038. [PMID: 36332544 PMCID: PMC9797034 DOI: 10.1016/j.eplepsyres.2022.107038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 12/31/2022]
Abstract
Epilepsy is a disease where disparities and inequities in risk and outcomes are complex and multifactorial. While most epilepsy research to date has identified several key areas of disparities, we set out to provide a multilevel life course model of epilepsy development, diagnosis, treatment, and outcomes to highlight how these disparities represent true inequities. Our piece also presents three hypothetical cases that highlight how the solutions to address inequities may vary across the lifespan. We then identify four key domains (structural, socio-cultural, health care, and physiological) that contribute to the persistence of inequities in epilepsy risk and outcomes in the United States. Each of these domains, and their core components in the context of epilepsy, are reviewed and discussed. Further, we highlight the connection between domains and key areas of intervention to strive towards health equity. The goal of this work is to highlight these domains while also providing epilepsy researchers and clinicians with broader context of how their work fits into health equity.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA.
| | - Philip M Alberti
- AAMC Center for Health Justice, Association of American Medical Colleges, Washington, DC, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center US Department of Veterans Affairs, Baltimore, MD, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department of Genetics and Genome Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology Case Western Reserve University, Cleveland, OH, USA
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA; Department Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University, Cleveland, OH, USA
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Liao P, Vajdic CM, Reppermund S, Cvejic RC, Watkins TR, Srasuebkul P, Trollor J. Readmission and emergency department presentation after hospitalisation for epilepsy in people with intellectual disability: A data linkage study. PLoS One 2022; 17:e0272439. [PMID: 35913969 PMCID: PMC9342714 DOI: 10.1371/journal.pone.0272439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Despite the high prevalence of epilepsy and multiple barriers to care in people with intellectual disability, the risk of returning to hospital after an admission for epilepsy is largely unknown. In this study, we sought to quantify and compare readmission and emergency department (ED) presentations after hospitalisation for epilepsy in people with and without intellectual disability.
Methods and findings
Using linked administrative datasets, we conducted a retrospective cohort study of people aged 5–64 years with an acute hospitalisation for epilepsy from 2005–2014 in New South Wales, Australia. Acute readmission and ED presentation rates within 30, 90, and 365 days of the index hospitalisation were estimated and compared between people with and without intellectual disability using modified Poisson regression. Of 13537 individuals with an index hospitalisation, 712 children and 1862 adults had intellectual disability. Readmission and ED presentation after the index hospitalisation were common in people with intellectual disability. Within 30 days, 11% of children and 15.6% of adults had an all-cause readmission and 18% of children and 23.5% of adults had an ED presentation. Over 60% of both children and adults presented to an ED within a year. Neurological, respiratory, and infectious conditions were overrepresented reasons for readmission in people with intellectual disability. Age-adjusted relative risks (RRs) within each period showed a higher risk of readmission and ED presentation in children and adults with intellectual disability than without. Most RRs remained statistically significant after controlling for covariates. The largest adjusted RRs were observed for readmission for epilepsy (RR 1.70, 95% CI: 1.42 to 2.04) and non-epilepsy related conditions (RR 1.73, 95%: CI 1.43 to 2.10) in children. Study limitations include lack of clinical data.
Conclusions
Increased risk of returning to acute care after epilepsy hospitalisation suggests there is a need to improve epilepsy care for people with intellectual disability. We recommend research into strategies to improve management of both seizures and comorbidity.
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Affiliation(s)
- Peiwen Liao
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Claire M. Vajdic
- Faculty of Medicine and Health, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Simone Reppermund
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Rachael C. Cvejic
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Tim R. Watkins
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Preeyaporn Srasuebkul
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Julian Trollor
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
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Doody O, Bailey ME, Hennessy T. Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research. BMJ Open 2021; 11:e051858. [PMID: 34615681 PMCID: PMC8496393 DOI: 10.1136/bmjopen-2021-051858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To capture the extent and nature of intellectual disability nursing publications in Ireland. DESIGN Scoping review using Arksey and O'Malley approach. DATA SOURCES Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. ELIGIBILITY CRITERIA Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. DATA EXTRACTION AND SYNTHESIS Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. RESULTS The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. CONCLUSIONS This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.
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Affiliation(s)
- Owen Doody
- Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria E Bailey
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
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The relationship between antiepileptic drug load and challenging behaviors in older adults with intellectual disability and epilepsy. Epilepsy Behav 2021; 122:108191. [PMID: 34265622 DOI: 10.1016/j.yebeh.2021.108191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022]
Abstract
Antiepileptic drugs (AEDs) may affect mood and behavior in people with epilepsy and intellectual disability. A high AED load, derived from AED polytherapy and/or high doses of AEDs, has been suggested to be a risk factor for behavioral side effects. Data were drawn from Wave 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). The Behavior Problems Inventory Short Form (BPI-S) was used to assess challenging behaviors. AED load was calculated and median AED loads obtained. Non-parametric tests and binary logistic regression were performed to determine the relationship between AED load and challenging behaviors. Of participants with a reported diagnosis of epilepsy who were taking a regular AED and had completed BPI-S (n = 142), 62.7% (n = 89) exhibited challenging behaviors. Challenging behavior was found to be more prevalent in those with more severe levels of intellectual disability (p < 0.001). Aggressive/destructive behavior and stereotyped behavior were significantly more likely in participants living in residential/campus settings. For participants with a severe/profound intellectual disability, a significantly higher median AED load was found for participants exhibiting aggressive/destructive behavior and self-injurious behavior (SIB) compared to participants not exhibiting these behaviors, indicating a high AED load may contribute to some behavioral problems in this population group. However, many factors can influence behavioral outcomes, creating difficulties in determining those that are associated and the nature of the association. Careful monitoring of AED load, together with increased vigilance for breakthrough behavioral issues is essential for dealing with these complex cases. Larger studies are needed to account for the potential confounding factors.
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McCausland D, Guerin S, Tyrrell J, Donohoe C, O'Donoghue I, Dodd P. A qualitative study of the needs of older adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1560-1568. [PMID: 34124818 DOI: 10.1111/jar.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research indicates that adults with intellectual disabilities are living longer. However, there is limited research on how this affects health and care needs. OBJECTIVE The present study aimed to examine the health and social care needs of older adults with intellectual disabilities in Ireland using multiple informants. METHODS Data were gathered from a sample of 20 adults aged 50 years or older (Mean = 59.1, SD = 5.9, range = 50-72; 11 female). The sample included individuals with mild (n = 7), moderate (n = 10) and severe/profound (n = 3) intellectual disabilities. Additional data from keyworkers (n = 19) and family carers (n = 15) provided a more complete understanding of needs. RESULTS Results revealed some areas of agreement and difference between adults with intellectual disability and their carers regarding the social care, employment, retirement, physical and mental health needs of this population. CONCLUSIONS The findings of this study have potential implications for the provision of high-quality services for older adults with intellectual disabilities.
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Affiliation(s)
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin 4, Ireland
| | | | - Clare Donohoe
- St Michael's House Disability Services, Dublin 9, Ireland
| | | | - Philip Dodd
- St Michael's House Disability Services, Dublin 9, Ireland
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Monaghan R, O’Dwyer M, Luus R, Mulryan N, McCallion P, McCarron M, Henman MC. Antiepileptic drugs, occurrence of seizures and effect of co‐administration of potential seizure threshold‐lowering psychotropic drugs in adults with intellectual disability who have epilepsy. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:818-829. [DOI: 10.1111/jar.12857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary Monaghan
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
- The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS‐TILDA) School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Máire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
| | - Retha Luus
- Trinity Centre for Ageing and Intellectual Disability School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Niamh Mulryan
- The Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS‐TILDA) School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
- Daughters of CharityDisability Support Services Ireland
| | - Philip McCallion
- School of Social Work College of Public Health Temple University Philadelphia PA USA
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Martin C. Henman
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
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Kluger BM, Drees C, Wodushek TR, Frey L, Strom L, Brown MG, Bainbridge JL, Fischer SN, Shrestha A, Spitz M. Would people living with epilepsy benefit from palliative care? Epilepsy Behav 2021; 114:107618. [PMID: 33246892 PMCID: PMC9326903 DOI: 10.1016/j.yebeh.2020.107618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Frey
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah N Fischer
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Shrestha
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Spitz
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ahlström G, Axmon A, Sandberg M, Flygare Wallén E. Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study. BMC Health Serv Res 2020; 20:949. [PMID: 33059705 PMCID: PMC7559468 DOI: 10.1186/s12913-020-05800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specific medical guidelines for health surveillance exist for people with Down syndrome (DS) since 25 years but knowledge of adherence to the guidelines is lacking. The guidelines were developed to avoid unnecessary suffering from preventable conditions. The aims of the study were to investigate 1) planned health care visits in relation to the co-morbidities described in specific medical guidelines as a measure of adherence, 2) unplanned health care visits as a measure of potentially unmet health care needs and 3) gender differences in health care utilisation among older people with DS. METHODS This register-based study includes people with DS (n = 472) from a Swedish national cohort of people with intellectual disability (n = 7936), aged 55 years or more, and with at least one support according to the disability law, in 2012. Data on inpatient and outpatient specialist health care utilisation were collected from the National Patient Register for 2002-2012. RESULTS A total of 3854 inpatient and outpatient specialist health care visits were recorded during the 11 years, of which 54.6% (n = 2103) were planned, 44.0% (n = 1695) unplanned and 1.4% (n = 56) lacked information. More than half of the visits, 67.0% (n = 2582) were outpatient health care thus inpatient 33% (n = 1272). Most planned visits (29.4%, n = 618) were to an ophthalmology clinic, and most unplanned visits to an internal medicine clinic (36.6%, n = 621). The most common cause for planned visits was cataract, found at least once for 32.8% in this cohort, followed by arthrosis (8.9%), epilepsy (8.9%) and dementia (6.6%). Pneumonia, pain, fractures and epilepsy each accounted for at least one unplanned visit for approximately one-fourth of the population (27.1, 26.9, 26.3 and 19.7% respectively). Men and women had similar numbers of unplanned visits. However, women were more likely to have visits for epilepsy or fractures, and men more likely for pneumonia. CONCLUSIONS Increased awareness of existing specific medical guidelines for people with DS is vital for preventive measures. The relatively few planned health care visits according to the medical guidelines together with a high number of unplanned visits caused by conditions which potentially can be prevented suggest a need of improved adherence to medical guidelines.
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Affiliation(s)
- G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Huddinge, Sweden.
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Lund University, 221 00, Stockholm, Sweden
| | - M Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00, Huddinge, Sweden
| | - E Flygare Wallén
- Department of Neurobiology, Care Sciences and Society (NVS), H1 Division of Family Medicine and Primary Care, Karolinska Institutet (KI), Alfred Nobels allé 10, 141 83, Huddinge, Sweden
- Academic Primary Health Care Center, Solnavägen 1e, 113 65, Stockholm, Sweden
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Hussain R, Wark S, Janicki MP, Parmenter T, Knox M. Multimorbidity in older people with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1234-1244. [PMID: 32307771 DOI: 10.1111/jar.12743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. METHODS A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. RESULTS Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). CONCLUSIONS There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.
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Affiliation(s)
- Rafat Hussain
- Australian National University, Canberra, ACT, Australia
| | - Stuart Wark
- University of New England, Armidale, NSW, Australia
| | | | | | - Marie Knox
- University of Sydney, Sydney, NSW, Australia
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O'Connell J, Henman MC, Burke É, Donegan C, McCallion P, McCarron M, O'Dwyer M. Association of Drug Burden Index with grip strength, timed up and go and Barthel index activities of daily living in older adults with intellectual disabilities: an observational cross-sectional study. BMC Geriatr 2019; 19:173. [PMID: 31234775 PMCID: PMC6591943 DOI: 10.1186/s12877-019-1190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/17/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Drug Burden Index (DBI), a measure of exposure to medications with anticholinergic and sedative activity, has been associated with poorer physical function in older adults in the general population. While extensive study has been conducted on associations between DBI and physical function in older adults in the general population, little is known about associations in older adults with intellectual disabilities (ID). This is the first study which aims to examine the association between DBI score and its two sub-scores, anticholinergic and sedative burden, with two objective measures of physical performance, grip strength and timed up and go, and a measure of dependency, Barthel Index activities of daily living, in older adults with ID. METHODS Data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) was analysed. Analysis of Covariance (ANCOVA) was used to detect associations and produce adjusted means for the physical function and dependency measures with respect to categorical DBI scores and the anticholinergic and sedative sub-scores (DBA and DBS). RESULTS After adjusting for confounders (age, level of ID, history of falls, comorbidities and number of non-DBI medications, Down syndrome (grip strength only) and gender (timed up and go and Barthel Index)), neither grip strength nor timed up and go were significantly associated with DBI, DBA or DBS score > 0 (p > 0.05). Higher dependency in Barthel Index was associated with DBS exposure (p < 0.001). CONCLUSIONS DBI, DBA or DBS scores were not significantly associated with grip strength or timed up and go. This could be as a result of established limitations in physical function in this cohort, long-term exposure to these types of medications or lifelong sedentary lifestyles. Higher dependency in Barthel Index activities of daily living was associated with sedative drug burden, which is an area which can be examined further for review.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland.
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Éilish Burke
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Clare Donegan
- School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Mary McCarron
- Dean of Faculty of Health Sciences, Trinity College, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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Strnadová I. Transitions in the Lives of Older Adults With Intellectual Disabilities: “Having a Sense of Dignity and Independence”. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Vreese LP, Mantesso U, De Bastiani E, Marangoni A, Weger E, Gomiero T. Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study. PLoS One 2018; 13:e0205897. [PMID: 30379948 PMCID: PMC6209221 DOI: 10.1371/journal.pone.0205897] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/03/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population. AIM To probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure. METHODS The 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed. RESULTS Overall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08-19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32-43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08-80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32-12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003). CONCLUSIONS Psychotropics drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.
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Affiliation(s)
- Luc Pieter De Vreese
- Geriatric Center, Luigi Boni Foundation, Suzzara, Italy
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Ulrico Mantesso
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Elisa De Bastiani
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | | | - Elisabeth Weger
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
| | - Tiziano Gomiero
- Project DAD (Down Alzheimer Dementia) ANFFAS Trentino Onlus, Trento, Italy
- * E-mail:
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O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:245-261. [PMID: 29314463 DOI: 10.1111/jir.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 09/28/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The prevalence of epilepsy is higher in people with intellectual disability (ID) and increases with the degree of ID. Although life expectancy for people with ID is increasing, people with ID coexisting with epilepsy have a higher mortality rate, particularly those who had recent seizures. There have been few observational studies of the prevalence and patterns of anti-epileptic prescribing among older people with ID and epilepsy. The aim of this study was to investigate prevalence and patterns of anti-epileptic prescribing in the treatment of epilepsy in a representative population of older people with ID and epilepsy. METHODS This was an observational cross-sectional study from wave 1 (2009/2010) of Intellectual Disability Supplement to the Irish Longitudinal Study on Aging, a nationally representative sample of 753 persons with ID aged between 41 and 90 years. Participants and/or proxies recorded medicines used on a regular basis and reported doctor's diagnosis of epilepsy; medication data were available for 736 (98%). Prescribing of anti-epileptic drugs (AEDs) for epilepsy in those with a doctor's diagnosis of epilepsy (N = 205) was the primary exposure of interest for this study. Participant exposure to these AEDs was then categorised into AED monotherapy and polytherapy. Participants/carers reported seizure frequency, when epilepsy was last reviewed and which practitioner reviewed epilepsy. In addition, medications that may lower the seizure threshold that were listed in the Maudsley prescribing guidelines in psychiatry were examined. RESULTS Of the 736 participants with reported medicines use, 38.9% (n = 287) were exposed to AEDs, and 30.6% (225) had a doctor's diagnosis of epilepsy. Of those with epilepsy (n = 225), 90.9% (n = 205) reported concurrent use of AEDs and epilepsy. Of these 205 participants, 50.3% (n = 103) were exposed to AED polytherapy, and 63 different polytherapy regimes were reported. The most frequently reported AEDs were valproic acid (n = 100, 48.7%), carbamazepine (n = 89, 46.3%) and lamotrigine (n = 57, 27.8%). In total, 13.7% had a concurrent psychotropic, which should be avoided in epilepsy, and 32.6% had a psychotropic where caution is required. Antipsychotics with potential epileptogenic potential accounted for 80% of these medications. Of those with AED polytherapy (n = 103), 29.5% (28) reported being seizure free for the previous 2 years. CONCLUSIONS Prevalence of epilepsy was high among older people with ID, and half were exposed to two or more AEDs. Despite the use of AED therapy, over half had seizures in the previous 2 years. As the primary goals of optimal AED treatment are to achieve seizure freedom without unacceptable adverse effects, this was not achievable for many older patients with ID and epilepsy. Our findings indicated that people with ID and epilepsy were often exposed to psychotropic medications that may lower the seizure threshold. Regular review of epilepsy and medicines (including medicines that may interact with AEDs or lower the seizure threshold) by multidisciplinary teams working to agreed standards may improve quality of prescribing. Improved exchange of information and coordination of care between specialists and primary care practitioners in line with expert consensus recommendations could bring substantial benefit.
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Affiliation(s)
- M O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - J Peklar
- School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - N Mulryan
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- School of Social Work. College of Public Health, Temple University, Philadelphia, PA, USA
| | - M McCarron
- Dean of the Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - M C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Examining health service utilization, hospital treatment cost, and mortality of individuals with epilepsy and status epilepticus in New South Wales, Australia 2012-2016. Epilepsy Behav 2018; 79:9-16. [PMID: 29223007 DOI: 10.1016/j.yebeh.2017.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
Abstract
This study examined the health service utilization and hospital treatment cost of individuals with epilepsy by age group, mortality within 30days, and surgical outcomes for individuals with refractory epilepsy in New South Wales (NSW), Australia. A retrospective examination of linked hospitalization and mortality data for individuals hospitalized with a diagnosis of epilepsy during 2012-2016. Hospitalized incidence rates per 1000 population were calculated, and negative binomial regression was used to examine temporal trends. Mortality within 30days of hospitalization was identified, along with cause of death. There were 44,722 hospitalizations during the five-year period, with a hospitalization rate of 85.6 per 1000 population (95% confidence interval (CI): 84.7-86.4). Total hospital treatment costs were AUD$402.9 million. Children aged ≤17years accounted for 32.0% of hospitalizations. Just over half to two-thirds of hospitalizations for each age group were for a principal diagnosis of epilepsy, with 2976 hospitalizations of individuals for status epilepticus. The overall mean hospital length of stay (LOS) for epilepsy hospitalizations was 5.1days (standard deviation (SD)=9.0). Thirty-day mortality was highest for individuals aged ≥65years (6.7%), and epilepsy was identified as the underlying cause of death for 18.2% of deaths. This research has provided insight into the healthcare utilization profiles of individuals with epilepsy at different ages. Epilepsy hospitalizations constitute a substantial cost to the healthcare system, and better overall management of seizures and comorbid conditions is likely to lead to a reduction in the need for hospitalization.
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O'Connell J, Burke É, Mulryan N, O'Dwyer C, Donegan C, McCallion P, McCarron M, Henman MC, O'Dwyer M. Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study. Br J Clin Pharmacol 2018; 84:553-567. [PMID: 29193284 DOI: 10.1111/bcp.13479] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/27/2017] [Accepted: 11/12/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS The drug burden index (DBI) is a dose-related measure of anticholinergic and sedative drug exposure. This cross-sectional study described DBI in older adults with intellectual disabilities (ID) and the most frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. METHODS This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a representative study on the ageing of people with ID in Ireland. Self- and objectively-reported data were collected on medication use and physical health, including health conditions. The Barthel index was the physical function measure. RESULTS The study examined 677 individuals with ID, of whom 644 (95.1%) reported taking medication and 78.6% (n = 532) were exposed to medication with anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high DBI score (≥1). Adjusted multivariate regression analysis revealed no significant association between DBI score and daytime dozing, constipation or falls. After adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that challenge, history of falls), DBI was associated with significantly higher dependence in the Barthel index (P = 0.002). CONCLUSIONS This is the first time DBI has been described in older adults with ID. Scores were much higher than those observed in the general population and higher scores were associated with higher dependence in Barthel index activities of daily living.
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Affiliation(s)
- Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.,IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Éilish Burke
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Niamh Mulryan
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Claire O'Dwyer
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Clare Donegan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.,IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Mary McCarron
- Dean of Health Sciences, Trinity College, Dublin, Ireland
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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Glassman LW, Grocott OR, Kunz PA, Larson AM, Zella G, Ganguli K, Thibert RL. Prevalence of gastrointestinal symptoms in Angelman syndrome. Am J Med Genet A 2017; 173:2703-2709. [PMID: 28816003 DOI: 10.1002/ajmg.a.38401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 02/06/2023]
Abstract
Angelman syndrome (AS) is a neurogenetic disorder characterized by intellectual disability, expressive speech impairment, movement disorder, epilepsy, and a happy demeanor. Children with AS are frequently reported to be poor feeders during infancy and as having gastrointestinal issues such as constipation, reflux, and abnormal food related behaviors throughout their lifetime. To assess the prevalence of gastrointestinal disorders in individuals with AS, we retrospectively analyzed medical records of 120 individuals seen at the Angelman Syndrome Clinic at Massachusetts General Hospital and 43 individuals seen at the University of North Carolina Comprehensive Angelman Clinic. The majority of patients' medical records indicated at least one symptom of gastrointestinal dysfunction, with constipation and gastroesophageal reflux disease (GERD) the most common. Other gastrointestinal issues reported were cyclic vomiting episodes, difficulty swallowing, excessive swallowing, and eosinophilic esophagitis. Upper gastrointestinal symptoms such as GERD, swallowing difficulties, cyclic vomiting, and eosinophilic esophagitis were more common in those with deletions and uniparental disomy, likely related to the involvement of multiple genes and subsequent hypotonia. The frequency of constipation is consistent among all genetic subtypes while early feeding issues appear to mainly affect those with deletions. Caregivers and healthcare providers should be aware of the high prevalence of these issues, as proper treatment may improve not only gastrointestinal dysfunction but also sleep and behavioral issues.
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Affiliation(s)
| | - Olivia R Grocott
- Department of Neurology, Angelman Syndrome Clinic, Massachusetts General Hospital, Boston, Massachusetts
| | - Portia A Kunz
- Department of Cell Biology and Physiology, Neuroscience Center, and Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, North Carolina
| | - Anna M Larson
- Department of Neurology, Angelman Syndrome Clinic, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School,, Boston, Massachusetts
| | - Garrett Zella
- Tufts University School of Medicine, Boston, Massachusetts.,Tufts Medical Center, Boston, Massachusetts
| | - Kriston Ganguli
- Harvard Medical School,, Boston, Massachusetts.,Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald L Thibert
- Department of Neurology, Angelman Syndrome Clinic, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School,, Boston, Massachusetts
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Abstract
The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care.
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Affiliation(s)
- Eimer Maloney
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Ronan N McGinty
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
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18
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O'Dwyer M, Maidment ID, Bennett K, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Br J Psychiatry 2016; 209:504-510. [PMID: 27660331 DOI: 10.1192/bjp.bp.115.173971] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 05/09/2016] [Accepted: 06/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND No studies to date have investigated cumulative anticholinergic exposure and its effects in adults with intellectual disabilities. AIMS To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. METHOD A modified Anticholinergic Cognitive Burden (ACB) scale score was calculated for a representative cohort of 736 people over 40 years old with intellectual disabilities, and associations with demographic and clinical factors assessed. RESULTS Age over 65 years was associated with higher exposure (ACB 1-4 odds ratio (OR) = 3.28, 95% CI 1.49-7.28, ACB 5+ OR = 3.08, 95% CI 1.20-7.63), as was a mental health condition (ACB 1-4 OR = 9.79, 95% CI 5.63-17.02, ACB 5+ OR = 23.74, 95% CI 12.29-45.83). Daytime drowsiness was associated with higher ACB (P<0.001) and chronic constipation reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0, P<0.001). CONCLUSIONS Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation.
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Affiliation(s)
- Máire O'Dwyer
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Ian D Maidment
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Kathleen Bennett
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Jure Peklar
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Niamh Mulryan
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Philip McCallion
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Mary McCarron
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Martin C Henman
- Máire O'Dwyer, PhD, School of Pharmacy and Pharmaceutical Sciences and IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Ian D. Maidment, PhD, School of Life and Health Sciences, Aston University, Birmingham, UK; Kathleen Bennett, PhD, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James Hospital, Dublin, Ireland; Jure Peklar, MPharm, School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia; Niamh Mulryan, MB MRCPsych, IDS-TILDA School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland; Philip McCallion, PhD, Centre for Aging and Excellence in Community Wellness, University At Albany, New York, USA; Mary McCarron, PhD, Trinity College Dublin, Ireland; Martin C. Henman, PhD, School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Irvine L, Durand MA. Wordless intervention for people with epilepsy and learning disabilities (WIELD): a randomised controlled feasibility trial. BMJ Open 2016; 6:e012993. [PMID: 28186943 PMCID: PMC5128894 DOI: 10.1136/bmjopen-2016-012993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 08/25/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of a full-scale randomised controlled trial of a picture booklet to improve quality of life for people with epilepsy and learning disabilities. TRIAL DESIGN A randomised controlled feasibility trial. Randomisation was not blinded and was conducted using a centralised secure database and a blocked 1:1 allocation ratio. SETTING Epilepsy clinics in 1 English National Health Service (NHS) Trust. PARTICIPANTS Patients with learning disabilities and epilepsy who had: a seizure within the past 12 months, meaningful communication and a carer with sufficient proficiency in English. INTERVENTION Participants in the intervention group used a picture booklet with a trained researcher, and a carer present. These participants kept the booklet, and were asked to use it at least twice more over 20 weeks. The control group received treatment as usual, and were provided with a booklet at the end of the study. OUTCOME MEASURES 7 feasibility criteria were used relating to recruitment, data collection, attrition, potential effect on epilepsy-related quality of life (Epilepsy and Learning Disabilities Quality of Life Scale, ELDQOL) at 4-week, 12-week and 20-week follow-ups, feasibility of methodology, acceptability of the intervention and potential to calculate cost-effectiveness. OUTCOME The recruitment rate of eligible patients was 34% and the target of 40 participants was reached. There was minimal missing data and attrition. An intention-to-treat analysis was performed; data from the outcome measures suggest a benefit from the intervention on the ELDQOL behaviour and mood subscales at 4 and 20 weeks follow-up. The booklet and study methods were positively received, and no adverse events were reported. There was a positive indication of the potential for a cost-effectiveness analysis. CONCLUSIONS All feasibility criteria were fully or partially met, therefore confirming feasibility of a definitive trial. TRIAL REGISTRATION NUMBER ISRCTN80067039.
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Affiliation(s)
- Silvana E Mengoni
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
- Division 4, Mental Health, NIHR Clinical Research Network: Eastern, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Lisa Irvine
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Marie-Anne Durand
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Durand MA. "Sometimes, it just stops me from doing anything": A qualitative exploration of epilepsy management in people with intellectual disabilities and their carers. Epilepsy Behav 2016; 64:133-139. [PMID: 27736660 PMCID: PMC5140003 DOI: 10.1016/j.yebeh.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/02/2016] [Accepted: 09/18/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Epilepsy affects 1 in 5 people with an intellectual disability (ID), but little is known about their experiences of living with epilepsy. A qualitative study was conducted to investigate the impact and management of epilepsy in people with ID. MATERIALS AND METHODS People with epilepsy and ID and their carers were invited to take part in semi-structured interviews. Eleven participants with ID and their carers were interviewed together, one participant with ID and their carer were interviewed separately, two interviews took place with the participant with ID only, and one interview took place with the carer only. The interviews were transcribed verbatim, coded, and analyzed thematically (dual independent coding for 30% of the transcripts). RESULTS Three themes emerged (participant characteristics, living with epilepsy, epilepsy management and information needs) which indicated the following: 1) diversity regarding health profiles, communication abilities, severity of epilepsy, perceived control of epilepsy, and support needs; 2) a reduction in severity and frequency of seizures for a sizeable proportion of participants through antiepileptic drugs; 3) the lifelong impact of epilepsy and related seizures on participants' activities and quality of life; 4) the perceived burden of epilepsy and difficulty managing the condition for a large proportion of participants; 5) high levels of satisfaction with epilepsy-related services and care; and 6) an overall lack of written accessible information about epilepsy. CONCLUSIONS This study has highlighted a significant impact of epilepsy and related seizures on the daily lives and quality of life of people with ID. Although a sizeable proportion of participants and their carers considered their epilepsy to be well controlled, the majority reported difficulties managing epilepsy and minimizing its impact on their wellbeing. Excluding care staff and the support provided by epilepsy clinics, the participants had not accessed any adapted self-management or information resources about epilepsy.
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Affiliation(s)
- Silvana E Mengoni
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK.
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Box 189, Cambridge Biomedical Campus, Cambridge CB2 2QQ, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK; NIHR Clinical Research Network: Eastern, Division 4, Mental Health, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Marie-Anne Durand
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Chitty KM, Evans E, Torr JJ, Iacono T, Brodaty H, Sachdev P, Trollor JN. Central nervous system medication use in older adults with intellectual disability: Results from the successful ageing in intellectual disability study. Aust N Z J Psychiatry 2016; 50:352-62. [PMID: 26019276 DOI: 10.1177/0004867415587951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Information on the rates and predictors of polypharmacy of central nervous system medication in older people with intellectual disability is limited, despite the increased life expectancy of this group. This study examined central nervous system medication use in an older sample of people with intellectual disability. METHODS Data regarding demographics, psychiatric diagnoses and current medications were collected as part of a larger survey completed by carers of people with intellectual disability over the age of 40 years. Recruitment occurred predominantly via disability services across different urban and rural locations in New South Wales and Victoria. Medications were coded according to the Monthly Index of Medical Specialties central nervous system medication categories, including sedatives/hypnotics, anti-anxiety agents, antipsychotics, antidepressants, central nervous system stimulants, movement disorder medications and anticonvulsants. The Developmental Behaviour Checklist for Adults was used to assess behaviour. RESULTS Data were available for 114 people with intellectual disability. In all, 62.3% of the sample was prescribed a central nervous system medication, with 47.4% taking more than one. Of those who were medicated, 46.5% had a neurological diagnosis (a seizure disorder or Parkinson's disease) and 45.1% had a psychiatric diagnosis (an affective or psychotic disorder). Linear regression revealed that polypharmacy was predicted by the presence of neurological and psychiatric diagnosis, higher Developmental Behaviour Checklist for Adults scores and male gender. CONCLUSION This study is the first to focus on central nervous system medication in an older sample with intellectual disability. The findings are in line with the wider literature in younger people, showing a high degree of prescription and polypharmacy. Within the sample, there seems to be adequate rationale for central nervous system medication prescription. Although these data do not indicate non-adherence to guidelines for prescribing in intellectual disability, the high rate of polypharmacy and its relationship to Developmental Behaviour Checklist for Adults scores reiterate the importance of continued medication review in older people with intellectual disability.
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Affiliation(s)
- Kate M Chitty
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia
| | - Elizabeth Evans
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia
| | - Jennifer J Torr
- Centre for Developmental Disability Health, Monash University, Notting Hill, VIC, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia Dementia Collaborative Research Centre, UNSW Australia, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Australia, Sydney, NSW, Australia Centre for Healthy Brain Ageing, UNSW Australia, Sydney, NSW, Australia
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Robertson J, Baines S, Emerson E, Hatton C. Service Responses to People with Intellectual Disabilities and Epilepsy: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 30:1-32. [DOI: 10.1111/jar.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Sydney NSW Australia
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
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Mortality in people with intellectual disabilities and epilepsy: A systematic review. Seizure 2015; 29:123-33. [DOI: 10.1016/j.seizure.2015.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 11/18/2022] Open
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Pharmacists’ medicines-related interventions for people with intellectual disabilities: a narrative review. Int J Clin Pharm 2015; 37:566-78. [DOI: 10.1007/s11096-015-0113-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
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Prevalence of epilepsy among people with intellectual disabilities: A systematic review. Seizure 2015; 29:46-62. [PMID: 26076844 DOI: 10.1016/j.seizure.2015.03.016] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/24/2015] [Accepted: 03/25/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Epilepsy is more common in people with intellectual disabilities than in the general population. However, reported prevalence rates vary widely between studies. This systematic review aimed to provide a summary of prevalence studies and estimates of prevalence based on meta-analyses. METHOD Studies were identified via electronic searches using Medline, Cinahl and PsycINFO and cross-citations. Information extracted from studies was tabulated. Prevalence rate estimates were pooled using random effects meta-analyses and subgroup analyses were conducted. RESULTS A total of 48 studies were included in the tabulation and 46 studies were included in meta-analyses. In general samples of people with intellectual disabilities, the pooled estimate from 38 studies was 22.2% (95% CI 19.6-25.1). Prevalence increased with increasing level of intellectual disability. For samples of people with Down syndrome, the pooled estimate from data in 13 studies was 12.4% (95% CI 9.1-16.7), decreasing to 10.3% (95% CI 8.4-12.6) following removal of two studies focusing on older people. Prevalence increased with age in people with Down syndrome and was particularly prevalent in those with Alzheimer's/dementia. CONCLUSION Epilepsy is highly prevalent in people with intellectual disabilities. Services must be equipped with the skills and information needed to manage this condition.
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Vargas-Vargas C, Rafanell A, Montalvo D, Estarlich M, Pomarol-Clotet E, Sarró S. Validity and reliability of the Spanish version of the diagnostic assessment for the severely handicapped (DASH-II). RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:537-542. [PMID: 25462514 DOI: 10.1016/j.ridd.2014.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/17/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The DASH-II scale is a specific instrument for measuring psychopathological symptoms in people with severe and profound intellectual disability (ID). The aim of the study is the validation of the Spanish version, evaluating its reliability and validity. At the same time we examine the prevalence of mental disorders in our sample. MATERIAL AND METHODS Two reviewers independently passed the Spanish version of the DASH-II (DASH-II-S) to 83 users to establish inter-rater reliability. To assess inter-rater reliability or test-retest reliability, fifty participants were reassessed by the same rater within 7 days. RESULTS DASH-II-S showed good internal consistency (Cronbach's α=0.879) and good reliability, both intra and inter-rater reliability. The prevalence of psychopathology in the sample is 94%, and the use of psychotropic drugs is also high, with 61.4% receiving one or more antipsychotics. CONCLUSIONS DASH-II-S is a valid and reliable instrument that can be used for the assessment of psychopathology in people with ID. The translated version retains the psychometric properties of the original English version. Moreover, the high prevalence of mental disorders in this population may explain the widespread use of psychotropic drugs, but it forces us to continuous reassessment and justification.
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Affiliation(s)
- Carmen Vargas-Vargas
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain.
| | - Anna Rafanell
- Centre Psicopedagògic Mare de Déu de Montserrat, Caldes de Malavella, Spain
| | - Dúnia Montalvo
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain
| | - Montse Estarlich
- Centre Psicopedagògic Mare de Déu de Montserrat, Caldes de Malavella, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; CIBERSAM, Madrid, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; CIBERSAM, Madrid, Spain
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